Ateneo de Zamboanga University

College of Nursing
NURSING SKILLS OUTPUT

NASOGASTRIC TUBE AND GAVAGE FEEDING

Definition

Nasogastric Tube is a long, skinny tube that goes through the nose, down the
throat and into the stomach. These tubes are held in place by pieces of tape on the
cheek. They are used for giving someone extra nutrition by carrying food, and giving
medicine to the stomach through the nose. Gavage feeding is the method of giving
fluids, nutrients, or medications with the use (insertion) of the Nasogastric tube inserted
through the nose and into the stomach when the oral intake is inadequate or impossible.

Purpose

The purpose of this is for children who are unable to take food orally, by bottle or
breastfeed, who are undergoing oral surgery like cleft lip or cleft palate, fracture of jaw,
and dysphagia. Moreover, this is for conditions that are not supportive to take large
amount of good orally such as severe burns, malnutrition, prematurity of babies, acute
and chronic infections, and conditions when patient is unable to retain food such as
anorexia nervosa and vomiting.

Objectives

1. To administer fluids, nutrition, and medication to support inadequate oral intake;

2. To provide breastmilk and formula directly to baby’s stomach;
3. To instill ice cold solution to control gastric bleeding;
4. To prevent complications on operated site by decompressing;
5. To relieve vomiting and distention;
6. To collect gastric juice for diagnostic purposes.

Equipment

 A tray containing: Feeding cup with water. Kidney tray.

 Mackintosh and towel.
 Cotton tipped applicators
 Saline or sodium bicarbonate solution
 Levine tube or Ryles tube in a bowl of ice
 Lubricant such as water-soluble jelly or glycerin or liquid paraffin
 Adhesive plaster and scissors
 Rag pieces in a container
 Paper bag
 Clean syringe or a funnel in a tray
 A glass of feed in a bowl of warm water
 Ounces glass
 A bowl with water
 Clamp
 Suction apparatus

PROCEDURE
1. 'Confirm patient’s identity using two patient identifiers according to your facility’s
policy.
Rationale: To administer gavage feeding to the right patient.

2. Verify physician’s order. Tube feedings MUST be ordered by a physician.

Rationale: To know whether patient requires tube feeding, and the order
indicates the formula to be used, route, amount and frequency of feeding.

3. Prepare the patient (parents if the patient is baby) by providing the necessary
information and education and by offering reassurance and inquire for medical
history.
 Rationale: Education increases the patient's understanding of the
procedure and the reason for it.

4. Provide privacy and explain the procedure to the patient.

Rationale: To provide comfort to the patient.

5. Provide safe and comfortable position to patient (sitting on a chair or bed), and
place mackintosh and face towel across chest.
 Rationale: To provide comfort throughout feeding and catch any spills of
the feeding.

6. Remove dentures, clean nostrils and check their patency by asking patient to
breathe through the other nostril.
Rationale: To provide better airflow during feeding.

7. Wash hands and don gloves.

 Rationale: Observe aseptic technique and prevent contamination.

8. Check tube patency.

 Rationale: To correct any blockage and prevent aspiration.

9. Next is to, measure the distance on the tube from the bridge of the nose to the
ear lobe plus the distance from the ear lobe to the tip of the xiphoid process of
 the sternum. Then mark the distance of the tube.
Rationale: To provide guide to determine estimate length of the tube to reach
the stomach.
10. Then, lubricate the tube for about 6 to 8 inches with the lubricant, using a rag
piece or a paper square. Lubricant should be applied to the minimum.
 Rationale: This is to reduce friction between mucus membrane and the
tube. Excess lubricant can cause respiratory distress.

11. Hold the tube coiled in the right hand and introduce the up into the left nostril.
Rationale: The nasal septum is deviated into the right side.
12. Pass the tube gently but quickly backwards and downwards. There will be
momentary resistance that may occur as the tube is passed into the
nasopharynx. Assist the client to flex the head. Withdraw the tube about one
inch, rotate it side to side and gently advance the tube.
 Rationale: Flexing of the head helps to flex the tube at the
nasopharyngeal junction and the tube enters the pharynx. Stop if there
is marked resistance and inspect the posterior cavity for coiled tubing.

13. When the tube reaches the pharynx, instruct that the client may gag. Allow him
to rest for a moment. Ask him to take panting breaths.
Rationale: Panting reflexes the pharynx. A brief pause may prevent vomiting.
14. Assist the client take sips of water and swallow on command. Advance the
tube 3 to 4 inches each time client swallows. Continue to advance the tube until
it reaches the previously designated mark.
 Rationale: The act of swallowing facilitates the entering of the tube
through the esophagus. Mark on the tube indicates the tube has
reached the stomach.

15. Presence of excessive gasping, coughing and cyanosis are signs of respiratory
distress. The tube may be in the trachea. Immediately pull it out. Check the
placement of the tube in the stomach. Aspirate for gastric contents using a
syringe.
 Rationale: Since fluids cannot be freely aspirated from the lungs.

16. Place the end of the tube with a syringe barrel or funnel into the bowl of water
and note the rhythm of escaping bubbles.
 Rationale: If the tube is in the trachea, air bubbles will coincide with the
expiration of each breath.

17. Ask the client to hum or speak.

Rationale: To check the placement of tube in trachea. The client will be unable
to hum or speak if the tube is in the trachea.
 18. After the tube is in place, tape it to the side of the face and wait for a few
minutes before giving the feed.
Rationale: Proper and careful taping/fixing of the tube prevents it from being
displaced. A few minutes rest will help to subside the peristalsis and prevent
nausea and vomiting.
19. Before giving the feed, pour some water through the funnel and lower the
funnel slowly, so as to expel the air. Then give the feed and the medicines kept
ready for the client. When the feed is finished, pour a little water and clamp the
tube firmly to prevent leakage of fluids.
Rationale: expelling the air from the tube before the feed is given, not allowing
the fluid to run completely, clamping the tube at the end of each feed, are some
of the measures to prevent the entry of the air into the stomach.
20. Place the end of the tube with a syringe barrel or funnel into the bowl of water
and note the rhythm of escaping bubbles.
Rationale: If the tube is in the trachea, air bubbles will coincide with the
expiration of each breath.
21. Place the end of the tube with a syringe barrel or funnel into the bowl of water
and note the rhythm of escaping bubbles.
Rationale: If the tube is in the trachea, air bubbles will coincide with the
expiration of each breath.
22. Remove and dispose of gloves in a proper receptacle.
Rationale: To promote cleanliness and prevent contamination.
23. Document time, amount and type of feeding.
Rationale: Proper documentation promotes proper patient monitoring and
proper endorsement.

Nursing Responsibilities with Rationale

1. Observe client’s response during and after tube feeding.

Rationale: Pain may indicate stomach distention which may lead to vomiting.

2. Prepare the exact equipment that will be use.

Rationale: To have a smooth way in performing the procedure and to prevent
contamination.

3. When inserting the nasogastric tube, place your other hand behind patient’s
head.
Rationale: To prevent the patient from pulling back and for proper head support.

4. Assess gastric emptying by aspirating and measuring residual gastric contents. If

the residual volume is greater than 150ml or the predetermined amount specified
in the physician’s order, hold feedings. Re-instill any aspirate obtained.
Rationale: To improve safety in patients receiving enteral nutrition, determining patient’s
GI tolerance.

5. Have client remain in upright position for at least 30 minutes after feeding.
Rationale: This position minimizes risk of backflow and discourage aspiration should
any vomiting occurs.

Illustration:

____________________________________
Clinical Instructor

References:

https://www.msdmanuals.com/professional/gastrointestinal-disorders/how-to-do-gastrointestinal-
procedures/how-to-insert-a-nasogastric-tube

https://intermountainhealthcare.org/ckr-ext/Dcmnt?ncid=529856978

https://www.canestar.com/tube-feeding--gastric-gavage----nursing-procedure-and-responsibility.-.html

https://rnspeak.com/gastric-gavage-tube-feeding/