NasoGastric Tube Feeding

Definition:
Also known as gastric gavage; installation of especially prepared formula into the digestive
tract through a tube that is inserted through one of the nostrils down to the alimentary tract.

Purpose:
- Prevent nausea, vomiting and gastric distention following surgery
- Remove stomach contents for laboratory analysis
- To lavage (wash) the stomach in cases of poisoning and overdose of medication
- To administer medication
- To administer supplemental fluid
- To provide feeding

Procedure:

A. Assess and Prepare the Client

1. Check the clients chart or confirm the physician’s order for NGT feeding, this is done
for us to be sure that we are doing the right procedure to the right client
/patient.
2. Assume handwashing.
3. Prepare the needed materials such as the correct amount of feeding solution as ordered
by the physician, asepto syringe/bulb syringe, emesis basin/kidney basin, 60 to 80 ml of
water, stethoscope and disposable pad.
4. After preparing the materials we are now ready to head to the clients room. Before
entering knock on the door, greet the patient if he/she is conscious or significant other if
the client is unconscious. Introduce self, asks the patient/client or significant others for
any allergies if it is the first time to do the NGT feeding.
5. Provide privacy because NGT feeding is embarrassing to some people.
6. Assist client to a fowler’s position in bed or sitting position in a chair. – This position
enhances the gravitational flow of the solution and prevents aspiration of fluid into the
lungs.
7. Place a disposable pad on the area where you are working. – To prevent client’s gown
from getting soiled or to avoid being messy.
8. Unpin the tube from under the pillow or from the client’s gown.

B. Assess the Patency of the Tubing

9. Inject 5-20 ml of air through the feeding tube while auscultating the left upper
abdomen while listening to gurgling, whoosing and bubbling sound. If you hear
gurgling, whoosing and bubbling sound we are now sure that the tube is patent.

C. Assess the Residual Feeding Contents

10. Aspirate all the stomach contents and measure the amount prior to administering the
feeding. – This is done to evaluate the absorption of the last feeding. If >50 ml of
undigested formula is withdrawn in adults and >10 ml in infants and its color
 is okay somewhat like yellow. Reinstill the gastric contents into the stomach. –
Removal of contents disturbs the clients electrolyte balance. If 50 ml or more of
undigested formula is withdrawn in adults and 10 ml < in infants check with the nurse
incharge before proceeding. The precise amount is usually determined by the
Physician’s order or by Policy of the agency. At some agency it is withheld when the
specified amount and more formula remains in the stomach. In other agencies, the
amount withdrawn is subtracted from the total feeding and that volume is administered
slowly. And feeding is also withheld if the color of the aspirated fluid is coffee ground.
– There is bleeding in the stomach.

D. Administer the Feeding

11. Before administering the feeding add 20 ml of water. – To clean the tube and
facilitate the smooth flow of the solution, be sure not to drain all the water.
12. When using the asepto syringe connect the syringe to a pinched or clamped
nasogastric tube. – Prevent excess air from entering the stomach and causing
distention.
13. Permit the feeding to flow slowly. Raise or lower the syringe to adjust the flow as
needed. Pinch or clamp the tubing to stop the flow for a minute if the client experiences
discomfort. Quickly administered feedings can cause flatus, crampy pain and reflux
vomiting.

E. Rinse the Feeding Tube Immediately before all the formula has run through the
tubing.
14. Instill the feeding tube with 60ml of water. – Water cleans the lumen of the tube,
preventing future blockage by sticky formula.
15. Be sure to add water before the syringe or tubing is empty. – Prevents the
instillation of air into the stomach or intestine which causes unnecessary
distention.

F. Clamp and Cover the Feeding Tube

16. Clamp the feeding tube before all of the water is instilled. – Prevents leakage and air
from entering the tube if done before water is instilled.

G. Ensure Client Comfort and Safety

17. Pin the tubing to the client’s gown. – This minimizes pulling of the tube thus
preventing discomfort and dislodgement.
18. Ask the client to remain sitting in Fowler’s position or in slightly elevated right lateral
position for at least 30 minutes. – These position facilitate digestion and movement of
the feeding from the stomach along the alimentary tract and prevent potential
aspiration of the feeding into the lungs.

H. Thank the client for the cooperation and dispose equipment properly, if it is to be
reused, washes it thoroughly with soap and water so that it is ready for reuse.
Afterwards do handwashing and document relevant information, kind, duration of
feeding. Assessment of the client and record the volume of the feeding and the water
administered on the clients intake and output record
 and lastly, monitor client for possible problem.

I. Removing NGT
1. Confirm the physician’s order to remove the tube. Assume handwashing to
reduce the number and transmission of microorganisms. Prepare the
materials/equipment needed such as tissues, clean disposable gloves, disposable
pad, disposable plastic bag and asepto syringe/bulb syringe. After preparing the
equipment we are now ready to head on to the client’s room. Knock on the door
before entering the room, greet the patient upon entering. Introduce yourself and
verify the client’s identity by asking the client’s fullname.
2. Prepare the client. Explain that the procedure will not cause any discomfort. Assist
the client to a sitting position if health permit’s. Place disposable pad across the
client’s chest to collect any spillage of mucous. Provide tissue to the client to wipe
the mouth and nose upon removal of the tube. Unpin the tube from the client’s
gown. Remove adhesive tape securing the tube to the nose.
3. Remove the tube.
- Put on disposable gloves. – Gloves prevent soiling the hand and clothing
when handling secretions and excretions.
- Instill 50 ml of air into the tube. – Air clears the lumen of any contents such as
food and gastric drainage.
- Ask the client to take a deep breath and hold it. – This closes the glottis,
thereby preventing accidental aspirations of any gastric contents.
- Pinch the tube. – Pinching prevents any contents inside the tube from
draining into the clients throat.
- Quickly and smoothly withdraw the tube. Place the tube in the plastic bag. –
Prevents the transfer of microorganisms from the tube.
4. Ensure client’s comfort. Assist the client as required to blow the nose. –
Excessive secretions may have accumulated in the nasal passages. Provide
mouthwash. Thank the client for cooperation.
5. Dispose all the equipment appropriately. Place the pad, bag with the tube and
gloves in the receptacle designated by the agency. – Correct disposal prevents the
transmission of microorganisms.
6. Do handwashing and document relevant information. Record the removal of the
tube and any relevant assessment of the client.