Alternative Feeding Methods

a. Nasogastric Feeding (gastric gavage)

- Levin Tube-commonly used NGT (nasogastric tube)

Purposes of NGT Insertion

1. To provide feeding (gastric gavage).
2. To irrigate stomach (gastric lavage).
3. For decompression (drainage of gastric content).
4. To administer medications.
5. To administer supplemental fluids.

Inserting Nasogastric tube (Gastric Intubation)

Inform the patient and explain the procedure. To allay anxiety.
1. Place in high – Fowler’s position. To facilitate insertion of NGT.
2. Measure length of NGT to be inserted (tip of the nose to the tip of
the ear lobe to the xiphoid process=50cm) (NEX technique)
3. Lubricate tip of the tube with water-soluble lubricant. To reduce
friction. Do not use oil. Oil may cause lipoid pneumonia.
4. Hyperextend the neck, gently advance the tube toward the
nasopharynx.
5. Tilt the patient’s head toward once the tube reaches the oropharynx
(throat) and ask to swallow, as the tube is advanced.
6. Secure the NGT by taping it to the bridge of the client’s nose after
checking position of tube placement.

Administering Tube Feeding (NGT feeding, Gastric gavage)

1. Assist client to a semi – Fowler’s position in bed or setting position in a
chair, or slightly elevated right side-lying position.
2. Assess tube placement and patency.
- Introduce 5-20 ml. of air into the NGT and auscultate at the
epigastric area, gurgling sound is heard.
- aspirate gastric content, which is yellowish or greenish in color.
- Immerse tip of the tube in water, no bubbles should be produced.
- Measure the pH of the aspirated fluid which should be acidic.
- Ask the client o speak or hum.
- Observed the client for coughing and choking.
The most effective method of checking NGT placement is radiograph/X-
ray verification then, checking pH of aspirated gastric content, then,
aspiration of gastric content.
 3. Assess residual feeding contents. To assess absorption of the last
feeding. If 50ml or more, verify if the feeding will be given.
4. Introduce feeding slowly. To prevent flatulence, crampy pain and or
reflex vomiting.
5. Height of feeding is 12 inches above the tube’s point of insertion into
the client. This allows slow introduction of feeding.
6. Instill 60 ml. of water into the NGT after feeding. To cleanse the lumen
of the tube.
7. Clamp the NGT before all of the water is instilled. To prevent entry of
air into the stomach.
8. Ask the client to remain in Fowler’s position or in slightly elevated right
lateral position for at least 30 min. To prevent potential aspiration of
feeding.
9. Do after care of equipment.
10. Make relevant documentation.

b. Administering Gastrostomy or Jejunostomy Feeding

1. Assess and prepare the client.
2. Insert a feeding tube into the ostomy opening 10-15 cm. (4 to 6 in.) if one
is not already in place (lubricate before insertion to reduce friction).
3. Check the patency of a tube sutured in place. (pour 15 to 30 ml. of water
into the syringe and allow the water to flow into the tube).
4. Check the residual formula. If 50 ml. or more, verify if the feeding will be
administered.
5. Administer feeding slowly. Hold syringe 7-15 cm. (3 to 6 inches) above
the ostomy opening. To prevent flatulence, crampy pain and reflex
vomiting.
6. Flush the tube with 30 ml of water.
7. After feeding, remain in sitting position or slightly elevated right lateral
position for at least 30 mins. To prevent gastric reflux and aspiration.
8. Assess status of peristomal skin for signs and symptoms of infection.
9. Make relevant documentation
Common Problem of Tube Feeding
1. Vomiting
2. Aspiration
3. Diarrhea (most common problem due to lactose intolerance).
4. Constipation
5. Hyperglycemia
6. Abdominal distention