Nasogastric tube feeding

Nasogastric tube feeding for nursing students.

1. Nasogastric tube feeding


Presented by,
Shubhalakshmi

3. Contents

➢Definition
➢Purpose
➢General Instruction
➢Articles Required
➢Procedure
➢Contraindication
➢Complications
➢Nursing care

4. Definition

Nasogastric intubation refers to the process
of placing a soft plastic nasogastric tube
through a patients nostril, pass the pharynx
down the esophagus into a patient stomach.

5. Purpose
●To remove fluid and gas from gastrointestinal
tract.
●Prevent or relieve nausea and vomiting after
surgery.
●To treat patients with mechanical obstruction
and bleeding of the upper gastrointestinal
tract.

6. ●To obtain a specimen of gastric contents for
laboratory studies.

●Administrator medication and feeding
directly into gastrointestinal tract.

7. General Instructions

8. ●Do not use force when inserting an NG tube. If
resistance occurs, rotate and retract the tube
slightly and try again. Forcing the tube can
cause traumatic injury to the tissue of the nose,
throat or esophagus
●Always check the tube positioning before
giving feed. If the tube is out of place, the
patient may aspirate the feeding solution into
the lungs.

9. ●Keep the patient in an upright or
semi upright sitting position when
delivering a tube feeding to enhance
peristaltic and avoid regurgitation of
the feeding.

10. ●Cap or clamp off the NG tube when not in
use to prevent backflow of stomach
contents or accumulation of air in the
stomach.
● If a patient has severe sinus conditions,
nasal obstruction or has had facial surgery,
it may be necessary to place an oral gastric
tube to avoid further nasal trauma.

11. ● If the amount of gastric aspirate is large prior to a
bolus or intermittent feeding, notify the physician.
The feeding size may need to be decreased if the
patient is not digesting it.
●NG tube placement is meant to be a short term
solution for feeding problems.
●Long term NG tube usage can cause nasal erosion,
sinusitis, esophagitis, gastric ulceration,
esophageal tracheal fistula formation, oral
infections and respiratory infections.

12. Articles Required

❖Mackintosh with drawsheet to protect bed
and garments.


❖Measurement cup and syringe

13. ❖A glass of water to offer at the end of
meal.

❖Feeding cup with water and kidney tray to
wash the mouth before and  after the
feeding .

16. Procedure

17. ➔Assess patient for the need for enteral tube
feeding. NPO or insufficient intake for more
than 5 days, functional GI tract, unable to
ingest sufficient nutrients.
Rationales:- It clarifies the purpose of NG
intubation.
➔Assess the patient for appropriate route of
administration.
●Close each nostril alternately and ask patient
to breath.

18. ●Assess for gag reflex.
●Inspect nares for any irritation or obstruction.
●Review patients medical history for nasal
problems and risk of aspiration. Nurse may
seek physicians order to change route of
nutritional support or to place tube that pass
through stomach into the intestine with
increase risk of aspiration.
Rationales:- identify ability to swallow.

19. ➔Review physicians order for type of
tube and enteral feeding schedule.
Rationales :- to assess needs.

➔Perform hand hygiene.
Rationales:- to prevent cross infection.

20. ➔Explain procedure to the patient.
Rationales:- this will reduce the anxiety and
help patient to assist in insertion.
➔Stand on same side of bed as nare for
insertion and assist patient to high fowlers
position.
Rationales :- fowlers position reduce the risk
of aspiration.

21. ➔Place bath towel over the chest. Keep
facial tissues within reach. Insertion of
tube may produce tearing.
Rationales :- to prevent soiling of gown.

22. ➔Determine length of tube to be inserted and
mark with tape. Traditional method,
measures distance from tip of nose to
earlobe to xiphoid process of sternum.
Length approximate distance from nose
stomach in 98% patients. For duodenal or
jeujunal placement, an additional 20 to 30
cm is required .
●Rationales:- to prevent wrong placement of
the tube.

24. ➔Prepare nasogastric tube for
intubation.
➔ Rationales:-to prevent any traum to
mucus membrane.
➔Put on sterile glove.
Rationales:- to reduce transmission of
infection.

25. ➔Dip tube with surface lubricant into glass
of water. Activates lubricant to facilitate
passage of tube from nares to GI tract.
Rationales :- For easy insertion of tube.

26. ➔Insert tube through nostril to back of
throat. Aim back and down toward
ear. Natural contours facilitates
passage of tube into GI tract.
Rationales :- To reduce gagging by
the patient.

27. ➔Flex patient head towards chest after
tube has passed through naso
pharynx.
Rationales :- to reduce the risk of tube
entering into trachea.

28. ➔Emphasis need to mouth breath and
swallow during the procedure.
Rationales :-helps and facilitate passage of
the tube.
➔Insert tube each time patient swallow until
desired length has been passed. Do not
force tube. If resistance is met or patient
starts to cough, shock or become
canonical, stop advancing the tube and pull
tube back.

29. Rationales :- to reduce discomfort and
trauma to the patient.
➔Check for position of tube in back throat
with pen light and tongue blade.
Rationales:- to check the tube placement
because it may be coiled or kinked.

30. ➔Perform measure to verify placement of
tube.
●Inject 30ml of air into the tube and
aspirate GI contents with syringe.

31. Gastric contents are usually cloudy or grassy
green. Intestinal fluid usually deep golden
yellow and is more clear than gastric fluid.
Rationales:- to assess the correct placement
of the tube.

➔Apply tincture of benzoin or other skin
adhesive on tip of patient's nose and tube.
Allow to dry.

32. Rationales:- It protects the skin.

33. ➔For intestinal placement, position the
patient on right side when possible until
radiological confirmation of correct
placement has been verified.
Rationales:- It promotes the passage of the
tube in to the small intestine.

34. ➔Apply gloves and administer oral hygiene.
Cleanse tubing at nostril.
Rationales :-to promote comfort and
integrity of oral mucus membrane

35. ➔Remove gloves , dispose off equipment
and wash hand .
Rationales :- It reduce the cross
infection.

36. ➔Inspect nares and oropharynx for any
difficulty in breathing or gagging.
Rationales:- to prevent further
complications.

37. Contraindication

38. ❏Esophageal varies
❏Esophageal surgery
❏GI bleeding
❏Facial fracture
❏Epistaxic
❏Nose and throat surgery
❏Sinusitis
❏Severe coagulopathies

39. Nursing care

40. ●Perform hand hygiene
●Patient identity
●Introduce self
●Monitor drainage output
●Perform tube care every 4hours
●Check tube placement
●Assess skin and observe for signs of irritation
and redness
●Frequent mouth care

41. Removal of tube
❖Before removing tube make sure that patient
experience any vomiting, irritation
❖Flushed with 10ml of water or normal saline,
ensure that it is free of debris.
❖Tube withdrawn gently and slowly
❖Force should not be used
❖Provide oral hygiene

42. Complications

43. 1)Pulmonary aspiration due to:
★Feeding tube displacement.
★Patient in supine position.
★Deficient gag reflex.
★Gastroesophageal reflex disease.

2)Diarrhea due to:-
★Hyperosmolar formula or medications.
★Antibiotic therapy.

44. ★Bacterial contamination.
★Malnutrition/ hypoalbuminemia.
★Malabsorption.

3) Tube occlusion due to :
★Insufficient tube irrigation.
★Reaction of incompatible medication or
formula.
★Pulverized medication given per tube.

45. 4) Constipation due to
★Medication
★Lack of free water
★Inactivity
★Lack of fiber
5) Abdominal cramping/ nausea/
vomiting due to:
★Lactose intolerance
★Delayed gastric emptying
★Intestinal obstruction

46. 6) Tube displacement due to:
★Not taped securely
★Coughing, vomiting

7) Serum electrolyte imbalance
★Renal insufficiency
★Diabetes mellitus
★ Excess GI losses