Tube feeding ( Gavage feeding )

This is pdf file for basic knowledge for nursing care for Gavage feeding in neonatal care in intensive care unit ( ICU ) .

1. GAVAGE FEEDING OR NASOGASTRIC FEEDING

2. Prepared : Riya yadav Class :B. Sc. Nursing , Third years Sub : Child Health Nursing

3. Nasogastric Tube feeding

4. Gavage feeding Gavage feeding is an artificial method of giving milk , fluids and nutrients to children . The process of feeding with the tube inserted through the nose , pharynx and o esophagus into the stomach to provide nutrition to the child

5. Definition A tube placed through child`s nose (called a Nasogastric or NG tube ) carries breast milk /formula ,and nutrients to the stomach.

6. Purpose and indications To feed the children who are unable to take feed orally . Feed the children who are undergoing oral surgery like cleft lip or cleft palate , fracture or jaw and in condition of difficulty in swallowing .

7. When patients is unconscious or semiconscious When the condition is not supportive to take large amount of food orally e. g. severe burns ,malnutrition ,prematurity ,acute and chronic infections . Conditions when the patient is unable to retain the food e. g anorexia nervosa and vomiting .

8. Types of Tube Feeding Intermittent : The feeding tube may be inserted and remove at each feeding . Indwelling : The feeding tube is inserted and left taped securely .

9. Advantages of Nasogastric feeding All types of nutrients including distasteful foods and medications can be given in adequate amount. Without any danger, feeding can be continued for weeks. According to need, stomach can be aspirated at any time

10. Cont ……. Large amount of fluids can be given with safety.

11. Principals involved in Gastric Gavage Tube feeding is a process of giving liquid nutrients or medications through a tube into the stomach when the oral intake is inadequate or impossible A thorough knowledge of the anatomy and physiology of the digestive tract and respiratory tract .Ensure safe induction of the tube (avoid misplacement of the tube ).

12. POLICY 6 ft feeding tube is used for infants <1000 grams . 6 ft or # ft feeding tube are used for infants >1000 grams. Never force the feeding under pressure.

13. CONT………… If possible, the infant should be held in semi – up- right Possible during the feeding ; if not possible ,position infant on right side or prone as this will facilitate gastric emptying . If respiratory rate > 70, check with physician about withholding feeding .

14. E quipment Feeding tube of baby and child size Stethoscope 5 -10 cc syringe Ryle`s tube in a bowel Adhesive tape Sterile formula Feed .

15. Cotton tipped “ application to clean the nostrils Examine the mouth of patient with tongue blade and light source

16. Procedure Explain the procedure to child and relative Give recumbent position with his neck hyper flexed with a rolled towel place under the , sometime restrain may required . Measure the tube by measuring from the bridge of the nose to umbilicus in infants and mark it .

17. In older children , measure from the nose to earlobe and then to the tip of the xiphoid process of sternum

18. Lubricate catheter with water Insert the catheter with water Insert the catheter through nares and \ or mouth in case of nasogastric feeding .slip the catheter into nostril and direct towards the occiput in a horizontal plane . In case of orogastric feeding pass the catheter through the mouth towards the back of throat.

19. Clamp the catheter and withdraw it Burp child and place on the abdomen. Observe for vomiting ,apnea ,abdominal distension Observer for abdominal distension ,regurgitation ,vomiting , gastric residue ,25 -50% or more than of that of the previous feed indicates poor tolerance to enteral feeding.

20. Record the procedure including type and amount of feeding ,time and observe child responses during feeding.

21. Gastrostomy feeding A gastrostomy is a feeding tube that is surgically placed through the abdominal wall , to feed formula ,liquids and medication directly into the stomach . The tube usually has a balloon or disk placed under the skin that holds the tube in place . It also has a retention device ( often called a button ) On the outside of the skin to seal the tube between feeds.

22. Definition The process of feeding a child through a tube directly inserted into stomach through the abdominal wall is known as gastrostomy feeding . Gastrostomy feeding may be an option when a child has swallowing problems (dysphagia) making it difficult for the them to safely swallow food and drink , or

23. Indication of Gastrostomy tube feeding Congenital abnormalities of the mouth ,esophagus , stomach ,or intestines Sucking and swallowing disorders , which are often related to prematurity , brain injury , development delay , or certain neuromuscular conditions , like severe cerebral palsy Failure to thrive , which is a general diagnosis that refers to a child`s inability to gain weight and grow appropriately Extreme difficulty taking medicines When maintaining healthy rates of growth and nutritional wellbeing cannot be achieved by oral feeding alone.

24. Purpose To feed a child who is unable to feed orally To provide nourishment in child with congenital anomaly ,such as trachea esophageal fistula To decompress the stomach

25. Articles Warm feeding formula Sterile water Mackintosh and towel 20 -50 cc syringe

26. Procedure of feeding Collect and check articles for functioning Place the child in proper position : hold child elevated Place mackintosh and towel on child`s abdomen Attach tubing to syringe and elevate syringe to 10-20 cm . Aspirate gently Pour feed and allow flow them with the help of gravity . Feed for 20- 30 minutes. Irrigate with clear water .

27. After feeds , the tube may be : Left unclamped to provide constant decompression Elevate and covered with gauge to prevent gastric reflux and abdominal distension Clamped if patient is to be prepared for home care .

28. CONT………. Don’t apply pressure Record types , amounts of feed , and child`s activity Keep child in fowlers position or turned right Tube should be secured in place to minimize traction . Keep the tube area clean and dry.