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Administering Nasogastric,Nasoenteric, and Enteric Tube Feedings

OVERVIEW

A nasogastric tubing is use to provide an alternative route for the administration of liquid nutrients to the patient who cannot take anything by mouth and has a nasogastric, nasoenteric, or gastrostomy (PEG) tube in place as well as use to restore and/or maintain the patient’s nutritional status.


PREPARATION

  • Assess for nasogastric or gastric tube placement.
  • If the equipment, such as the catheter tip syringe, is to be reused, clean it thoroughly after each use.
  • Do not allow feeding formula to hang more than 8 hours, and change reservoir bag and administration set with addition of feeding according to protocol.
  • Gastrostomy or PEG tube site care and dressings should be done at least once per shift or as needed if soiled and according to facility protocol.
  • Assess the site for signs of tube migration, dislodgment, infection, or skin breakdown at least every 8 hours, prn, and according to facility protocol.
  • Follow prescriber and facility protocol related the use of blue tinting of the formula for detection of aspiration.
  • Review appropriate blood work that may be critical for optimum nutritional replacement and management (i.e., complete blood count [CBC] and renal function studies).
  • Special Considerations
  • Monitor patient often for coughing, movement, or attempts to remove the nasogastric (NG) tube, which can cause tracheobronchial aspiration during enteral feedings.
  • If the patient is on a pump, monitor often and do not exceed 40 psi because excessive pressure can cause the tubing to rupture.
  • In patients with endotracheal or tracheostomy tubes, check cuff inflation.
  • If deflated, inflate and maintain at least 30 to 60 minutes after feeding to prevent aspiration.

Elderly Patient
  • Check level of consciousness.
  • Check for aspiration.
  • Place in Fowler’s position (30–45 degrees) before and after feeding, to prevent aspiration.

Pediatric Patient
  • Make sure children are in high Fowler’s or upright position during and after feeding to prevent aspiration.
  • Hold and rock the infants and children if possible during the feeding.
  • Give a pacifier to an infant during the feeding to meet developmental needs.
  • Burp or bubble infants at intervals during the feeding and after.
  • Position an infant in a prone or side-lying position for at least an hour following the feeding to prevent aspiration.

EQUIPMENT/SUPPLIES

  • Prescribed amount of nutrition formula/product
  • Graduated container for measuring the feeding
  • Irrigating syringe (60 mL) with catheter tip for bolus feeding or calibrated plastic feeding bag with tubing
  • Feeding pump if required
  • Calibrated container of water for flushing
  • Water for diluting and flushing
  • Clean gloves
  • Alcohol swabs

IMPLEMENTATION

  • Check the expiration date, and swab unopened formula container top with alcohol.
  • Reduces transmission of microorganisms.
  • Date and refrigerate opened formula can.
  • Discard unused formula after 24 hours and change formula delivery syringe daily to reduce the transmission of microorganisms.
  • Warm refrigerated formula to room temperature.
  • Excessively cold feedings may cause cramping.
  • Prepare the patient for the feeding.
  • This process of feeding should not cause discomfort, but the patient may have a sensation of fullness.
  • Don nonsterile gloves.
  • Reduces transmission of microorganisms.
  • Elevate the head of the bed to a Fowler’s position in bed or a sitting position in a chair.
  • These positions facilitate gravitational flow of the feeding and prevent aspiration of feeding in the lungs.
  • Assess patient’s abdomen, and verify the presence of bowel sounds.
  • Absence of bowel sounds indicates lack of peristalsis; gastric feeding should not be given in the case.
  • Check tube placement by two methods: aspiration of gastric contents, checking pH of gastric contents, air insufflation with 20 to 30 mL of air, or radiographic confirmation.
  • Gastric contents may vary from clear to yellow or green. Medical diagnosis may also affect color. Usually pH of 0 to 4 ensures that tube is correctly placed in the stomach. Air insufflation while auscultating over the epigastrium assists in determining proper placement. NOTE: Radiographic determination of placement is most accurate but is costly and may not be feasible in all situations.
  • If the feeding is being given through a gastrostomy tube, assess the migration or change of length of the exposed tube, which is usually 1/2 inch.
  • Changes in the length of the exposed tube may indicate tube displacement.
  • Aspirate and measure gastric contents to determine residual volume.
  • If residual volume is greater than half the volume previously delivered or greater than 100 mL, hold feeding and recheck in 1 hour.
  • Return aspirated contents to stomach.
  • Secretions contain electrolytes that, if removed, may cause an electrolyte imbalance.
  • For continuous tube feedings, connect administration tubing to formula bag, thread tubing through pump per manufacturer’s instructions, connect the feeding tube to the nasoenteric tube or the jejunostomy tube, and start feeding at a slow, constant infusion rate (25 to 50 mL/hr). Priming the tube according to manufacturer’s instructions prevents administration difficulties, and incremental increases in rate may be better tolerated (maximum rate is usually 100 to 150 mL/hr). For intermittent tube feedings, remove the plunger from the syringe and connect the empty syringe barrel to a pin.
  • Pinched or clamped NG tube. Pinching or clamping the NG tube prevents excess air from entering the stomach.
  • Holding the syringe no higher than 18 inches above the patient’s stomach, administer 30 mL of water to flush the tubing; clamp tubing by folding before syringe empties. Prevents administering air into the patient’s stomach.
  • Pour feeding into the syringe barrel and allow to flow slowly by gravity over
  • 15 minutes. Rapid or forced delivery of feeding increases the risk for cramping, nausea, or vomiting.
  • Clamp tubing before the syringe empties, and continuously fill syringe before it completely empties. If the syringe empties and fills with air, the additional formula will move this air into the patient’s stomach and increase the risk for vomiting.
  • Flush the tubing with 30 mL of water following the intermittent feeding or every 4 hours during a continuous feeding. Prevents the tube from clogging.
  • Clamp the feeding tube before all the water is instilled. Clamping prevents leakage and air from entering the tube.
  • Keep the head of the bed elevated for 2 hours following intermittent feeding or at all times during a continuous feeding. This position facilitates digestion and movement of the feeding from the stomach along the alimentary tract and prevents potential aspiration of the feeding into the lungs.

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