Daily Care

It is important to keep your tube in optimal condition to avoid unnecessary replacement of the tube. Regular care and flushing of the tube will help to prevent the tube becoming blocked.

> Wash your hands before every handling of the tube feed or your feeding system.> Check the position of the tube before starting a feed by measuring the pH

value of stomach contents. Check at least three times a day or when you are in doubt about the position of your tube. Never start feeding before confirmation.

> Flush the tube before and after feed and medication administration, and at least 3 times a day with ca. 20-40 ml of water to prevent your tube from blocking.

> Use a new feeding set every 24 hours to avoid contamination of the feed or feeding set.

> Care of the nose: change hypoallergenic tape every day, clean the skin carefully, place the tube into the other nostril in case of damaged skin.

> Care of the mouth, teeth and lips: especially important when you are not able to eat. Brush teeth once a day, rinse the mouth several times a day, and apply cream on the lips.

> Hanging time of tube feed is limited: follow the instructions on the label.> The tube should be replaced every 6-8 weeks.

Nasogastric Tube

You are being fed through a nasogastric tube. This feeding tube is positioned in the stomach and consequently feeding will start in your stomach.

Position check

It is important to check the position of your tube to make sure that your feed goes directly where it should in your body. If not, intestinal inconveniences or potentially dangerous situations may occur.

Position check nasogastric tube by pH measurementEquipment:> a syringe,> pH indicator paper,> water (tap water or as recommended by your health care professional).

Wash hands before and after checking your tube position. Remove end cap from the tube and attach a syringe to the end of the tube. Very slowly and carefully pull back on the plunger of the syringe until a small

amount of fluid appears in the syringe. Detach the syringe from the tube, remembering to replace the end cap of the tube. Place a little of the fluid onto pH indicator paper.

If the pH value is 5.5 or less, your tube is in the correct position (in the stomach). Flush the tube with 20-40 ml of water.

If the pH value is more than 5.5, do not administer anything via your tube. Check the pH value again in 30-60 minutes. If the pH value remains above 5.5 contact your nurse. Do not administer feeds or fluid via your tube.

Note: If it is not possible to obtain fluid for checking pH, you could try the following: Lie on your left side, wait for a few minutes, and then try again. If you are able, and it is safe for you to do so, take a little fluid, then try again to test

the tube. If it is still not possible to obtain any fluid, contact your doctor or nurse.

1

2

3

4

5

?pH pH>5,5 pH<5,5

1

2

3

(Re)placement of a nasogastric tube

Only perform placement if you have been taught how to place a nasogastric tube. It is important that you always follow the training advice given to you so that your tube is placed safely and correctly.

Equipment:> new nasogastric tube, dressing - to protect the patient’s skin, > clean scissors,> 50 ml syringe, > pH indicator paper,> tape (to secure the tube), > a marker pen,> water, > gloves.

1Make sure you are in a comfortable sitting or semi-recumbent position.Measure the required length of the tube: the length between the ear, the tip of the nose (A-B) and from the nose to the lowest point of the sternum (B-C). Mark the tube at this point with a pen or tape.

2

Fully insert the guide wire in the tube and ensure it is firmly attached to the connector.Start with blowing your nose. Choose the nostril through which you breathe most easily.

3

Submerge the tip of the tube into a container with water; this will facilitate the introduction of the tube.

4Bend your head backwards and introduce the tube into the cho-sen nostril. Bend forwards as soon as he feels the tube in his throat. Advance the tube further and swallow to get the tube fur-ther down, potentially by drinking small sips of water. Sigh deeply to prevent retching. Push the tube gently, never force it. Intro-duce the tube further until the previously applied mark reaches the nose.

B

A

C

?cm

cm✓

5

Confirm correct placement of the tube through aspiration of gas-tric contents.

?pH>/<5,5

6

Measure the pH value of the gastric contents.The tube is correctly placed in the stomach if the pH value measure is below 5.5. Never start feeding before confirmation of correct tube placement.

7

Flush the tube with 20-40 ml water. This will avoid blocking of the tube.

9

Tape the tube to the nose; avoid compression of the tube against nostrils. Record the brand name, the charrière and the length of the tube.

8

Remove the guide wire. Never reinsert a guide wire, as this may cause perforation of the gastro-intestinal tract.

Never use syringes smaller than 20 ml as they provide too much pressure in the tube and may cause the tube to rupture.

Removal of the tube

The tube can be removed by gently pulling the tube out the nose.

Trouble shooting nasal tubes

My nasogastric tube has become blocked

If you experience resistance when flushing the tube, do not force water into the tube.> First, using a syringe, draw off all liquid on top of the blockage, if possible.> Second, gently flush the tube using luke warm water, using a 50 ml syringe.

Do not use acidic solutions such as fruit juices or cola as they can curdle the tube feed.

> If a blockage still exists, gently squeeze the tube between your fingers along the length of the tube as far as possible.

> If you still cannot clear the blockage, very gently draw back on the syringe and then attempt to flush as before.

> If you are still unable to clear the blockage, contact your nurse or doctor.

My nasogastric tube has come out

It is important that you have a new nasogastric tube placed in time for your next feed or medication, particularly if you are having a carefully calculated fluid balance, or if your medication has to be given at set times. Otherwise you may go hungry, become dehydrated, or suffer from the symptoms that your medication normally prevents or controls.

A. If you have been trained how to place a nasogastric tube, assemble the equipment as you have been taught and proceed to place a new nasogastric tube, following the training advice you have been given. If you have not got any of the necessary equipment follow the steps below.

B. If you have not been trained to place a nasogastric tube do NOT attempt to place a new nasogastric tube. Follow the steps below.

> Remain calm.> Contact your nurse and explain that your nasogastric tube has come out. Note

your next feeding time to your nurse.> If you do not have a nurse or the nurse is unavailable, you may need to attend the

hospital emergency department. You should contact your doctor for further advice> Telephone the hospital to let them know you are coming in and that you need to

Important notes:

Never administer anything through the nasogastric tube until you are sure the tube is in the right place.

If you are unable to confirm that the tube is in the correct position (the stomach), but the patient seems comfortable and the tube seems to have passed smoothly, you can either:> Remove the tube and start again.> Leave the tube in and contact your nurse for advice. Remove the nasogastric tube at once if at any time during the placement of the patient’s nasogastric tube:> The patient coughs or vomits excessively.> The patient goes more blue than usual.> The tube curls in your patient’s mouth.> The tube comes out of your patients other nostril.

have a nasogastric tube placed. This will give the department time to find your medical notes and to make sure that a member of staff is available who is able to place your nasogastric tube.

> If you have a spare nasogastric tube at home take it with you, this will save time, as your type and size of tube may not be readily available in the emergency department. Take the tube that has fallen out with you so the staff can identify which type of tube it is.

> Once the new nasogastric tube has been placed, inform the person who routinely changes your nasogastric tube.

> Order a new nasogastric tube so that you have a spare ready in case your feeding tube comes out unexpectedly again.

171082 / BP&MC 21100802