Nasogastric Tube Feeding

A. Definition:

A feeding tube is a medical device used to provide nutrition to patients who

cannot obtain nutrition by swallowing. The state of being fed by a feeding tube is called

enteral feeding or tube feeding. Placement may be temporary for the treatment of acute

conditions or lifelong in the case of chronic disabilities.

B. Purpose:

• To restore or maintain nutritional status

• To administer medication

C. Materials:

• Correct amount of feeding solution

• 20 to 50 ml syringe with an adapter

• Emesis basin

• Clean gloves

• Large syringe with plunger or calibrated plastic feeding bag with tubing that can be

attached to the feeding tube or prefilled bottle with a drip chamber, tubing, and a

flowregulator clamp

• pH test strip or meter

• Measuring container from which to pour the feeding (if using open system)

• Water (60 ml unless otherwise specified) at room temperature

• Feeding pump as required

Procedure

Procedure Rationale

1. Assist the client to a Fowler’s position in

bed or sitting position in a chair, the

normal position for eating. If a sitting

position is contraindicated, a slightly

elevated right side lying position is

acceptable.

These positions enhance the gravitational

flow of the solution and prevent aspiration

of fluid into the lungs.

2. Explain to the client what you are going

to do, why it is necessary, and how he or

she can cooperate. Inform the client that

the feeding should not cause any

discomfort but may cause feeling of

fullness. For an adult, the usual

intermittent feeding will take about 30 min.

The exact length of time depends largely

on the volume of the feeding.

To gain client’s cooperation and ensure

client’s participation to procedure.

3. Wash hands and observe appropriate

infection control throughout the procedure.

Maintain asepsis.

4. Provide privacy for this procedure.

5. Assess tube placement.

a. attach the syringe to the open end of the

tube and aspirate alimentary secretion at

level of patient’s forehead.

b. Allow one hour to elapse before testing

the pH if the client has received a

medication.

c. Use pH meter rather than pH paper if

the client is receiving a continuous feeding

or if food coloring has been added to

To conform the position of the tube and

note the residual amount. If held too high,

pressure is increased at which fluid enters

stomach.

Blue litmus paper turns to red if tube is

properly situated in the stomach.

formula.

6. Assess residual feeding contents.

a. Aspirate all stomach contents and

measure the amount before administering

the feeding.

b. If 100 ml (or more than half the last

feeding) is withdrawn, check with the

nurse in charge or refer to agency policy

before proceeding. The precise amount is

usually determined by the physician’s

order or by agency policy.

This is done to evaluate absorption of the

last feeding; that is, whether undigested

formula from the previous feeding remains

and review feeding regime if necessary.

7. Administer the feeding.

• before administering the feeding:

Check the expiration date of the feeding.

Warm the feeding to room temperature.

• when an open system is used, clean the

top of the feeding container with alcohol

before opening it.

An excessively cold feeding may cause

cramps This minimizes the risk of

contaminants entering the feeding syringe

or feeding bag.

FEEDING BAG (OPEN SYSTEM)

•hang the bag from an infusion pole about

30 cm. (12 in.) above the tube’s point of

insertion into the client.

•clamp the tubing and add the formula bag

•open the clamp, run the formula through

the tubing, and reclamp the tube.

•attach the bag to the

nasogastric/nasoenteric tube and regulate

the drip by adjusting the clamp to the drop

factor on the bag.

The formula will displace the air in the

tubing, thus preventing the installation of

excess air into the client’s stomach or

intestine.

SYRINGE (OPEN SYTEM)

•remove the plunger from the syringe and Pinching or clamping the tube prevents

connect the syringe to a pinched or

clamped nasogastric tube.

•add the feeding to the syringe barrel.

•insert the feeding to flow in slowly at the

prescribed rate. Raise or lower the syringe

to adjust the flow as needed. Pinch or

clamp the tubing to stop the flow for a

minute if the clients feel discomfort.

excess air from entering the stomach and

causing distention.

Quickly administering feeding can cause

flatus, cramps, and/or reflux vomiting.

PREFILLED BOTTLE WITH DRIP

CHAMBER(CLOSED SYSTEM)

•remove the screw on cap from the

container and attach the administration set

with the drip chamber and tubing

•close the clamp on the tubing

•hang the container on an intravenous pole

about 30 cm (12 in) above the tube

insertion point into the client.

•squeeze the drip chamber to fill it to one

half of its capacity

•open the tubing clamp, run the formula

through the tubing, and reclamp the tube

•attach the feeding set tubing to the

feeding tube and regulate the drip rate to

deliver the feeding over the desired length

of time. Prefilled tube feeding sets can be

attached to a feeding pump to regulate the

flow.

At this height, the formula should run at a

safe rate into the stomach or intestine.

8. Rinse the feeding tube immediately

before all of the formula has run through

the tubing.

• instill 50 to 100 ml of water through the

feeding tube.

• be sure to add the water before the

feeding solution has drained from the neck

of a syringe or from the tubing of an

administration set. Before adding water to

a feeding bag or prefilled tubing set, first

clamp and disconnect both feeding and

administration tubes.

Water flushes the lumen of the tub,

preventing future blockage by sticky

formula.

Adding water before the syringe or tubing

is empty prevents the instillation of air into

the stomach or intestine and thus prevents

unnecessary distention.

9. Clamp and cover the feeding.

•clamp the feeding tube before all of the

water instilled.

•cover the end of the feeding tube with

gauze held by an elastic band.

To prevent leakage.

10. Monitor and ensure client’s comfort

and safety.

To monitor any adverse reaction following

feeding.

11. Dispose the equipment appropriately. Per agency protocol.

12. Document all relevant

Information.