ENTERAL/NASOGASTRIC FEEDING – Purpose, Advantages of Enteral Tube Feeding, Methods of Tube Feeding, General Instructions, Preliminary Assessment, Preparation of the Patient and Environment, Equipment, Procedure, Post-Procedure Care and Complications of Tube Feeding
Nasogastric feeding or gastric gavage is the instillation of specially prepared nutrients into the digestive tract through a tube that is inserted through one of the nostrils, down the nasopharynx and into the alimentary tract
Enteral tube feedings are delivered to the distal duodenum or proximal jejunum when it is necessary to bypass the esophagus and stomach
PURPOSE
- To supply the body with adequate nourishment, when the patient is unable to take food by mouth (e.g. unconscious, semiconscious and delirious patients) or for patients who will not eat
- To supply with adequate nutrients when conditions of mouth or esophagus make the chewing or swallowing difficult or impossible, e.g. patients with fracture jaw, structure esophagus, surgery of mouth and esophagus
ADVANTAGES OF ENTERAL TUBE FEEDING
- Intraluminal delivery of nutrients preserves gastro-intestinal integrity
- Tube feedings preserve the normal sequence of intestinal and hepatic metabolism prior to nutrient delivery to the arterial circulation
- The intestinal mucosa and liver are important in fat metabolism and are the only sites of lipoprotein synthesis
- Normal insulin – glucagon ratios are maintained with the intestinal administration of carbohydrates
GENERAL INSTRUCTIONS
- Patient receiving internal tube feedings should be in an upright position to avoids aspiration or reflux
- If the patient is ambulatory, he is encouraged to walk, since movement facilitates absorption of the feeding
- Fluid balance is carefully recorded to identify decreased intake or excessive diarrhea
- Feeding are delayed for 2 hours if gastric residue is greater than to 150 ml. if this amount persists, the physician is notified
- During the feeding monitor for signs of intolerance which includes cramping, diarrhea, nausea, vomiting, aspiration, glycosuria and diaphoresis
- Always check the placement of the tube. Gently aspirate gastric contents with a syringe, and measure the pH of the gastric contents
- If the feeding solution does not initially flow through a bulb syringe, attach the bulb and squeeze it gently to start the flow. Then remove the bulb. Never use the bulb to force the formula through the tube
- If the patient becomes nauseated or vomits, stop the feeding immediately
- During continuous feedings, assess the patient frequently for abdominal distension
- Flush the tubing by adding about 50 ml of water to the gavage bag or bulb syringe. This maintains the tube’s patency by removing excess formula, which could occlude the tube
- If the patient develops diarrhea, administer small frequent, less concentrated feedings to administer bolus feeding over a long time
- Drugs can be administered through the feeding tube. Except for enteric coated drugs
PRELIMINARY ASSESSMENT
- Check the doctor’s order
- Type of formula
- Time, frequency amount of feeding
- Specific indications for the client
PREPARATION OF THE PATIENT AND ENVIRONMENT
- Explain procedure to patient
- Ask patient for any history of allergies
- Auscultate for bowel sounds before feeding
- Check placement of gastric tube by means of aspiration of gastric juice is by checking with stethoscope while introducing air into the stomach
- Position patient to high Fowler’s position or elevate head if bed 30 degrees
- Place a towel under the chin
- Examine the appearance of aspirated contents
EQUIPMENT
A clean tray containing:
- Large volume syringe
- Required feed a fluid
- Kidney tray
- Stethoscope
- A glass with water for flushing the tubing
- Continuous infusion set in continuous drip method is ordered
- Disposable gloves
- Measured glass to measure to fluid intake
PROCEDURE
- Wash hands and put clean gloves
- Pinch proximal end of the feeding tube and elevate to 18 inches above the patients head. Fill the syringe with the required feed. Allow syringe to empty gradually, refill until prescribed amount has been given to the patient
- If continuous drip method is used hang the feeding bag to the pole above 18 inches above patients head and connect end of the bag to the proximal end of the feeding tube and set rate
- Regulate the drip rate to permit the formula to infuse over 20-30 minute by adjusting the height of the feeding bag or adjusting the rate of flow
- When the tube feedings are not being administered, clamp the proximal end of the tube
- Rinse the tube with pain water at the end of feeding
- Reclamp the gastric tube
- Remove gloves and wash hands
POST-PROCEDURE CARE
- Cover the end of the feeding tube with its plug or cap to prevent leakage and contamination of the tube
- Leave the patient in semi-Fowler’s or high Fowler’s position for at least 30 minutes
- Rinse all reusable equipment with warm water. Dry it and store it in a convenient place for the next feeding. Change the equipment every 24 hours or according to your facility’s policy
- The patient and family members are gradually included in these activities
- Weight is checked daily and watch for sudden gain in weight
- Observe for signs of dehydration (dry mucous membranes, thirst, and decreased urine output)
- Watch for possible complications
- Record amount of feeding, patient’s response to tube feeding and untoward effects in nurse’s notes and record intake in fluid balance chart
COMPLICATIONS OF TUBE FEEDING
- Mechanical: nasopharyngeal, luminal obstruction, mucosal erosions, tube displacement, aspiration
- Gastrointestinal: cramping/distention, vomiting/diarrhea
- Metabolic: hypertonic dehydration, glucose intolerance, hyperosmolar nonketotic coma, hepatic encephalopathy, renal failure, cardiac failure
