Definition
Administering nasogastric tube feeding (NG) is a vital nursing procedure used to deliver nutrition, fluids, or medications directly into the stomach for patients who cannot eat orally.
Purposes
- To provide adequate nourishment to patients who cannot feed themselves, e.g., surgery in oral cavity, unconscious or comatose state.
- To administer medication.
Indications
- Head and neck injury.
- Coma.
- Obstruction of esophagus or oropharynx.
- Severe anorexia nervosa.
- Recurrent episodes of aspiration.
- Increased metabolic needs-burns, cancer, etc.
- Poor oral intake.
Articles
- Formula feed.
- Graduated container.
- Large syringe (30-60 mL).
- Water in a container.
- Stethoscope.
- Kidney tray.
- Towel.
- Clean gloves.
Procedure
| Nursing Actions | Rationale | |
| 1. | Before procedure Identify patient and explain procedure to patient and that feeding will take around 10-20 minutes to complete. Also explain that patient will experience a feeling of fullness after feeding. | Proper explanation allays anxiety and ensures cooperation. Explanation to be given to patients who are comatosed or unconscious as they may hear and perceive the instructions. |
| 2. | Assess for food allergies, time of last feed, bowel sounds, and laboratory values. | Proper assessment will prevent risk of complication. |
| 3. | Place container with feed in warm water. | Warms the fluid to be fed. |
| 4. | Assist patient to Fowler’s position (35-45o). | Fowler’s position enhances gravitational flow of feed through tube and prevents risk of aspiration. |
| 5. | During procedure Wash hands. | Reduces risk of transmission of microorganisms. |
| 6. | Spread towel and mackintosh over patient’s chest. | Protects patient and bed linen from soiling. |
| 7. | Don gloves and attach syringe to nasogastric tube. | |
| 8. | Aspirate stomach contents. If there is doubt about tube placement inform physician and obtain an order for X-ray. | If residual gastric contents exceed 100 mL for intermittent tube feedings or greater than 1.5 times the hourly rate for continuous feeding, withhold feed and notify physician. |
| 9. | If residual contents are within normal limits and placement of the tube has been confirmed, return gastric contents to stomach through syringe using gravity to regulate flow. | Returning gastric contents to stomach prevents fluid and electrolyte imbalance. |
| 10. | If tube placement is confirmed in stomach, pinch the feeding tube and attach barrel of feeding syringe to tube. | Pinching of feeding tube prevents air from entering the stomach and causing distention. |
| 11. | Fill syringe barrel with water and allow fluid to flow in by gravity, by raising barrel above level of patient’s head. | Water clears the tube, and the rate of flow is regulated by raising or lowering the syringe. |
| 12. | Pour feed into syringe barrel and allow it to flow by gravity. Keep on pouring feed/formula to barrel when it is three quarters empty. Pinch tube whenever necessary to stop when pouring. | Prevents air from entering tube. |
| 13. | After feeding is completed, flush tube with at least 30 cc of plain water. | Prevents clogging of feeding tube. |
| 14. | After tube is cleared, close end of feeding tube. | Prevents leakage. |
| 15. | Rinse equipment with warm water and dry. | Prevents bacterial growth. |
| 16. | Keep head of bed elevated for 30-60 minutes after feeding. | Prevents aspiration. |
| 17. | After procedure Wash hands. | Reduces risk of transmission of microorganisms. |
| 18. | Document type and amount of feeding, amount of water given, and tolerance of feed. | |
| 19. | Monitor for breath sounds, bowel sounds, gastric distention, diarrhea, constipation, and intake and output. | Evaluates aspiration effects on gastrointestinal system and therapeutic effect of feeding. |
| 20. | Instruct patient to notify nurse if he experiences sensation of fullness, nausea or vomiting. | May indicate intolerance of feeding. |
Special Considerations
- Intermittent/continuous feeding of solution from an intravenous (IV) pole and adjusting rate of administration by flow regulators are done in some situations.
- Siphon method can be used to administer clear fluids. This is done by immersing tip of tube in feed, taking care to avoid air entering into it and then raising container 12 inches above patient’s head and observing flow of fluids.
- Change the nasogastric tube according to institutions policy.
- Change the articles every 24 hours or according to institutions policy.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
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