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    Nursing Skills: Enteral Nutrition / NGT

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    James Bryan ⎝⏠⏝⏝⏠⎠ Nobora
    Nasogastric tubes are inserted through the nose to deliver nutrition and medications to patients unable to eat or swallow. The nurse must properly measure and insert the tube to the stomach, checking placement by testing pH and auscultation. Tube feedings are then administered slowly by syringe or pump over 30 minutes to prevent intolerance issues. Special care is taken when feeding infants, children, and elders due to risks like irritation, obstruction, or delayed gastric emptying. When removing the tube, the nurse secures it, has the patient take a deep breath, and smoothly withdraws it to prevent aspiration of stomach contents.

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    Nursing Skills: Enteral Nutrition / NGT

    Uploaded by

    James Bryan ⎝⏠⏝⏝⏠⎠ Nobora
    26 views6 pages
    Nasogastric tubes are inserted through the nose to deliver nutrition and medications to patients unable to eat or swallow. The nurse must properly measure and insert the tube to the stomach, checking placement by testing pH and auscultation. Tube feedings are then administered slowly by syringe or pump over 30 minutes to prevent intolerance issues. Special care is taken when feeding infants, children, and elders due to risks like irritation, obstruction, or delayed gastric emptying. When removing the tube, the nurse secures it, has the patient take a deep breath, and smoothly withdraws it to prevent aspiration of stomach contents.

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    Nasogastric tubes are inserted through the nose to deliver nutrition and medications to patients unable to eat or swallow. The nurse must properly measure and insert the tube to the stomach, checking placement by testing pH and auscultation. Tube feedings are then administered slowly by syringe or pump over 30 minutes to prevent intolerance issues. Special care is taken when feeding infants, children, and elders due to risks like irritation, obstruction, or delayed gastric emptying. When removing the tube, the nurse secures it, has the patient take a deep breath, and smoothly withdraws it to prevent aspiration of stomach contents.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    26 views6 pages

    Nursing Skills: Enteral Nutrition / NGT

    Uploaded by

    James Bryan ⎝⏠⏝⏝⏠⎠ Nobora
    Nasogastric tubes are inserted through the nose to deliver nutrition and medications to patients unable to eat or swallow. The nurse must properly measure and insert the tube to the stomach, checking placement by testing pH and auscultation. Tube feedings are then administered slowly by syringe or pump over 30 minutes to prevent intolerance issues. Special care is taken when feeding infants, children, and elders due to risks like irritation, obstruction, or delayed gastric emptying. When removing the tube, the nurse secures it, has the patient take a deep breath, and smoothly withdraws it to prevent aspiration of stomach contents.

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    of 6

    NURSING SKILLS

    ENTERAL NUTRITION / NGT


    Lecturer: Mark Fredderick R. Abejo RN,MAN
    _____________________________________________

    NASOGASTRIC TUBE is inserted through one of the nostrils, down the nasopharynx and into the
    alimentary canal

    Fr. 12 , 36 inches NG tube

    Fr. 8 Opaque, 45 inches, stylet, weighted tip

    Inserting a Nasogastric Tube


    Purposes:
    To administer tube feedings and medications to
    clients unable to eat by mouth or swallow a
    sufficient diet without aspirating foods or fluids
    into the lungs (gastric gavage)
    To establish a means for suctioning stomach
    contents to prevent gastric distention, nausea
    and vomiting. (gastric lavage)
    To remove stomach contents for laboratory
    analysis
    To lavage (wash) the stomach in case of
    poisoning or overdose of medications

    Equipment
    - Nasogastric Tube ( Levin Tube )
    - Clean gloves
    - Water soluble lubricant
    - Non allergic adhesive tape
    - Glass of water or drinking straw
    - Asepto syringe
    - Basin
    - Stethoscope
    - pH test strip (optional)
    - Facial tissue or cloth
    - Clamp or plug (optional)

    Lecture Notes on Enteral Nutrition ( Nasogastric Tube )


    Prepared By: Mark Fredderick R Abejo R.N, M.A.N
    Clinical Instructor

    Assessment:
    Check the patency of nares and intactness of
    nasal tissue:
    - Ask the client to hyperextend the head, using
    flashlight, observe the intactness of the tissue of
    the nostrils.
    - Ask the client to breath through one nostril while
    occluding the other, select the nostril that has
    greater airflow.
    Determine presence of gag reflex
    Ability to cooperate with the procedure

    Steps / Procedure
    Identify and inform
    the client and explain
    the procedure.
    Assist the client to a
    high fowlers
    position if his/her
    health condition
    permits, support head
    with pillow.
    Measure the length
    of NGT to be inserted

    Rationale

    Mark this length with


    adhesive tape if the tube
    does not have markings.

    Insert the tube


    Put on gloves
    Lubricate the tip with
    water-soluble lubricant.
    Hyperextend the neck,
    gently advance the tube
    toward the nasopharynx
    Note:
    If the tube meets resistance,
    withdraw it, relubricate it,
    and insert to the other
    nostril

    This length
    approximates the
    distance from the
    nares to the
    stomach

    To reduce friction
    Hyperextension of
    the neck reduces
    the curvature of the
    nasopharyngeal
    junction.
    To prevent injury

    To allay anxiety

    It is often easier to
    swallow in this position
    and gravity helps the
    passage of tube
    NEX technique ( noseear-xiphoid)

    Tilt the clients head


    forward once the tube
    reaches the throat and
    ask the client to
    swallow or drink water
    as the tube advances.

    Measuring the appropriate length to insert the


    NGT ( NEX technique )

    Pass the tube 5-10 cm


    with each swallow,
    until the indicated
    length is inserted.
    Checking the patency
    Aspirate stomach
    contents and check the
    pH, which should be
    acidic

    Tilting the head


    forward facilitates
    passage of tube into
    the esophagus
    rather than into
    larynx.
    Swallowing moves
    the epiglottis cover
    the opening to the
    larynx

    Testing pH is a
    reliable way to
    determine location
    of a feeding tube.

    Lecture Notes on Enteral Nutrition ( Nasogastric Tube )


    Prepared By: Mark Fredderick R Abejo R.N, M.A.N
    Clinical Instructor

    Introduce 10-30 ml of
    air into the NGT and
    auscultate at the
    epigastric area, gurgling
    sound is heard.
    Ask the client to speak
    or hum
    Observe the client for
    coughing and choking
    Note:
    The most accurate method
    of assessing the placement
    of NGT is X-ray study
    Secure the NGT by
    tapping it to the bridge of
    the clients nose.

    Note:
    Gastric contents
    must be re-instill to
    the stomach to
    prevent electrolyte
    imbalances
    Difficulty in
    speaking and client
    is choking and
    continuously cough,
    tube is possibly in
    the lungs
    This prevents the
    tube from pressing
    against and
    irritating the edge
    of the nostril

    Special Considerations:
    Inserting a NGT to Infants and Young
    Children:
    Restraints may be necessary during tube
    insertion and throughout therapy. Restraints
    will prevent accidental dislodging of the tube.
    Place the infant in an infant seat or
    position the infant with a rolled towel or
    pillow under the head and shoulders.
    When assessing the nares, obstruct one of
    the infants and feel for air passage from the
    other. If the nasal passageway is very small or
    is obstructed, an orogastric tube may be more
    appropriate.
    Measure appropriate NGT length from the
    nose to the tip of the earlobe and then to the
    point midway between the umbilicus and
    xiphoid process.
    If an orogastric tube is used, measure from
    the tip of the earlobe to the corner of the
    mouth to the xiphoid process.
    Do not hyperextend or hyperflex an
    infants neck. Hyperextension or hyperflexion
    of the neck could occlude the airway.

    Tape the tube to the area between the end


    of the nares and the upper lip as well as to the
    cheek.

    Administering Tube Feeding


    (NGT Feeding , Gastric Gavage)
    Purposes:
    To restore or maintain nutritional status.
    To administer medications
    Equipment:
    - Correct amount of feeding solution
    - Asepto syringe
    - Measuring container or cup
    - Emesis basis
    - Clean gloves
    - Stethoscope
    - pH test strip (optional)
    - Facial tissue or cloth
    - Water
    Assessment:
    Assess for any signs of malnutrition or
    dehydration.
    Check for allergies to any food in the feeding.
    Assess for the presence of bowel sounds
    Note any problems that suggest lack of
    tolerance of previous feedings (e.g delayed
    gastric emptying, abdominal distention,
    dumping syndrome, constipation or
    dehydration)
    Steps / Procedure
    Identify and inform
    the client and
    explain, why it is
    necessary and how
    he/she can cooperate
    Assist the client to a
    fowlers position in
    bed or a sitting
    position in chair, if
    his/her health
    condition permits.
    Wash hands and
    observe appropriate
    infection control and
    provide privacy

    Rationale
    To allay anxiety

    This positions enhance


    the gravitational flow of
    the solution and prevent
    aspiration of fluid into
    the lungs

    Lecture Notes on Enteral Nutrition ( Nasogastric Tube )


    Prepared By: Mark Fredderick R Abejo R.N, M.A.N
    Clinical Instructor

    Through A Syringe
    (open system)
    - Introduce feeding
    slowly
    - Height of feeding is
    12 inches above the
    point of insertion.
    - Instill 60- 100 ml of
    water to NGT after

    Check the patency of


    the tube:
    - Aspirate stomach
    contents and check the
    pH, which should be
    acidic
    - Introduce 10-30 ml of
    air into the NGT and
    auscultate at the
    epigastric area, gurgling
    sound is heard.
    Assess residual
    feeding contents. To
    assess absorption of
    the last feeding, if 50
    ml or more, verify if
    the feeding will be
    given.

    - Clamp the cover of


    the feeding before all
    water is instilled
    Note:
    Gastric contents must
    be re-instill to the
    stomach to prevent
    electrolyte imbalances

    Note:
    If the client is on
    continuous feeding,
    check the gastric
    residual 4-6 hours
    Administer the feeding
    Check the feeding,
    time it was
    prepared, its
    expiration
    Warm the feeding at
    room temperature
    Through A Feeding
    Bag
    - Hang the bag from an
    infusion pole about 12
    inches above the point
    of insertion.
    - Clamp the tubing and
    add the formula to the
    bag.
    - Open the clamp, run
    the formula to the tube,
    to prevent instillation of
    air to the clients
    stomach.
    - Attach the bag to the
    NGT and regulate the
    drip.

    To prevent flatulence,
    cramps , and reflex
    vomiting

    To cleanse the lumen of


    the tube
    To prevent leakage and
    air from entering the
    tube.

    Ensure client comfort


    and safety :
    - Pin the tubing to the
    clients gown

    Minimizes pulling of the


    tube thus preventing
    discomfort

    - Ask the client to


    This facilitate digestion
    remain in position for at and prevent potential
    least 30 min.
    aspiration.

    Spoiled feeding cause


    diarrhea and
    abdominal pain to the
    client.
    Excessively cold
    feeding may cause
    cramps

    Monitor patient for


    possible problem and
    complications on
    tube feedings
    Make relevant
    documentation
    Feeding Through a Syringe

    Lecture Notes on Enteral Nutrition ( Nasogastric Tube )


    Prepared By: Mark Fredderick R Abejo R.N, M.A.N
    Clinical Instructor

    Special Considerations:
    Administering a Tube Feeding to:
    Infants
    Feeding tubes may be reinserted at each
    feeding to prevent irritation of the mucous
    membrane, nasal airway obstruction and
    stomach perforation.
    Children
    Position a small child or infant in your lap,
    provide a pacifier, and hold and cuddle the
    child during feedings. This promotes comfort,
    supports the normal sucking instinct of the
    infant and facilitates digestion
    Elders
    Decreased
    gastric
    emptying
    may
    necessitate checking frequently fir gastric
    residual.
    Diarrhea from administering the feeding
    too fast or at too high concentration may cause
    dehydration
    If feeding has a high concentration of
    glucose, assess hyperglycemia

    Removing a Nasogastric Tube


    Equipment:
    - Disposable pad
    - Clean gloves
    - 50 ml syringe (optional)
    - Disposable bag
    Steps / Procedure
    Confirm the
    physicians order.
    Identify and inform
    the client and explain
    the procedure.
    Assist the client into
    a sitting position if
    health permits
    Place the disposable
    pad across the
    clients chest
    Wash hands
    Detach the tube:
    - Disconnect to suction

    Rationale

    To allay anxiety

    To collect any spillage


    of mucous and gastric
    secretions from the tube

    apparatus if connected
    - Unpin the tube to the
    clients gown
    - Remove the adhesive
    tape securing the tube
    to the nose
    Remove the Tube
    Wear gloves
    (optional) Instill 50
    ml of air into the
    tube
    Ask the client to
    take deep breath
    and hold it
    Pinch the tube with
    he gloved hand
    Quickly and
    smoothly, withdraw
    the tube.
    Dispose the tube
    immediately
    Provide oral care if
    desired
    Assist the client to
    blow the nose
    Document relevant
    information

    This clears the tube of


    any gastric contents
    This closes glottis,
    preventing aspiration of
    gastric contents
    This prevent gastric
    contents inside the tube
    from draining into the
    clients throat
    To prevent possible
    transfer of
    microorganism

    To remove accumulated
    secretions

    Common Problems of Tube Feedings


    1. Vomiting
    2. Aspiration
    3. Diarrhea
    4. Constipation
    5. Hyperglycemia
    6. Abdominal Distention

    Lecture Notes on Enteral Nutrition ( Nasogastric Tube )


    Prepared By: Mark Fredderick R Abejo R.N, M.A.N
    Clinical Instructor

    Administering a Gastrostomy or
    Jejunostomy Feeding

    Gastrostomy Tube Feeding

    After feeding, remain in sitting position or


    slightly elevated right lateral position for at
    least 30 mins. To prevent gastric reflux and
    possible aspiration.
    Assess status of peristomal skin for signs and
    symptoms of infection.
    Make relevant documentation

    Total Parenteral Nutrition (TPN)


    Intravenous Hyperalimentation (IVH)
    TPN or IVH, is provided when the
    gastrointestinal tract is nonfunctional because of
    an interruption in its continuity or because its
    absorptive capacity is impaired.
    Parenteral Nutrition, is administered
    intravenously such as through a central venous
    catheter into the superior vena cava.
    Because TPN solutions are hypertonic
    ( highly concentrated in comparison to the solute
    concentration of blood), they are injected only
    into high flow central veins, where they are
    diluted by the clients blood

    Procedure:
    Assess and prepare the client
    Insert a feeding tube into the ostomy opening
    10-15 cm (4-6 inches) if one is not already in
    place. Lubricate with water soluble lubricant
    before insertion to prevent friction.
    Check the patency of a tube suture in place.
    Pour 15-30 ml of water into the syringe and
    allow water to flow into the tube.
    Check the residual formula. If 50mls or more,
    verify if the feeding will be administered.
    Administer feeding slowly. Hold the syringe
    7-15 cm (3-6 inches) above the ostomy opening.
    To prevent flatulence, crampy pain and reflex
    vomiting
    Flush the tube with 30 ml. Flushing the tube
    preserves its patency.

    Clients suggestive for TPN


    Severe malnutrition
    Severe burns
    Bowel disease disorders
    Acute renal failure
    Hepatic failure
    Metastatic cancer
    Major surgeries ( where NPO is taken for more
    than 5 days)

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