Nasogastr|c feed|ng

Def|n|t|on
A feeding tube 8 a med.al dev.e u8ed to provde nutrton to patent8 who .annot obtan
nutrton by 8wallowng. The 8tate of beng fed by a feedng tube 8 .alled enteraI feeding or
tube feeding. Pla.ement may be temporary for the treatment of a.ute .ondton8 or lfelong n
the .a8e of .hron. d8ablte8. A varety of feedng tube8 are u8ed n med.al pra.t.e. They are
u8ually made of polyurethane or 8l.one. The dameter of a feedng tube 8 mea8ured n Fren.h
unt8 (ea.h Fren.h unt equal8 0.33 mllmeter8. They are .la88fed by 8te of n8erton and
ntended u8e.
Purpose:
OTo re8tore or mantan nutrtonal 8tatu8
OTo admn8ter med.aton
ateriaIs:
Oorre.t amount of feedng 8oluton
O20 to 50 ml 8yrnge wth an adapter
OEme88 ba8n
Olean glove8
OLarge 8yrnge wth plunger or .albrated pla8t. feedng bag wth tubng that .an be
atta.hed to the feedng tube or preflled bottle wth a drp .hamber, tubng, and a flowregulator
.lamp
OpH te8t 8trp or meter
OMea8urng .ontaner from wh.h to pour the feedng ( f u8ng open 8y8tem
OWater ( 60 ml unle88 otherw8e 8pe.fed at room temperature
OFeedng pump a8 requred
1. A888t the .lent to a
Fowler'8 po8ton n bed or
8ttng po8ton n a .har,
the normal po8ton for
eatng. f a 8ttng po8ton
8 .ontrand.ated, a
8lghtly elevated rght 8de
lyng po8ton 8
a..eptable.

2. Explan to the .lent what
you are gong to do, why t
8 ne.e88ary, and how he r
8he .an .ooperate. nform
the .lent that the feedng
8hould not .au8e any d8.omfort
but may .au8e
feelng of fullne88. For an
adult, the u8ual
ntermttent feedng wll
take about 30 mn. the
exa.t length of tme
depend8 largely on the
volume of the feedng.

3. wa8h hand8 and ob8erve
approprate nfe.ton
.ontrol pro.edure

4. Provde prva.y for th8
pro.edure f the .lent
de8re8 t.

5. a88e88 tube pla.ement.
a. atta.h the 8yrnge
to the open end of
The8e po8ton8 enhan.e the
gravtatonal flow of the
8oluton and prevent a8praton
of flud nto the lung8.
































Reg8tered Nur8e
the tube and
a8prate almentary
8e.reton. he.k
pH.
b. Allow one hour to
elap8e before
te8tng the pH f
the .lent ha8
re.eved a
med.aton
.. U8e pH meter
rather than pH
paper f the .lent
8 re.evng a
.ontnuou8 feedng
or f food .olorng
ha8 been added to
formula.

6. A88e88 re8dual feedng
.ontent8.
a. a8prate all
8toma.h .ontent8
and mea8ure the
amount before
admn8terng the
feedng
b. f 100 ml (or more
than half the la8t
feedng 8wthdrawn, .he.k
wth the nur8e n
.harge or refer to
agen.y pol.y
before pro.eedng
the pre.8e amount
8 u8ually
determned by the
phy8.an'8 order
or by agen.y
pol.y.

7. Admn8ter the feedng.
before admn8terng the
feedng:
he.k the expraton date
of the feedng
Warm the feedng to
room temperature
when an open 8y8tem 8
u8ed, .lean the top of the feedng
.ontaner wth al.ohol before
openng t

FEEDNG BAG (OPEN
SYSTEM
hang the bag from an nfu8on
pole about 30 .m. (12 n. above
the tube'8 pont of n8erton nto
the .lent.
.lamp the tubng and add the
formula bag
open the .lamp, run the formula


















Th8 8 done to evaluate
ab8orpton of the la8t feedng;
that 8, whether undge8ted
formula form the prevou8
feedng reman8.























An ex.e88vely .old feedng
may .au8e .ramp8
Th8 mnme8 the r8k of
.ontamnant8 enterng the
feedng 8yrnge or feedng bag











through the tubng, and re.lamp
the tube. The formula wll
d8pla.e the ar n the tubng,
thu8 preventng the n8tallaton
of ex.e88 ar nto the .lent'8
8toma.h or nte8tne.
atta.h the bag to the
na8oga8tr.na8oenter. tube and
regulate the drp by adju8tng the
.lamp to the drop fa.tor on the
bag.

SYRNGE (OPEN SYTEM
remove the plunger from the
8yrnge and .onne.t the 8yrnge
to a pn.hed or .lamped
na8oga8tr. tube.
add the feedng to the 8yrnge
barrel.
n8ert the feedng to flow n
8lowly at the pre8.rbed rate.
Ra8e or lower the 8yrnge to
adju8t the flow a8 needed. Pn.h
or .lamp the tubng to 8top the
flow for a mnute f the .lent8
feel d8.omfort.

PREFLLED BOTTLE WTH
DRP HAMBER(LOSED
SYSTEM
remove the 8.rew on .ap from
the .ontaner and atta.h the
admn8traton 8et wth the drp
.hamber and tubng
.lo8e the .lamp on the tubng
hang the .ontaner on an
ntravenou8 pole about 30 .m
(12 n above the tube n8erton
pont nto the .lent.
8queee the drp .hamber to fll
t to one half of t8 .apa.ty
open the tubng .lamp, run the
formula through the tubng, and
re.lamp the tube
atta.h the feedng 8et tubng to
the feedng tube and regulate the
drp rate to delver the feedng
over the de8red length of tme.
Preflled tube feedng 8et8 .an be
atta.hed to a feedng pump to
regulate the flow.

8. Rn8e the feedng tube
mmedately before all of
the formula ha8 run
through the tubng
n8tll 50 to 100 ml of water
through the feedng tube. Water
flu8he8 the lumen of the tub,
preventng future blo.kage by
8t.ky formula.
be 8ure to add the water












Pn.hng or .lampng the tube
prevent8 ex.e88 ar from enterng
the 8toma.h and
.au8ng d8tenton.





Qu.kly admn8terng
feedng .an .au8e flatu8,
.ramp8, andor reflux
vomtng.









At th8 heght, the formula
8hould run at a 8afe rate nto
the 8toma.h or nte8tne.

























before the feedng 8oluton ha8
draned from the ne.k of a
8yrnge or from the tubng of an
admn8traton 8et. Before addng
water to a feedng bag or
preflled tubng 8et, fr8t .lamp
and d8.onne.t both feedng and
admn8traton tube8.

9. lamp and .over the
feedng.
.lamp the feedng tube before
all of the water n8tlled
.over the end of the feedng
tube wth gaue held by an
ela8t. band
10. En8ure .lent .omfort and
8afety
11. D8po8e the equpment
approprately
12. Do.ument all relevant
nformaton
13. Montor .lent for po88ble
Problem8.



Addng water before the
8yrnge or tubng 8 empty
prevent8 the n8tllaton of ar
nto the 8toma.h or nte8tne
and thu8 prevent8 unne.e88ary
d8tenton.




To prevent leakage
nsg dx
O lmbalanced nuLrlLlon less Lhan body requlremenLs relaLed Lo lnadequaLe lnLake of nuLrlenLs
O 8lsk for dlarrhea relaLed Lo Lhe dumplng syndrome or Lo Lube feedlnglnLolerance
O 8lsk for lneffecLlve alrway clearance relaLed Lo asplraLlon of Lube feedlng
O 8lsk for deflclenL fluld volume relaLed Lo hyperLonlc dehydraLlon
O 8lsk for lneffecLlve coplng relaLed Lo dlscomforL lmposed by Lhe presence of Lhe nC or nasoenLerlc Lube
O 8lsk for lneffecLlve LherapeuLlc reglmen managemenL
O ueflclenL knowledge abouL home Lube feedlng reglmen
Nsg cons|darat|ons
uo noL use force when lnserLlng a nC Lube lf reslsLance occurs roLaLe and reLracL Lhe Lube sllghLly and Lry agaln lorclng Lhe Lube
can cause LraumaLlc ln[ury Lo Lhe Llssue of Lhe nose LhroaL or esophagus
Always check Lhe Lube poslLlonlng before glvlng feedlngs lf Lhe Lube ls ouL of place Lhe paLlenL may asplraLe Lhe feedlng soluLlon
lnLo Lhe ngs
keep Lhe paLlenL ln an uprlghL or semluprlghL slLLlng poslLlon when dellverlng a Lube feedlng Lo enhance perlsLalsls and avold
regurglLaLlon of Lhe feedlng
Check paLlenLs who are recelvlng conLlnuous feedlngs vla a pump or gravlLy hourly or accordlng Lo Lhe medlcal seLLlngs pollcy Lo
assure LhaL Lhe Lube ls ln poslLlon Lhe formula ls flowlng aL Lhe correcL raLe and Lhe paLlenL ls comforLable wlLh no slgns of
dlsLenLlon or dlsLress
Cap or clamp off Lhe nC Lube when noL ln use Lo prevenL backflow of sLomach conLenLs or accumulaLlon of alr ln Lhe sLomach
lf a paLlenL has severe slnus condlLlons nasal obsLrucLlon or has had faclal surgery lL may be necessary Lo place a oralgasLrlc Lube Lo
avold furLher nasal Lrauma
lf Lhe amounL of gasLrlc asplraLe ls large prlor Lo a bolus or lnLermlLLenL feedlng noLlfy Lhe physlclan and follow Lhe proLocol of Lhe
medlcal seLLlng for relnsLllllng Lhe gasLrlc asplraLe 1he feedlng slze may need Lo be decreased lf Lhe paLlenL ls noL dlgesLlng lL
nC Lube placemenL ls meanL Lo be a shorLLerm soluLlon for feedlng problems aLlenLs LhaL requlre long Lerm Lube feedlng should
have surglcal placemenL of a gasLrosLomy Lube or gasLrosLomy buLLon LongLerm nC Lube usage can cause nasal eroslon slnuslLls
esophaglLls gasLrlc ulceraLlon esophagealLracheal flsLula formaLlon oral lnfecLlons and resplraLory lnfecLlons
enema
8CCLuu8L lC8 1PL lnSL81lCn Cl LnLMAS Anu
SuCSl1C8lLS
rlor Lo admlnlsLerlng an enema or supposlLory Lhe perl anal reglon should be
checked for abnormallLles (Peywood!ones 1994 Addlson 1999) A dlglLal
examlnaLlon should be carrled ouL for faecal loadlng and for abnormallLles
lncludlng blood paln and obsLrucLlon
See ollcy for u8L
LCulMLn1
non sLerlle gloves
1lssue
AbsorbenL pad
LubrlcaLlng gel
SupposlLorles/Lnemas
8ed proLecLlon
Lxplaln Lhe procedure checklng wlLh
Lhe cllenL and any noLes for prevlous
ano/recLal surgery or abnormallLles
Lxplaln Lhe procedure Lo Lhe paLlenL
and Lhe expecLed effecL of Lhe
supposlLory and Lhen galn consenL
(Campbell 1993 MalleL 8alley
1996)

Clve Lhe cllenL an opporLunlLy Lo
urlnaLe (MalleL 8alley 1996)
Check Lhe prescrlpLlon charL and
assemble Lhe equlpmenL
Lnsure LhaL Lhe bed ls proLecLed
(Campbell 1993 Peywood!ones
1994 MalleL 8alley 1996)

Wash hands and puL on apron and
gloves
oslLlon Lhe paLlenL lylng on Lhe lefL
slde wlLh knees flexed and place an
absorbenL pad under Lhe hlp

lL ls cusLomary Lo ask Lhe paLlenL Lo lle
ln lefL laLeral poslLlon
Ask Lhe cllenL Lo breaLhe deeply

lnserL supposlLorles abouL 4cm lnLo Lhe
recLum usually uslng Lhe lndex flnger
(MalleL 8alley 1996)
lnserL enema Lhe lengLh of
admlnlsLraLlon Lube

uo noL lnserL a supposlLory lnLo a
faecal mass


1o galn cooperaLlon
lf Lhls ls noL obLalned Lhe procedure
may consLlLuLe assaulL








1o reduce cross lnfecLlon and
unnecessary mess









1o ald relaxaLlon and mlnlmlse
reslsLance and dlscomforL on lnserLlon













lf Lhe supposlLory ls an evacuanL assess
Lhe paLlenL's ablllLy Lo reach Lhe LolleL
prlor Lo admlnlsLraLlon LubrlcaLe Lhe
blunL end of Lhe supposlLory wlLh a
lubrlcaLlng gel
lnserL Lhe supposlLory blunL end
foremosL lnLo Lhe anal canal (AbdelMaebound eL al 1991
Addlson eL al
2000 MoppeLL 2000)

Lnemas musL be aL room LemperaLure
or should be warmed

LubrlcaLe Lhe fulllengLh of Lhe Lube
wlLh gel

Lnsure LhaL all alr ls removed from
enemas before Lhey are admlnlsLered
(Peywood!ones 1994 MalleL
8alley 1996)

use gravlLy noL force Lo admlnlsLer
waLerbased enema
Clean Lhe cllenL's perl anal area Ask
Lhe cllenL Lo reLaln Lhe supposlLory
Lnsure LhaL asslsLance ls avallable lf
cllenL ls unable Lo walk Lo Lhe LolleL A
supposlLory wlll Lake abouL 20 mlnuLes
Lo dlssolve (Addlson eL al 2000)

uocumenL LhaL Lhe supposlLory has
been glven monlLor Lhe cllenL and
record Lhe effecLs of Lhe recLal
medlcaLlon uslng Lhe 8rlsLol SLool
Scale (see ollcy for u8L)
ulspose of equlpmenL remove apron
and gloves
1hls allows Lhe lower edge of Lhe
conLracLlng sphlncLer Lo close LlghLly
around Lhe anus also makes lL easler
for Lhe paLlenL Lo reLaln Lhe
supposlLory





1o mlnlmlse shock and prevenL bowel
spasms

1he purpose of long Lubes ls noL Lo
reach hlgher lnLo Lhe bowel buL Lo
allow ease of selfadmlnlsLraLlon




lorclng an enema lnLo Lhe recLum
could resulL ln bowel spasm leakage
and shock







1o prevenL cross lnfecLlon Some
cllenLs may prefer Lo lnserL Lhe
supposlLory Lhemselves lf so Lhe nurse
should explaln Lhe procedure and be
avallable Lo offer asslsLance lf
necessary