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POLICIES AND PROCEDURES MANUAL

TUBE FEEDING (NASOGASTIC)


DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** ***
*** REVIEW DUE
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SUBJECTS: TUBE FEEDING (NASOGASTRIC)

1. EQUIPMENT:

1. Feeding ordered by physician


2. 50ml of water
3. Absorbent pad
4. Gavage bag with tubing and flow regulator clam (if a gavage bag is
unavailable, us a bulb syringe or a catheter tip syringe)
5. 50ml syringe
6. Stethoscope
7. Gloves
8. Basin
9. Suction source
10. I.V. standard

2. PREPERATION OF EQUIPMENT:

A. After obtaining from the pharmacy, the unopened cans of formula may be
stored and are to be administered at room temperature. Hot formula may
coagulate formula proteins and clog tubing. Heat may change the
chemical composition of the formula. It may burn or irritate gastric
mucosa. Chilling the formula is avoided because it increases viscosity of
the liquid, which may clog the tube. Cold formula may also cause
vasoconstriction, which reduces the flow of gastric digestive secretions,
which may cause cramping, nausea, vomiting and distention.
B. Wash hands
C. Close the gavage-tubing clamp and pour the appropriate amount of
formula into the gavage bag. Squeeze the drip chamber and fill half way.
Remove the cap from the distal end of the tubing. Open the clamp and
run the formula through the length of tubing and clamp the tubing.
D. All air in tubing is removed so that it does not enter the
Individual’s stomach and cause distention and discomfort.

3. PROCEDURE:

NOTE: if Individual shows any signs of respiratory distress discontinue


feeding immediately and re-assess placement of feeding tube and
Individual status.
POLICIES AND PROCEDURES MANUAL
TUBE FEEDING (NASOGASTIC)
DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** ***
*** REVIEW DUE
***
***

NURSING ACTION RATIONAL- PRECAUTIONS


A. Approach and identify Individual. A. To gain Individual confidence and
Explain the procedure and provide lessen anxiety and embarrassment.
privacy Assure Individual’s identity
B. Wash hands B. To avoid cross contamination
C. Bring assembled equipment to C. The equipment need not be sterile.
Individual’s room maintaining a clean Since the stomach is not a sterile
technique. cavity, however, clean technique is
necessary
D. Elevate the head of the Individual’s D. Prevent aspiration of feeding by
bed to semi-fowlers or high position gastroesophageal reflex and to aid
unless contraindicated digestion
E. Place towel or Chux on Individual’s E. Protect Individual’s gown from
chest spillage
F. Put on disposable gloves F. Prevent cross contamination
G. remove cap or plug from distal end G. To check tube patency and
of feeding tube and use syringe to position. To be sure it has not become
inject 10-15 ml of air through the tube displaced. Listen for hissing or gurgling
while auscultating the Individual’s sound (air passing through the
stomach with a stethoscope stomach)
H. Aspirate stomach contents H. Confirm proper position and
patency of the tube
I. Re-install the aspirated stomach I. To prevent the loss of electrolytes ad
contents into the stomach gastric juices
J. NEVER GIVE A FEEDING UNLESS J. Administering a tube feeding
YOU ARE SURE THE TUBE IS through a misplaced tube can cause
PROPERLY POSITIONED IN formula to enter the lungs leading to
INDIVIDUAL’S STOMACH suffocation and death
K. Gavage Bag Feeding K. To prevent air from entering
a) Connect the gavage stomach. Prevents sudden stomach
feeding bag tubing to the distention, which can cause nausea,
feeding tube. Depending vomiting, cramps, or diarrhea. Maintain
on the type of tube used tube patency by removing excess
you may need an adapter sticky formula, which could occlude the
to connect the two tubes. nasogastric tube. To prevent air from
b) Open the regulator clamp entering the stomach causing gastric
on the gavage bag tubing distention.
and adjust the flow rate.
c) Initially administer feeding
slowly & increase rate as
tolerated.
d) After administering the
appropriate amount of
feeding flush the tubing
POLICIES AND PROCEDURES MANUAL
TUBE FEEDING (NASOGASTIC)
DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** ***
*** REVIEW DUE
***
***

with about 100ml of water


e) Close the regulator clamp
on the gavage bag
tubing.
L. Catheter Tip Syringe L. Prevent excess air form entering the
f) Attach the syringe to the stomach, causing gastric distention and
feeding tube discomfort. Prevent air from entering
g) Fill the syringe with stomach. NOTE: No more than 500 cc
formula and allow formula of fluid is given at one time.
to flow through. The
height at which you hold
the syringe will determine
flow rate. When the
syringe is ¾ empty, pour
more formula into it.
h) Disconnect the syringe
from the feeding tube and
plug off nasogastric tube
M. “Kangaroo Pump” Place amount of
formula in Kangaroo Pump gavage
bag. Check patency of tube following
N.P. 328. Set up pump to rate as
ordered by Physician.
N. Observe Individual & respiration
throughout the procedure
O. Cover the end of the feeding tube O. To prevent leakage and tube
with its plug or cap. Then release the contamination
tubing or clamp on the tubing. Secure
tubing.
P. Leave the Individual in semi- or P. To prevent gastroesophageal reflux
high-fowlers position for at least 30 and to aid digestion. To prevent
minutes aspiration and suffocation.
Q. Rinse all re-usable equipment with Q. To prevent bacterial growth
warm water and store in a brown paper
bag labeled with the Individual’s name.
R. Change feeding/equipment every R. to prevent bacterial growth
24 hours
S. Wash hands S. To prevent infection

SPECIAL CONSIDERATION RATIONAL-PRECAUTIONS


A. When ready to administer, shake A. Agitation corrects separation, which
the can well immediately before could alter the content of the planed
opening. Once opened, dispense the feeding and potentially clog the tube.
prescribed volume and discard any Immediate use and discard ensures the
unused formula. formula is not a vehicle for microbial
contamination/growth.
POLICIES AND PROCEDURES MANUAL
TUBE FEEDING (NASOGASTIC)
DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** ***
*** REVIEW DUE
***
***

B. Aspirate stomach contents 2 or 3 B. a) To verify adequate gastric


hours emptying and decrease vomiting
and aspiration .
b) To maintain acid-base balance.
c) The nutritionist will be able to
calculate the caloric intake
accurately by knowing the amount
of feeding returned.
C. During continuous feeding, assess C. Distention may cause nausea,
the Individual frequently for abdominal vomiting and is uncomfortable.
distention.
D. If diarrhea occurs, notify the D. Diarrhea is the most common
physician so that the underlying cause complication. Common causes are: too
can be determined and corrected, e.g., high infusion rate or volume, lack of
alternating the prescribed medications, fiber, altered gastrointestinal flora (e.g.
changing the formula and/or due to medication or contamination),
administration rate/volume, switching to hypoalbuminemia, or hyperosmolar
a fiber containing formula, solutions (Isotonic formulas are best
administering antidiarrheal medication, tolerated.)
or correcting a low serum albumin. Also
ensure that proper infection control and
equipment practices are being
followed.
E. If constipation occurs, notify the E. Irregular bowel movements can
physician so that the underlying cause result from the low fiber content of the
can be determined and corrected , e.g., formula, inadequate fluids, medication
altering the formula, adding fluids, or lack of activity. The feeding should
ordering a bulk forming laxative, be stopped and evaluated if obstruction
increasing Individual activity, or is suspected.
changing a medication.
F. Assess hydration and increase fluid F. Dehydration may cause
intake as necessary if fluids are not constipation
contraindicated.
G. Drugs may be administered through G. Avoid need for discomfort of I.M.
the feeding tube, except for enteric- Injections
coated drugs. Crush tablets or open
and dilute capsules in water prior to
administering. Flush the tubing with
water after administering drugs.
H. Monitor blood glucose to assess H. To determine response nutritional
glucose tolerance. Also monitor serum support.
electrolytes and other blood studies as
ordered by the physician.
POLICIES AND PROCEDURES MANUAL
TUBE FEEDING (NASOGASTIC)
DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** ***
*** REVIEW DUE
***
***

4. DOCUMENTATION:

A. Document the feeding on the Medication Administration Record (MAR)


including:
1. The time the food product was opened & administered
2. The amount and type of formula given
3. The amount of water given
4. The time(s) that the tubing was changed
B. Record total I. & O. don the Intake and Output flow sheet
C. Record amount of residual feeding aspirated and returned on the IDN’s.
D. In the IDN’s record the placement and patency of the tube, the amount of
residual feeding (if any), the Individual’s reaction to and the tolerance of
feeding, including any cramping, diarrhea or abdominal distention. Also
note the results of blood tests.

REFERENCE: Nutrition Care Manual Feeding and Liquid Supplements