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NGT INSERTION & NGT FEEDING

NGT INSERTION a tube inserted by way of the nasopharynx and place into the clients

stomach (small intestine

PROCEDURE:

1. Explain procedure to patient and provide privacy. (discuss the need and importance of the
insertion)
2. Place the patient in high-fowlers position. (in order to facilitate the insertion of the
tube)
3. Measure the length of the NGT to be inserted.
a. Tip of the nose to the tip of the earlobe to the xiphoid process = 50 cm
b. NEX TECHNIQUE nose earlobe xiphoid process
4. Lubricate tip of the tube with water-soluble lubricant. (to reduce friction)

NOTE: Do not use oil, it may cause LIPOID PNEUMONIA

5. Hyperextend the neck, gently advance the tube toward the nasopharynx.
6. Tilt the patients head once the tube reaches the oropharynx (throat) and ask the patient to
swallow, as the tube is advanced. (apply topical analgesic to nostril and oropharynx or ask
patient to hold ice chips in his or her mouth for several times)
7. Secure the NGT by taping it to the bridge of the clients nose, after checking position of tube
placement.

EQUIPMENT: nasogastric tube adhesive tape (non-allergenic)


Syringe gloves
Water-soluble lubricant

KINDS OF NGT:

LEVIN/LEVINE TUBE - has single lumen (Hole)

- It ranges from Fr 14-18 in size


- Most commonly use NG tube
- Made of plastic or rubber

Rubber NGT place in basin with ice


Plastic NGT place in warm water

GASTRIC SUMP/SALEM SUMP - is a radiopaque, clear plastic, double lumen NG tube

- Used to decompress stomach and keep it empty (120 cm


long/48 inches)

LARGER TUBE drains gastric content


Smaller tube also known as BLUE PIGTAIL
- Kept above waist of patient to prevent reflux of the gastric content
NGT FEEDING/NASOGASTRIC FEEDING OR GASTRIC GAVAGE
Most common enteral feeding
Enteral through the GIT
Alternative feeding method to ensure adequate nutrition

EQUIPMENT: tray stethoscope


Asepto syringe osteorized food (OF)
Facial tissue glass of water

PURPOSES OF NGT FEEDING:

1. To provide feeding (gastric gavage)


2. To irrigate stomach (gastric lavage) wash or cleanse in case of poisoning or
overdose of medication
remove and use for laboratory analysis
3. For decompression (drainage of gastric content)
DECOMPRESSION prevent gastric distention after surgery
4. To adminster medication
5. To administer supplemental feedings

PROCEDURE:

1. Explain procedure to patient. (to gain trust and cooperation)


2. Provide privacy. (NGT feeding is embarrassing)
3. Place patient on high-fowlers position / sitting position. (position enhance gravitational flow
of solution and prevent aspiration)
4. Assess tube placement and patency.

ASSESSMENT OF TUBE PLACEMENT : (NOTE: always remember GI placement v/s


respiratory placement)
Aspirate GI secretions. (yellowish or greenish in color and should be acidic)
(assess residual feeding more than 50 ml, refer to
the Phycisian)
Measure pH if acidic. (normal range 2-3)
Inject 5-20 ml or air thru the tube, auscultate in the epigastric area, L lower
abdominal quadrant. (gurgling sound is heard)
Ask client to speak or hum. (if tube is in the trachea, patient cant speak)
Assess for coughing and choking. (any signs of distress may indicate displacement of
tube)
X-RAY or RADIOGRAPH most effective verification of tube placement (not feasible
because of cost, discomfort and radiation risk)
5. Pinch the tubing. (to prevent air from entering the stomach)
6. Administer the feeding; but.

CHECK THE DOCTORs ORDER:


Frequency and amount
Determine food allergies (ex. milk and egg)
Check the expiration date (discard the expired solution)
7. Introduce feeding slowly through the tubing [b/w 20-35 min.] (to prevent flatulence, crampy
pain or reflex vomiting)
Administer at room temperature unless there is a specific order;
HOT irritate mucus membrane
COLD cause stomach cramp
8. Height of feeding is 12 inches above the tubes point of insertion. (to control the flow of
feeding)
USING A FEEDING BAG:
Hang bag on IV pole and adjust to about 12 inches above stomach. Clamp tubing.
Cleanse top of feeding container with alcohol before opening it. Pour formula into
feeding bag and allow solution to run through tubing. Close clamp.
Attach feeding set-up to feeding tube, open clamp, and regulate drip rate according
to physicians order or allow feeding to run in over 30 minutes.
Add 30-60 ml of sterile water to irrigate the feeding bag when feeding is almost
finished. Clamp tubing immediately after water has been instilled.
Disconnect from feeding tube and cover end with sterile gauze or cap.
9. Instill 60 ml of water into NGT after feeding. (to cleanse the lumen of the tube/flush)
10. Clamp the NGT before all of the water is instilled. (THEN: pin tubing to gown --- to minimize
pushing of tube --- to prevent discomfort and dislodge)
11. Ask the client to remain in fowlers position or in slightly elevated right lateral position for at
least 30 minutes. (to prevent potential aspiration of feeding/reflux)
12. Make relevant documentation.

DOCUMENT the following:


Amount of feeding
Kind of solution
Duration of feeding
Volume of feeding
Intake and output ( I & O )
13. Do after care equipment. Wash, rinse and dry equipment after each feeding.

ASSESSMENT OF CLIENTS RECEIVING TUBE FEEDING:

1. Allergies to any food. (like milk and egg)


2. Bowel sounds before each feeding. (determine intestinal activity)
3. Abdominal distention. (check abdominal girth daily)
(may indicate intolerance to previous feeding)
4. Check placement of tube.
5. Presence of regurgitation and feeling of fullness after feeding. (may indicate delayed gastric
emptying; need to decrease quantity or rate of feeding; or if the feeding has lot of fat
content)
6. Diarrhea , flatulence, constipation ( may be the feeding is too concentrated; lack of bulk in
liquid)

COMMON PROBLEM OF TUBE FEEDING:

1. Vomiting medulla oblongata vomiting center


2. Aspiration most life-threatening complication of vomiting and tube feeding
3. Diarrhea because of intolerance
4. Constipation lack of liquid and too concentrated food
5. Hyperglycemia elevated blood glucose
6. Abdominal distention poor digestive system/digestion
NGT INSERTION & NGT FEEDING

NGT INSERTION a tube inserted by way of the nasopharynx and place into the clients

stomach (small intestine)

PROCEDURE:

1. Explain procedure to patient and provide privacy.


2. Place the patient in high-fowlers position.
3. Measure the length of the NGT to be inserted.
a. Tip of the nose to the tip of the earlobe to the xiphoid process = 50 cm
b. NEX TECHNIQUE nose earlobe xiphoid process
c. Lubricate tip of the tube with water-soluble lubricant

NOTE: Do not use oil, it may cause LIPOID PNEUMONIA

4. Hyperextend the neck, gently advance the tube toward the nasopharynx.
5. Tilt the patients head once the tube reaches the oropharynx (throat) and ask the patient to
swallow, as the tube is advanced. Secure the NGT by taping it to the bridge of the clients
nose, after checking position of tube placement.

EQUIPMENT: nasogastric tube adhesive tape (non-allergenic)


Syringe gloves
Water-soluble lubricant

KINDS OF NGT:

LEVIN/LEVINE TUBE - has single lumen (Hole)

- It ranges from Fr 14-18 in size


- Most commonly use NG tube
- Made of plastic or rubber

Rubber NGT place in basin with ice


Plastic NGT place in warm water

GASTRIC SUMP/SALEM SUMP - is a radiopaque, clear plastic, double

lumen NG tube

- Used to decompress stomach and keep it empty (120 cm long/48


inches)

LARGER TUBE drains gastric content


Smaller tube also known as BLUE PIGTAIL
- Kept above waist of patient to prevent reflux of the gastric content

NGT FEEDING/NASOGASTRIC FEEDING OR GASTRIC GAVAGE

Most common enteral feeding


Enteral through the GIT
Alternative feeding method to ensure adequate nutrition
EQUIPMENT: tray stethoscope
Asepto syringe osteorized food (OF)
Facial tissue glass of water

PURPOSES OF NGT FEEDING:


6. To provide feeding
7. To irrigate stomach
8. For decompression
DECOMPRESSION prevent gastric distention after surgery
9. To adminster medication
10. To administer supplemental feedings

ASSESSMENT OF TUBE PLACEMENT : (NOTE: always remember GI placement v/s


respiratory placement)
Aspirate GI secretions.
Measure pH if acidic. (normal range 2-3)
Inject 5-20 ml or air thru the tube, auscultate in the epigastric area
Ask client to speak or humAssess for coughing and choking
X-RAY or RADIOGRAPH most effective verification of tube placement

CHECK THE DOCTORs ORDER:


Frequency and amount
Determine food allergies (ex. milk and egg)
Check the expiration date (discard the expired solution)

Administer at room temperature unless there is a specific order;


HOT irritate mucus membrane
COLD cause stomach cramp

USING A FEEDING BAG:


Hang bag on IV pole and adjust to about 12 inches above stomach. Clamp tubing.
Cleanse top of feeding container with alcohol before opening it. Pour formula into
feeding bag and allow solution to run through tubing. Close clamp.
Attach feeding set-up to feeding tube, open clamp, and regulate drip rate according
to physicians order or allow feeding to run in over 30 minutes.
Add 30-60 ml of sterile water to irrigate the feeding bag when feeding is almost
finished. Clamp tubing immediately after water has been instilled.
Disconnect from feeding tube and cover end with sterile gauze or cap.

DOCUMENT the following(FEEDING)


Amount of feeding
Kind of solution
Duration of feeding
Volume of feeding
Intake and output ( I & O )
ASSESSMENT OF CLIENTS RECEIVING TUBE FEEDING:

7. Allergies to any food.


8. Bowel sounds before each feeding.
9. Abdominal distention.

10. Check placement of tube.


11. Presence of regurgitation and feeling of fullness after feeding.
12. Diarrhea , flatulence, constipation

\COMMON PROBLEM OF TUBE FEEDING:

6. Vomiting medulla oblongata vomiting center


7. Aspiration most life-threatening complication of vomiting and tube feeding
8. Diarrhea because of intolerance
9. Constipation lack of liquid and too concentrated food
10. Hyperglycemia elevated blood glucose
11. Abdominal distention poor digestive system/digestion