NG & GASTROSTOMY

INSERTION & TUBE FEEDING

By: Rochelle Joy T. Ramos

ENTERAL FEEDING
Levin tube
Salem
sump
tube
PEG TUBE
Gastrostomy tube
PURPOSE/INDICATIONS
CONTRAINDICATIONS

ENTERAL

GI obstruction
Prolonged ileus
Severe diarrhea &
vomiting
Intercutaneous fistula
 CONTRAINDICATIONS
NGT
Head trauma
Any presence of skull
fractures
Severe facial trauma
 obstructed esophagus
Obstructed airway
Esophageal
strictures/varices
Patients with Alkali ingestion at risk for
suspected
esophageal penetration
Cervical spine
injury
 CONTRAINDICATIONS
Gastrostomy tube
Aspiration pneumonia
Gros ascites
Blod coagulation disorders
Esophageal varices
Enlarged liver or spleen
Had previous gastric surgery
 NGT
ASSESSMENT
Medical history
History of nasal surgery or deviated
septum
Nutritional status
Any existing chronic illness
Nares patency/discharge/irritation
Mental status/ ability to cooperate
Fluid intake and output
Allergies to any food
Presence of gag reflex
Digestive tract functioning
Kidney function/BUN/electrolytes
 ASSESSMENT
NGT
Hematocrit & urine specific gravity
Meds and therapies
Correct placement of tube
Bowel sounds
Diarrhea/constipation/flatulence
Presence of regurgitation and feelings of fullness
Lack of tolerance of previous feedings
Lactose intolerant
 G-TUBE
ASSESSMENT
Ability to adjust change in body image
Participation in self-care
Psychological status of pt/ & family
Skin condition
Fluid & nutritional needs
Signs of malnutrition
Weight, Fluid intake and output
Urine spec gravity, acetone & glucose in urine
Lactose intolerant
Proper maintenance of tube
Presence of bowel sounds
Problems that suggest lack of tolerance of previous
feedings
Regurgitation and feelings of fullness
Insertion of NGT
 NGT Feeding
Correct & type of amount of solution
60 mL catheter tip syringe
Emesis basin
Clean gloves
pH test strip meter
Water at room temperature
Large syringe/calibrated plastic feeding bag with
label/prefilled bottle with a drip chamber
Measuring container
Feeding bag
PROCEDURE &
NURSING CARE
 NGT insertion
Gather equipments
Introduce self, verify client’s identity
Explain purpose and importance of procedure
Establish a method of communication
Assess nares
Position client, provide privacy
Place towel on chest
Observe infection control measures
Determine size of tube by measuring length
Wear gloves, lubricate 4 inches of the tip of the tube
Insert tube, tell pt to hyperextend neck, swallow and
drink water
If tube meets resistance, withdraw and insert it into
another nostril. Do not force against resistance. Stop if
pt experience respiratory distress
Pass tube until length is inserted
Determine correct placement of the tube
For optional-attach to suction as ordered
Remove gloves, dispose contaminated materials
Wash hands
Ensure comfort and safety. Place call light within
reach
Document- type of tube inserted, date and time
inserted, color and amount of gastric contents, client’
tolerance.
Provide daily nasogastric care
Evaluate client comfort and tolerance
Administering NGT Feeding
Check expiration date of feeding. Feeding formula in
room temperature.
Assess proper placement of tube
Assess residual feedings and reinstill gastric contents
back
Clean top of feeding
Connect syringe to a clamped tube.
Add feeding to the syringe barrel
Allow feeding to flow in slowly
Ensure client comfort and safety
Ask client to remain sitting for at least 30 min.
Dispose equipment or wash reusable. Change
Gastrostomy Tube Insertion & Feeding
Gather equipments
Introduce self, verify client, explain procedure and its
importance
Provide privacy, observe infection control measures
Insertion:
Wear gloves, remove dressing
Discard dressing & gloves, apply new gloves
Lubricate end of tube
Insert it into the ostomy opening
Check location and patency of the tube
Assess residual
Hold barrel of syringe 3-6 in. above ostomy opening
Slowly pour solution into the syringe, allow to flow by
gravity
Add 30 mL of water to flush tube
Ensure comfort and safety of client
Ask to remain sitting atleast 30 min.
Assess status of peristomal skin
Check orders about cleaning the peristomal skin
Observe for complications
When appropriate, teach client how to administer
feedings and when to notify hcp
Evaluate effectiveness of feeding
 COMPLICATIONS
Nosebleed Diarrhea
Sinusitis Constipation
sore throat Nausea and vomiting
Esophageal erosion Gas/bloating/cramping
Pulmonary /Dumping syndrome
aspiration Aspiration pneumonia
Collapsed lung Tube displacement
Intracranial Tube obstruction
placement the tube Nasopharyngeal irritation
Hyperglycemia
Dehydration, azotemia
Thank you for listening!!!