RT Feeding

RYLES TUBE FEEDING/ NG FEEDING
INTRODUCTION:
 Patients in the hospital, as well as home care settings, often require nutritional
supplementation with enteral feeding.
 Enteral feeding can be administered via nasogastric, Naso-duodenal and Naso- jejunal
means.
 The focus of this clinical practice guideline is on the nursing management of nasogastric
tube feeding.
 Nasogastric tube feeding may be accompanied by complications. Thus, it is important for
the practitioner to be aware of how to prevent it.
DEFINITION:
Administration of feed directly into the stomach through the nose(nasogastric) or
mouth(orogastric).
PURPOSES:
 To provide adequate nourishment to patients who cannot feed themselves.
 To administer medication.
 To provide nourishment to patients who cannot be feed through mouth, e.g. surgery in
oral cavity, unconscious or coma state.
INDICATIONS:
1. Head and neck injury
2. Coma
3. Obstruction of esophagus or oropharynx
4. Severe anorexia nervosa
5. Recurrent episodes of aspiration
6. Increased metabolic needs burns, cancer, etc.
7. Poor oral intake
ARTICLES:
1. Formula feed
2. Graduated container
3. Large syringe (30-60 ml)
4. Water in a container
5. Stethoscope
6. Kidney tray
7. Towel and mackintosh
8. Clean gloves
PROCEDURE:
BEFORE PROCEDURE:
1. Identify patient and explain procedure to patient and that feeding will take around 10 to
20 minutes to complete. Also explain that patient will experience a feeling of fullness
after feeding. Proper explanation allays anxiety and ensures cooperation. Explanations to
be given to patients who are comatose or unconscious as they may hear and perceive the
instructions.
2. Assess for food allergies, time of last feed, bowel sounds, and laboratory values. Proper
assessment will prevent risk of complications.
3. Place container with feed in warm water. Warms the fluid to be fed.
4. Assist patient to fowler’s position (35 to 45 degree). Fowler’s position enhances
gravitational flow of feed through tube and prevents risk of aspiration.
DURING PROCEDURE:
5. Wash hands. Reduces risk of transmission of microorganisms
6. Spread towel and mackintosh over the patient’s chest, Reduces risk of transmission of
microorganisms.
7. Don gloves and attach syringe to nasogastric tube. Pinch tube while attaching the syringe
to the tube. Pinching of the tube prevents air from entering the tube.
8. Aspirate stomach contents. If there is doubt about tube placement inform physician and
obtain an order for X-ray. If residual gastric contents exceed 100ml for intermittent tube
feedings or greater than 1.5 times the hourly rate for continuous feeding, withhold feed
and notify physician.
9. Also assess the aspirant for visual characters.
Visual characteristics of feeding tube aspirates:

Gastric: May be grassy green with sediment, brown (if blood is present and has been acted upon
by gastric acid). May also appear clear and colorless (often with shreds of off-white to tan mucus
or sediment).
Intestinal: Generally, more transparent than gastric aspirants and may appear bile-stained
ranging in color from light to dark golden yellow or brownish green.
Respiratory: Tracheobronchial secretions may consist of off-white to tan sediment.
Assessing the aspirants for visual characters provides information about

placement of tube.
10. If residual contents are within limits and placement of tube is confirmed, return gastric
contents to stomach through syringe using gravity to regulate flow. Returning gastric
contents to stomach prevents fluid and electrolyte imbalance.
11. If tube placement is confirmed in stomach, pinch the feeding tube and attach barrel of
feeding syringe to tube. Pinching of feeding tube prevents air from entering the s stomach
and causing distention.
12. Fill Syringe barrel with water and allow fluid to flow by gravity, raising the barrel above
the level of the patient’s head. Water clears the tube and the rate of flow is regulated by
raising or lowering the syringe.
13. Pour feed into syringe barrel and allow it to flow by gravity. Keep on pouring
feed/formula to barrel when it is three quarters empty. Pinch tube whenever necessary to
stop when pouring. Prevents air from entering tube.
14. After feeding the patient flush the tube with at least 30cc of water. Prevents clogging of
tube.
15. After tube is clear close end of the feeding tube while pinching the tube. Prevents
leakage. Pinching prevents air entry.
16. Rinse equipment with warm water and dry. Prevents bacterial growth.
17. Keep head of bed elevated for 30 to 60 minutes after feeding. Prevents aspiration.
AFTER PROCEDURE:
18. Wash hands. Reduces the risk of transmission of microorganisms.
19. Document type and amount of feeding, amount of water given, and tolerance of feed.
20. Monitor for breath sounds, bowel sounds, gastric distension, diarrhea, constipation and
intake and output. Evaluates for aspiration effects on gastrointestinal system and
therapeutic effects of feeding.
21. Instruct the patient to notify nurse if he experiences a sensation of fullness, nausea and
vomiting. Indicates intolerance of feed.
SPECIAL CONSIDERATIONS:
1. Intermittent/continuous feeding of solution from an intravenous (IV) pole and adjusting
the rate of administration by flow regulators are done in some situations.
2. Siphon method can be used to administer clear fluids. This is done by immersing the tip
of the tube in the feed, taking care to avoid air entering into it and then raising the
container 12 inches above the patients head and observing the flow of fluids.
3. Change the nasogastric tube according to institution policy.
4. Change the articles every 24 hours or according to institution policy.
REFERENCE:
1. Jacob Annamma, “Clinical Nursing Procedures: The art of Nursing Practice, 2020, 4
edition, Jaypee Publications.
2. CMC Vellore Procedure manual
3. Perry Potter, Fundamentals of Nursing, 2017,2nd South Asia Edition, Elsevier.
4. https://www.slideshare.net/murlirups/nasogastric-tube-insertion-and-feeding

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RYLES TUBE FEEDING/ NG FEEDING

Visual characteristics of feeding tube aspirates:

Assessing the aspirants for visual characters provides information about

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