Procedure of NG Tube Feedings

Procedure of NG Tube Feedings

■ Confirm placement prior to using: (1) using a 20-mL syringe, inject a 20-mL bolus of air into the feeding tube while auscultating the abdomen. Loud gurgling indicates proper placement. DO NOT attempt this with water! (2) Use a 20-mL syringe and gently aspirate gastric content. Dip litmus paper into gastric aspirate a pH of 1–3 suggests proper placement.

■ Maintenance: Flush with 30 mL of water every 4 to 6 hours and before and after administering tube feedings, checking for residuals, and administering medications.

■ Medication: Dilute liquid medications with 20–30 mL of water. Obtain all medications in liquid form. If liquid form is not available, check with pharmacy to see if medication can be crushed. Administer each medication separately and flush with 5–10 mL of water between each medication. Do not mix medications with feeding formula!

■ Residuals: Check before bolus feeding, administration of medication, or every 4 hours for continuous feeding. Hold feeding if greater than 100 mL and recheck in 1 hour. If residuals are still high after 1 hour, notify physician.

Types of Tube Feedings
■ Initial tube feedings: Advance as tolerated by 10–25 mL/hour every 8–12 hours until goal rate is reached.
■ Intermittent feedings: Infusions of 200–400 mL of enteral formulas several times per day infused over a 30-minute period.
■ Continuous feedings: Feedings that are initiated over 24 hours with the use of an infusion pump.

Checking Residuals
■ Using a 60-mL syringe, withdraw from the gastric feeding tube any residual formula that may remain in the stomach.
■ The volume of this formula is noted, and if it is greater than a predetermined amount the stomach is not emptying properly and the next feeding dose is withheld.
■ This process can indicate gastroparesis and intolerance to the advancement to a higher volume of formula.