Nasogastric Tube Feeding Procedure

Before commencing nasogastric feeding, determine the type amount, and frequency of feedings.

Purposes
- To restore or maintain nutritional status
- To administer medications

Equipment
- Correct amount of feeding solution
- Pacifier
- 20 to 50 mL syringe with an adapter
- Emesis basin
- Bulb syringe (for an intermittent feeding)
- Calibrated plastic feeding bag and a drip chamber, which can be attached to the tubing or
- Pre-filled bottle with a drip chamber, tubing, and a flow regulator clamp.
- Measuring container from which to power the feeding (if using bulb syringe)
- Water (60 ml unless other wise specified) at room temperature
- Feeding pump (optional)

Procedure/Intervention
1. Prepare the client and the feeding
- Explain the patient about the feeding
- Provide privacy
- Position the patient in Fowler’s position in bed or sitting position in a chair
- Position a small child or infant in your lap, and provide a pacifier during feeding

2. Assess tube placement. Attach the syringe to the open end of the tube, aspirate alimentary secretions. Check the PH.

3. Assess residual feeding contents
- Aspirate all the stomach contents, and measure the amount prior to administering the feeding. If 50 mL or more undigested formula is withdrawn in adults, or 10 ml
or more in infants, check with the nurse in charge before proceeding.
- Reinstill the gastric contents in to the stomach if this is the agency or physician’s practice. Remove the syringe bulb or plunger, and pour the gastric contents via the syringe in to the nasogastric tube.

4. Administer the feeding Before administering feeding:
a) Check the expiration date of the feeding
b) Warm the feeding to room temperature

Bulb syring
- Remove the bulb from the syringe, and connect the syringe to a pinched or clamed nasogastric tube
- Add feeding to the syringe barrel
- Permit the feeding to flow in slowly at the prescribed rate. Raise or lower the syringe to adjust the flow as needed. Pinch or clamp the tubing to stop the flow for a minute if the client experiences discomfort.

Feeding Bag
- Hang the bag from an infusion pole about 30 cm above the tube’s point of insertion in to the client
- Clamp the tubing, and add the formula to the bag, if it is not pre-filled.
- Open the damp, run the formula through the tubing, and reclamp the tube.
- Attach the bag to the nasogastric tube and regulate the drip by adjusting the clamp to drop factor on bag.

5. Rinse the feeding tube immediately before all the formula has run through the tubing:
- Instill 60 mL of water the feeding tube
- Be sure to add the water before the feeding solution has drained from the neck of a bulb syringe or from the tubing of an administration set. Before adding water to a feeding bag or prefilled tubing set, first clamp and disconnect both feeding and administration tubes.

6. Clamp and cover the feeding tube
- Clamp the feeding tube before all of the water is instilled
- Cover the end of the feeding tube with gauze held by an elastic band

7. Ensure client comfort and safety
- Pin the tubing to the clients gown
- Ask the client to remain sitting upright in Fowler’s position or in slightly elevated right lateral position for at least 30 minutes.

8. Dispose of equipment appropriately
- If the equipment is to be reused, wash with soap and water so that it is ready for reuse.
- Change the equipment every 24 hours or according to the agency’s policy.

9. Document all relevant information
- Document the feeding, including amount, and kind of solution taken, duration of feeding and assessment of client.
- Record the volume of the feeding and water administered on the client’s intake and out put record.

10. Monitor the client for possible problems:
- Carefully assess clients receiving tube feeding for problems
- To prevent dehydration, give the client supplemental water in addition to the prescribe tube feeding as ordered.