NGT powerpoint.pptx

8/14/2019 NGT powerpoint.pptx

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NASOGASTRIC

TUBE FEEDING


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TOTAL ENTERAL NUTRITION (TEN)

A type of nutrition provided when a client is unable to ingest foods or the upper GIT is

impaired and the transport of food to the small intestine is interrupted.

TOTAL PARENTERAL NUTRITION (TPN) via blood vessel

UPPER GIT mouth LOWER GIT small intestine

esophagus large intestine

stomach anus

TYPES OF ENTERAL FEEDING

1. Nasogastric Tube (NGT)

2. Gastrostomy Tube

3. Jejunostomy Tube

NGT is a type of enteral feeding where tube is inserted through on of the nostrils down the

nasopharynx and into the alimentary tract.

Infants & newborns are not allowed to use NGT because they are obligatory nose

breathers.


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PURPOSES:

1. To administer tube feeding & medication to clients who areunable to eat by mouth, or swallow a sufficient diet without

aspirating foods or fluids into the lungs.

2. To remove stomach contents for laboratory analysis.

3. To prevent nausea & vomiting, gastric distention followingsurgery.

4. To lavage the stomach in case of poisoning or overdose of

medication.


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ASSESSMENT OF CLIENTS FOR TUBE FEEDING

1. Any signs of malnutrition & dehydration (ex. Paralyzed pt.)

2. Check for allergies to any food to the feeding solution (ex. Iodine content ofseafoods)

3. Check for the presence of bowel sounds.

BORBORYGMUS

4. Note any problems that suggest the lack of tolerance of previous feedings.

Examples: delayed gastric emptying

abdominal distention

dumping syndrome

constipation/ dehydration

4-5 hours interval of feeding

Add 30ml water after feeding to rinse the tube & lubricate the food given.


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PLANNING

Before a tube feeding, determine the type,amount & frequency of tube feeding and

intolerance of previous feedings


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INSERTINGN SOG STRIC

TUBE


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PROCEDURE 5 4 3 2 1 Remarks

1. Check the Physicians order for the insertion of

NGT.

2. Prepare/Assemble all equipment and bring

them to bedside.

Nasogastric tube (F 8 or 18)

Asepto bulb syringe

Stethoscope

Small basin with ice and sterile water or warm

water

Water soluble lubricant

Sterile gloves

Mouth wipes

Waterproof pad/rubber

Plaster Penlight

Tongue depressor

Towel

3. Perform hand washing.

4. Explain the procedure to the client.


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5. Prepare and place the rubber tubing in a basin

with sterile water and ice/plastic tube in a basin

with warm water for at least 15 minutes.

6. Place client in sitting or semi-fowlers position.Place water proof pad and towel on the clients

chest.

7. Prepare lubricant. Wear sterile gloves.

8. Measure NEX by placing the tip of the tube in

the clients nostril then stretch to earlobe and tothe tip of the xiphoid process to measure the

length of insertion. Mark the length with a tape.

9. Lubricate the tube with water- soluble lubricant.

Instruct the client to lift his head and insert tube

through the nostril.

10. When the tube reaches the pharynx. Instruct

client to swallow. Follow the downward-backward

stroke in inserting the NG tube white the client

swallows. Stop the insertion if the client begins to

gag.


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11. Discontinue the procedure if the client

becomes cyanotic, starts to cough continuously,

gasps for air or become unable to speak. Continue

insertions if none of the aforementioned

manifestations are observed.

12. Check the location of the tube with a penlight

and tongue depressor if the client starts to gag or

cough. In case there is resistance, slowly rotate the

tube while advancing it. Continue inserting until

the marking is reached.

13. Determine if the tube is in the stomach.

Introduce a small amount of air and auscultate

for sound (borborygmic) in the stomach region)

Aspirate fluid from the stomach check for the

character of pH of the fluid (pH 4 or less in

normal and it indicates that fluid is coming from

the stomach). (Smith,2005)

14. Clamp the tube or apply the cover. Secure the

tubes with a plaster/tape on the clients cheek and

attach it to the clients gown with a tape or safety

pin.


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15. If the tube will be used as suction

(lavage), connect tubing to the suction

device.

16. Place the client in a comfortable

position. If desired, assist the client in

gargling. Wipe secretions from clients

nose/mouth if theres any.

17. Wash dry all non-disposable equipment

and return them to their proper place.

Discard all disposable equipment.

18. Remove gloves and perform hand

washing.

19. Document the time of insertion,

description of gastric content and clients

response to the procedure.


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N SOG STRICTUBE FEEDING


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1. Check the physicians order for the

type, amount and frequency of tube

feeding.

2. Prepare all the equipments:

Tube feeding prepared at room

temperature

Asepto syringe/large syringe

pH strip meter

Water at room temperature

Container for measuring the

residual gastric content

Stethoscope

3. Perfume hand washing.

4. Explain the procedure to the

client.


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5. Elevate the bed of the client to a 30o

angle if possible.

6. Check the expiration date, character,

and odor of the prepared feeding

solution.

7. Check if the tube is properly located.

Introduce a small amount of air,

auscultate for sound in the stomach.

Attach the syringe to the end of thetube and aspirate a small amount of

gastric content to measure the pH.

If the tube is in the stomach, aspirate

all gastric contents with a syringe.

Measure and return the contents

immediately through the tube (id this

is agency policy as per doctors order)

Continue feeding if the residual

feeding is less than 100 ml; refer if

100 ml or more is withdrawn.


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8. Always guard the free-end of the tube

against air entry.

9. Connect the syringe barrel to the free-

end of the tube. Slightly elevate the

barrel.10. Pour the prescribed amount of the

tube feeding solution.

11. Add 30 ml of water before the end of

feeding. Rinse the lumen of the tube.

12. Disconnect the syringe from the tubeand close the clamp.

13. Instruct the client to remain in that

position for at least 30 minutes after

feeding.

14. Observe the clients response tofeeding.

15. Wash all dry equipment and return

them to their proper places.

16. Wash hands.

17. Record time, amount of feeding andthe clients response to feeding.


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IRRIG TINGN SOG STRIC

TUBE


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1. Check the physicians order for

irrigation identify client.

2. Prepare all equipments:

Disposable gloves

NSS for irrigation

Stethoscope

Asepto syringe

Disposable pad/bath towel

Measuring container

3. Perform hand washing. Wear

gloves.

4. Explain the procedure.


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5. Assist the client in assuming a semi-fowlers

position if indicated. Place disposable pad or

bath towel at clients chest.

6. Check placement of the NG tubing.

Aspirate fluid if from the stomach, check for

the character of the pH of the fluid (pH 4 or

less)

Introduce a small amount of air and

auscultate for sound in the stomach region.

7. Place the tip of Asepto syringe into the tube.

Hold the syringe upright.

8. Hold the Asepto syringe upright and pour 30

ml of normal saline solution (or the amount

ordered by the physician) and allow the solution

to flow because of gravity.

9. If unable to irrigate the tube, reposition the

client, try to irrigate again. If after repeated

attempts the irrigation still fails, refer to

physician.


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10. Aspirate the fluid using Asepto

syringe, or reconnect the tube to the

suction. Observe the movement of the

solution.

11. Measure the amount aspirated.

12. Clean equipment and discard all

disposable articles according to agency

policy.

13. Remove glove and do hand

washing.

14. Record the date, time of the

irrigation, the description of the

drainage, the clients response.


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