tube feeding care
tube feeding care
the nursing care and management of a patient receiving nourishment through a nasogastric tube.
method The tip of a nasogastric tube is lubricated with a water-soluble lubricant, inserted into a nostril, and rapidly advanced into the stomach as the patient, if conscious, is asked to swallow hard repeatedly. Correct placement of the tube may be best determined by x-rays. Placement also may be checked, although not as reliably, by listening for a bubbling sound through a stethoscope placed over the stomach as 5 mL of air is injected into the tube. The pH of secretions may also be checked. If the patient coughs forcefully when 1 or 2 mL of water is injected into the tube, it is placed in the upper respiratory tract rather than the stomach. The tube, held securely and comfortably by a tape across the nose or upper lip, may be left in place in adults and older children but usually is removed and reinserted for each feeding in infants. Before each feeding the patient is helped up to a semi-Fowler's position or is turned on the right side and elevated slightly if unconscious. If a cuffed tracheostomy tube or endotracheal tube is in place, the cuff is inflated. The nasogastric tube is checked for proper placement and for the amount of residual formula in the stomach. Any solid medication to be given with the feeding is dissolved in water. The normal liquefied diet formula contains a mixture of milk, eggs, sugar, skim milk powder, and protein hydrolysates. A low-residue formula consists of amino acids, sugars, vitamins, and minerals. Blue food coloring can be added to the formula to help detect aspirations by distinguishing gastric contents from respiratory secretions. Depending on the patient's preference, the formula is at or below room temperature when administered slowly by gravity at a rate of no more than 300 mL an hour. During feeding the patient is observed for respiratory distress, nausea, vomiting, abdominal cramps, and restlessness. At the completion of the procedure, the tube is flushed with water as ordered and then clamped. The patient receives oral hygiene and lubrication and cleaning of the nares and is maintained in the same position for 30 minutes after feeding. At that time, the cuff on the tracheostomy or endotracheal tube is deflated.
interventions The nurse positions the patient for feeding, checks the tube placement, notes and replaces the amount of residual formula, and reports residual volume in excess of 100 mL, or 75% of the previous feeding. Bags and tubing need to be changed per institutional protocol to prevent bacterial growth. The nurse administers the feeding, ensures that the patient and family members understand the purpose of the procedure, and cautions the patient to report symptoms such as nausea, abdominal cramps, diarrhea, or constipation.
outcome criteria A formula containing the proper proportions of protein, carbohydrate, and fat administered through a nasogastric tube can provide adequate nutrition over a short term. A high content of simple sugars may cause diarrhea. Concentrated mixtures containing too little water or large volumes administered rapidly may dehydrate the patient. See also nasogastric intubation.