Definition: also known as gastric gavage; installation of especially prepared formula into the digestive tract through a tube that is inserted through one of the nostrils down to the alimentary tract.
Purpose:
- Prevent nausea, vomiting & gastric distention following surgery
- Remove stomach contents for laboratory analysis
- To lavage (wash) the stomach in cases of poisoning & overdose of medication
- To administer medication
- To administer supplemental fluid
- To provide feeding
Procedure:
A. Assess & Prepare the Client
1. Check the clients chart or confirm the physician’s order for NGT feeding, this is done for us to be sure that we are doing the right procedure to the right client/patient.
2. Assume handwashing..
3. Prepare the needed materials such as the correct amount of feeding solution as ordered by the physician, asepto syringe/bulb syringe, emesis basin/kidney basin, 60 to 80 ml of water, stethoscope & disposable pad.
4. After preparing the materials we are now ready to head to the clients room. Before entering knock on the door, greet the patient if he/she is conscious or significant other if the client is unconscious. Introduce self, ask the patient/client or significant others for any allergies if it is the first time to do the NGT feeding.
5. Provide privacy because NGT feeding is embarrassing to some people.
6. Assist client to a fowler’s position in bed or sitting position in a chair. – This position enhance the gravitational flow of the solution & prevent aspiration of fluid into the lungs.
7. Place a disposable pad on the area where you are working. – To prevent client’s gown from getting soiled or to avoid being messy.
8. Unpin the tube from under the pillow or from the client’s gown.
B. Assess the Patency of the Tubing
9. Inject 5-20 ml of air through the feeding tube while auscultating the left upper abdomen while listening to gurgling, whoosing & bubbling sound. If you hear gurgling, whoosing & bubbling sound we are now sure that the tube is patent.
C. Assess the Residual Feeding Contents
10. Aspirate all the stomach contents & measure the amount prior to administering the feeding. – This is done to evaluate the absorption of the last feeding. If >50 ml of undigested formula is withdrawn in adults & >10 ml in infants & its color is okey somewhat like yellow. Reinstill the gastric contents into the stomach. – Removal of contents disturb the clients electrolyte balance. If 50 ml or more of undigested formula is withdrawn in adults & 10 ml < in infants check w/ the nurse incharge before proceeding. The precise amout is usually determined by the Physician’s order or by Policy of the agency. At some agency it is withheld when the specified amount & more formula remains in the stomach. In other agencies, the amount withdrawn is subtracted from the total feeding & that volume is administered slowly. And feeding is also withheld if the color of the aspirated fluid is coffee ground. – There is bleeding in the stomach.
D. Administer the Feeding
11. Before administering the feeding add 20 ml of water. – To clean the tube & facilitate the smooth flow of the solution, be sure not to drain all the water.
12. When using the asepto syringe connect the syringe to a pinched or clamped nasogastric tube. – Prevent excess air from entering the stomach & causing distention.
13. Permit the feeding to flow slowly. 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. Quickly administered feedings can cause flatus, crampy pain & reflux vomiting.
E. Rinse the Feeding Tube Immediately before all the formula has run through the tubing.
14. Instill the feeding tube w/ 60ml of water. – Water cleans the lumen of the tube, preventing future blockage by sticky formula.
15. Be sure to add water before the syringe or tubing is empty. – Prevents the instillation of air into the stomach or intestine which causes unnecessary distention.
F. Clamp & Cover the Feeding Tube
16. Clamp the feeding tube before all of the water is instilled. – Prevents leakage & air from entering the tube if done before water is instilled.
G. Ensure Client Comfort & Safety
17. Pin the tubing to the client’s gown. – This minimizes pulling of the tube thus preventing discomfort & dislodgement.
18. Ask the client to remain sitting in Fowler’s position or in slightly elevated right lateral position for at least 30 minutes. – These position facilitate digestion & movement of the feeding from the stomach along the alimentary tract & prevent potential aspiration of the feeding into the lungs.
H. Thank the client for the cooperation & dispose equipment properly, if it is to be reused, wash it thoroughly with soap & water so that it is ready for reuse. Afterwards do handwashing & document relevant information, kind, duration of feeding. Assessment of the client & record the volume of the feeding & the water administered on the clients intake & output record & lastly, monitor client for possible problem.
Removing NGT
1. Confirm the physician’s order to remove the tube. Assume handwashing to reduce the number and transmission of microorganisms. Prepare the materials/equipment needed such as tissues, clean disposable gloves, disposable pad, disposable plastic bag & asepto syringe/bulb syringe. After preparing the equipment we are now ready to head on to the client’s room. Knock on the door before entering the room, greet the patient upon entering. Introduce yourself & verify the client’s identity by asking the client’s fullname.
2. Prepare the client. Explain that the procedure will not cause any discomfort. Assist the client to a sitting position if health permit’s. Place disposable pad across the client’s chest to collect any spillage of mucous. Provide tissue to the client to wipe the mouth & nose upon removal of the tube. Unpin the tube from the client’s gown. Remove adhesive tape securing the tube to the nose.
3. Remove the tube.
- Put on disposable gloves. – Gloves prevent soiling the hand & clothing when handling secretions & excretions.
- Instill 50 ml of air into the tube. – Air clears the lumen of any contents such as food & gastric drainage.
- Ask the client to take a deep breath & hold it. – This closes the glottis, thereby preventing accidental aspirations of any gastric contents.
- Pinch the tube. – Pinching prevents any contents inside the tube from draining into the clients throat.
- Quickly & smoothly withdraw the tube. Place the tube in the plastic bag. – Prevents the transfer of microorganisms from the tube.
4. Ensure client’s comfort. Assist the client as required to blow the nose. – Excessive secretions may have accumulated in the nasal passages. Provide mouthwash. Thank the client for cooperation.
5. Dispose all the equipment appropriately. Place the pad, bag with the tube & gloves in the receptacle designated by the agency. – Correct disposal prevents the transmission of microorganisms.
6. Do handwashing & document relevant information. Record the removal of the tube & any relevant assessment of the client.
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