I. Definition:
In this method of feeding, liquid is introduced into the stomach through a rubber catheter which is passed through the anterior and posterior nose and the pharynx into the esophagus. When forced feeding is necessary, this method is less exhausting as the mouth does not have to be forced or kept open.
II. Therapeutic Uses:
1. When a patient is weakened and cannot swallow food.
2. Sometimes in the operation of the mouth such as carcinoma of the tongue, a cleft palate or fracture of the jaw etc.
3. In the operation of the throat and sometimes after tracheotomy.
4. In tetanus or meningitis with a locked jaw.
5. In forced feeding for irrational and violet patients.
6. In very weak patient who cannot swallow food very well.
III. Equipment:
Tray with:
· Medium size rubber catheter
· Sterile (No.2 French catheter for adult)
· Sterile glass syringe or a small glass funnel attached
· O.S
· Kidney basin
· Dressing rubber
· Draw sheet
· Lubricant
· A flask containing the nourishment ordered at temperature of 104 to 105°F
IV. Procedure
· Food consists of any liquid for which will readily pass through the tube.
· The temperature should be warm, not hot, as the lining of the nose is much sensitive than that of the mouth.
· The danger of burning the patient is greater when feeding by this method
1. The position of the patient may be lying down with the head turned to one side or sitting up with the head titled forward. An Infant should lie across knees of the nurse with head turned away from the nurse.
2. Expel the air and lubricate the tube.
3. Insert the curve thru the nose and backward inward the septum. Instruct the patient to make motion of swallowing till about 3 inches of the catheter is introduced.
4. Tell patient to open the mouth and look if the catheter has passed if patient coughs, wait before moving down the catheter.
5. Introduce 6 to 8 inches. Wait until the patient is accustomed to the presence of the tube.
6. Connect the funnel to the catheter; then pour the liquid slowly at the sides. Raise 3 to 4 inches above the nostril and release food slowly.
7. Wait for a few minutes then pinch the tube and withdraw. In some cases the tube is left and hold in place by adhesive.
VI. Precautionary Measures While Doing the Nasal Gavage
The following precautions should be strictly observe during a nasal gavage:
1. The catheter should first be lubricated and in inserting it should be directed toward the septum of the nose. If there is difficulty in passing it, the tube should be removed and inserted again in the other nostril.
2. As the catheter is small, there is considerable danger of its passing into the larynx therefore the patients color and breathing should be observed closely before pouring in the solution which if the tube should be in the larynx would down the patient.
3. Even a small amount of food in the lungs would cause a severe irritation, and dyspnea and if, allowed to remain (that is if not cough up) would decompose and probably lead to a lung abscess or septic pneumonia, if the tube is in the trachea a whistling sound will be heard when the funnel is hold to ear, while if in the esophagus probably a gurgling sound will be heard.
4. As the tube is soft it may become coiled upon itself in the mouth or in the throat. If the fluid, is poured in while the tube is in this position it will cause gagging, checking and gasping. And will almost certainly enter the larynx causing dyspnea, cyanosis and later a possible abscess and septic pneumonia. Look in the mouth or pass the finger to the back of the throat to seal the tube is in position.
5. Before pouring in the solution, wait until the patient is at rest, until all distress has subsided and normal breathing is established and to make sure that the tube is in the esophagus.
6. Pour in only few drops at first, then pour the balance in very slowly, if there are not symptoms of checking
7. After all the fluid has left the funnel, pinch the catheter and quickly withdraw.
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h. Tubes may attached to suction and left in place for several days
i. Offer the client frequent oral hygiene, if possible offer hard candy or gum to reduce thirst
j. Removal of the tube depends on the relief of the intestinal obstruction
k. May be removed by gradual pulling back (4-6 inches per hour) and eventual removal via the nose or mouth
l. May be allowed to progress through the intestines and expelled via the rectum.
How to Insert a Nasogastric (NG) Tube
· Check physician’s order.
· Check client’s identaband and if able have client state name.
· Discuss procedure to client.
· Provide privacy.
· Gather equipment.
· Position client at 45 degree angle or higher with head elevated.
· Wash hands and don clean gloves.
· Provide regular oral and nasal hygiene.
· Remove gloves and wash hands.
· Position client for comfort.
· Document procedure.
