Give Food via Nasogastric Tube

If you've been to a hospital and were able to visit the Intensive Care Unit (ICU), you will have noticed many patients with plastic rubber tubing from the nose. It is not something that you breathe in, it is one way of ensuring that a person is adequately nourished, when they cannot feed themselves.

The acronym NGT stands for Naso-Gastric Tube. It is so termed as the plastic tube passes from the nose (for naso) and gastric to indicate the stomach. From the nasal cavity it passes to the esophagus up to the stomach. Yes, it is intended for feeding.

Why do some people have it and some people don't?

Not all people who are confined to a hospital bed require an NGT-tube or naso-gastric tube. Most of the time, when a person is hospitalized, it is enough that he receives fluids intravenously. When he can eat and feed himself on his own, NGT is not required. Who then, requires it? Below are the situations where a person needs to have an NGT:

• People who have sustained serious physical injuries involving the neck and face. Serious physical injury involving the neck and face are not just painful. Depending on the degree of injury, their ability to swallow may have been compromised or feeding them the usual way will pose as danger. They may choke on the food, rendering them unconscious leaving the food lodged in the throat making it impossible to breathe.

• Individuals who are unconscious for a long time, commonly known as comatose. If you have watched the movie While You Were Sleeping, you can remember the main character, Jack, was unconscious for a long time. He fell on the railroad track and may have hit his head. You cannot force-feed someone who cannot swallow the food, even if the food has been mashed or processed, as there's no way of sending the food to the stomach without using a nasogastric tube.

• Adults or children who have had surgery and cannot swallow or have depressed swallowing reflex.
  
  Anesthesia, especially of the general type will make you sleep. This helps you go through a surgery without remembering the surgical procedure as well as depressing the pain sensors in your brain. It would not help anyone to undergo a surgery and have him remember it. It would be a traumatic experience, thus the use of anesthesia is needed.

Post surgery, your digestive system (the system responsible for processing the food you eat), may still be inactive or sluggish. In fact, when doctors expect that you may be asleep for quite some after the surgery, they insert the NG tube as a precaution - for feeding purposes.

A surgery that involves the face will naturally render your facial muscles either painful or not yet ready for mastication. Mastication is the process of chewing and grinding your food with the use of your mouth. Surgery involving the throat may also create a need for tube feeding.

• Those people whose breathing is assisted by a mechanical ventilator. A person whose breathing is assisted by a mechanical ventilator cannot put food in their mouth. The position of the mechanical ventilator will make it impossible to do so. In addition, it is common that a person who is breathing using a mechanical ventilator has a pair of lungs that are not capable of expanding on its own, thus eating the expected way will complicate the condition.
  
• Infants born prematurely. Infants who were born prematurely are not yet fully developed. You may find them attached to a mechanical ventilator. They cannot be nursed by their mother, as their swallowing reflexes are not yet active. Aside from this, they cannot suckle as effectively as a term infant.

Before the process of nasogastric feeding ensues, the doctor or a practiced health professional inserts the tube via the nose bypassing the throat going to the esophagus and into the stomach. It is secured with a balloon like-tip at the end of the tube where it touches the stomach. This prevents the tube from being pulled out by restless children or elderly or confused patients. The following are the items that one needs to prepare before starting the tube feeding: For Checking Proper Placement and Patency of the Naso-Gastric Tube

• Stethoscope
• Tongue Blade
• Penlight
• Tissue
• Asepto Syringe - this is a syringe that has a large bulb at the end
• Empty basin - for regurgitations that comes out from the tube and individual's mouth

• Feeding Formula - The feeding formula may range from a commercially provided formula to formulas prepared at home. During discharge, the doctor prescribes a list of food that can be processed or mashed using a blender. A nurse or a trained medical assistant will usually show you how to prepare the formula and explain how it is stored.

The formula is usually prepared for the day and refrigerated. Make sure to bring out the formula at least 15 minutes before feeding and warm it by soaking the bottle in warm water in a basin. It can also be heated using the microwave oven.

Make sure to ask the doctor or nurse if the formula already contains the prescribed medication. If it already has, heating it may destroy the effectiveness of the medication. You may ask to have a list of what to do if you find the procedure difficult to remember. You could also take down notes to make sure you don't forget anything.

• Medicine - It is also advisable to ask whether to give the oral medications via the NG tube right after the feeding or wait for some minutes before giving it.

• Water - Water for flushing the tube and food

Inform your client or your ward what you are about to do and what it is for. For conscious and coherent individuals, this first step usually doesn't have to be repeated every time, especially when they get used to it. However for elderly patients and children, it is advisable to start by telling them of what you are about to do. Doing so relieves their anxiety and will facilitate ease in accomplishing the procedure.

When the individual indicates that he understands, position your client in a semi-Fowler's position, as shown here and prepare to check proper placement of the nasogastric tube in the stomach and its patency. This is to ensure that you will not be putting food into the lungs. When this happens, aspiration may happen which may eventually put the individuals life in danger.

With the use of your penlight and tongue blade, check the person's mouth. Do not proceed if you see that part of the tube is coiled.

Secure the tip of the asepto syringe into the nasogastric port. Put on your stethoscope and place its diaphragm on the epigastric region. The epigastric region is where the stomach is located.

Carefully introduce 10cc of air into the tube. The tube is in its proper place when you hear a whooshing or gurgling sound. Another way to check is to aspirate gastric contents. The nurse or medical practitioner will explain this, and show you what to look for regarding the gastric contents, during the demonstration.

Do not push the aspirated gastric contents back to the tube. Instead, put it into the empty basin. Flush the asepto syringe with water and you can then start the actual feeding process.

• Open the bottle of feeding formula.
• Remove the bulb of the asepto syringe. You will now use the remaining part of the syringe as a funnel. While doing these, make sure that you have a part of the tube kinked so as to prevent air from entering the tube.
• Pour 30ml of water into the syringe (while you have the tube kinked) then release to flush the remaining contents on the tube.

• Slowly pour the prescribed feeding formula into the syringe afterwards. It is necessary to lift the tube slightly higher to increase the flow rate.
• Do not rush the feeding.

• If indicated, administer the oral medicine after the last amount of feeding has been poured.

When the prescribed amount of feeding and medication has been poured, follow it with another 30ml of water.

After the procedure, position your ward on his right side with his head slightly elevated. This is to prevent regurgitates from the esophagus.

• Try to insert a misplaced or coiled nasogastric tube.
• Forget to check patency and proper placement of the tube.
• Immerse the tip of the tube in a basin of water to check if its in the lungs. This may cause aspiration should the tube be in the lungs.
• Force contents into the tube when it doesn't go down.

It is always advisable to call a medical health professional should you encounter problems with a nasogastric feeding.

How to prepare NGT food?

NGT food is prepared by using a food processor or a blender. The amount of food is usually prescribed by the physician. For instance, the recommended food for an individual is oatmeal and banana. The doctor, in coordination with the dietitian, will provide accurate measurements of each food. You will then process this in a blender. In fact, before discharge from the hospital, a nurse or a dietitian will approach you and show you how it's done. You will get a pretty clear idea of the mixture's consistency before you use it for NGT feeding.

This is something you should really have your doctor help you with. They often times will prescribe certain foods for NGT patients. Here you can find a very common step by step instruction for preparing an NGT for a patient. http://www.makatimed.net.ph

When NGT feeding, how do I check tube place on epigastric?

There are two ways on how you can check if the tube is placed on epigastric when NGT feeding.

Get a barb syringe and flush the tube with air, then listen using a stethoscope for gurgling sound at the tummy.

You can also put the end of the tube in a basin of water, if it bubbles then it's in.

Usually how much formula will be given to those patients with stroke?

Specifically formula given every 4 hours? total of 6 feedings each day

Feeding should be done more often but in smaller quantities for stroke patients. This is because they are not capable of digesting food normally. Therefore, you need to space out the feeding in a way that their body will be able to cope with the slow digestion. Every 4 hours is just about right, but you have to see as well if the patient is showing some signs of bloating. If there is, you may want to do it every 5 hours instead.

Prepare Nasogastric Feeding Tube?

In order to properly prepare an NGT you should consult your physician for the proper instructions. If a physician is not available then there are many medical websites that you can consult for step by step instructions on preparing a feeding tube. Warning though, these sites do not replace proper instruction by a medical professional. For the most part there is not much preparation other than clearing the patients nose and lubricating the throat. For a more detailed step by step instruction check this http://www.makatimed.net.ph

Position to nurse patient in with nasogastric tube?

There is not a "best" position necessarily for NGT feeding. For the most part either sitting upright or a slightly reclined position will be the best. You just want to ensure the patient has the ability to swallow without much effort. The NGT usually goes far enough down into the throat that choking is not too much of a hazard, but its always good to be in an upright position when eating or drinking for proper digestion.

Where to place stethoscope for ng tube placement?

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Why are the water coming out from the stomach is so greenish?

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How can I know how much kcal for NGT in an easy way?

I don't have Height or Weight of the patient, so I need an easy way, only by age

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Hi, my daughter has a NG tube but was sick a few times when the energy multi fiber is given to her she is 5 years 9 months old?

Hi, my daughter has a NG tube but was sick a few times when the energy multi fiber is given to her she is 5 years 9 months old. I have tried: We have only placed the child milk b4 & was fine with that. I think it was caused by: I don't think she can take the energy multi fiber so I would like to know what other food can be given that way in her NG tube.

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what is the name of that powder food given to NGT feed patient?

powder food given to nasogastric tube-feed patient. I have tried: Google. I think it was caused by: ERROR

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What is the purpose of NGT? What are the precautions?

I want to know the purpose of NGT, and the precautions and the steps of giving NGT feeding

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When NGT becomes smelly, is its bad?

We have a week after we'll go back to the doctor. Now 4 days left but now the NGT smells not that good, is it bad? is it harmful?. I have tried: Feeding her since we went out of the hospital but the NGT never been replaced. I think it was caused by: Feeding of the NGT

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