1. NURSING SKILLS
ENTERAL NUTRITION / NGT
Lecturer: Mark Fredderick R. Abejo RN,MAN
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NASOGASTRIC TUBE is inserted through one of the nostrils, down the nasopharynx and into the
alimentary canal
Fr. 12 , 36 inches NG tube Fr. 8 Opaque, 45 inches, stylet, weighted tip
Inserting a Nasogastric Tube
Purposes: Equipment
To administer tube feedings and medications to - Nasogastric Tube ( Levin Tube )
clients unable to eat by mouth or swallow a - Clean gloves
sufficient diet without aspirating foods or fluids - Water soluble lubricant
into the lungs (gastric gavage) - Non allergic adhesive tape
- Glass of water or drinking straw
To establish a means for suctioning stomach
- Asepto syringe
contents to prevent gastric distention, nausea
- Basin
and vomiting. (gastric lavage)
- Stethoscope
To remove stomach contents for laboratory
- pH test strip (optional)
analysis
- Facial tissue or cloth
To lavage (wash) the stomach in case of - Clamp or plug (optional)
poisoning or overdose of medications

2. Lecture Notes on Enteral Nutrition ( Nasogastric Tube )
Prepared By: Mark Fredderick R Abejo R.N, M.A.N
Clinical Instructor
Assessment: Mark this length with This length
Check the patency of nares and intactness of adhesive tape if the tube approximates the
nasal tissue: does not have markings. distance from the
nares to the
- Ask the client to hyperextend the head, using stomach
flashlight, observe the intactness of the tissue of Insert the tube
the nostrils.  Put on gloves
 Lubricate the tip with To reduce friction
- Ask the client to breath through one nostril while water-soluble lubricant.
occluding the other, select the nostril that has  Hyperextend the neck, Hyperextension of
greater airflow. gently advance the tube the neck reduces
toward the nasopharynx the curvature of the
Determine presence of gag reflex Note: nasopharyngeal
Ability to cooperate with the procedure If the tube meets resistance, junction.
withdraw it, relubricate it,
and insert to the other To prevent injury
Steps / Procedure Rationale nostril
Identify and inform
the client and explain To allay anxiety
the procedure.
Assist the client to a
high fowler’s It is often easier to
position if his/her swallow in this position
health condition and gravity helps the
permits, support head passage of tube
with pillow.
Measure the length NEX technique ( nose-
of NGT to be inserted ear-xiphoid)
 Tilt the client’s head Tilting the head
forward once the tube forward facilitates
reaches the throat and passage of tube into
ask the client to the esophagus
swallow or drink water rather than into
as the tube advances. larynx.
Swallowing moves
the epiglottis cover
the opening to the
larynx
 Pass the tube 5-10 cm
with each swallow,
until the indicated
length is inserted.
Checking the patency
 Aspirate stomach Testing pH is a
Measuring the appropriate length to insert the contents and check the reliable way to
NGT ( NEX technique ) pH, which should be determine location
acidic of a feeding tube.

3. Lecture Notes on Enteral Nutrition ( Nasogastric Tube )
Prepared By: Mark Fredderick R Abejo R.N, M.A.N
Clinical Instructor
 Introduce 10-30 ml of
Tape the tube to the area between the end
air into the NGT and Note:
of the nares and the upper lip as well as to the
auscultate at the Gastric contents
cheek.
epigastric area, gurgling must be re-instill to
sound is heard. the stomach to
 Ask the client to speak prevent electrolyte Administering Tube Feeding
or hum imbalances (NGT Feeding , Gastric Gavage)
 Observe the client for
coughing and choking Difficulty in Purposes:
speaking and client To restore or maintain nutritional status.
Note: is choking and To administer medications
The most accurate method continuously cough,
of assessing the placement tube is possibly in Equipment:
of NGT is X-ray study the lungs - Correct amount of feeding solution
- Asepto syringe
Secure the NGT by This prevents the - Measuring container or cup
tapping it to the bridge of tube from pressing - Emesis basis
the client’s nose. against and - Clean gloves
irritating the edge - Stethoscope
of the nostril - pH test strip (optional)
- Facial tissue or cloth
Special Considerations: - Water
 Inserting a NGT to Infants and Young Assessment:
Children: Assess for any signs of malnutrition or
dehydration.
Restraints may be necessary during tube Check for allergies to any food in the feeding.
insertion and throughout therapy. Restraints Assess for the presence of bowel sounds
will prevent accidental dislodging of the tube.
Note any problems that suggest lack of
Place the infant in an infant seat or tolerance of previous feedings (e.g delayed
position the infant with a rolled towel or gastric emptying, abdominal distention,
pillow under the head and shoulders. dumping syndrome, constipation or
dehydration)
When assessing the nares, obstruct one of
the infant’s and feel for air passage from the
Steps / Procedure Rationale
other. If the nasal passageway is very small or
is obstructed, an orogastric tube may be more Identify and inform
appropriate. the client and To allay anxiety
explain, why it is
Measure appropriate NGT length from the necessary and how
nose to the tip of the earlobe and then to the he/she can cooperate
point midway between the umbilicus and Assist the client to a
xiphoid process. fowler’s position in This positions enhance
If an orogastric tube is used, measure from bed or a sitting the gravitational flow of
the tip of the earlobe to the corner of the position in chair, if the solution and prevent
mouth to the xiphoid process. his/her health aspiration of fluid into
condition permits. the lungs
Do not hyperextend or hyperflex an Wash hands and
infant’s neck. Hyperextension or hyperflexion observe appropriate
of the neck could occlude the airway. infection control and
provide privacy

4. Lecture Notes on Enteral Nutrition ( Nasogastric Tube )
Prepared By: Mark Fredderick R Abejo R.N, M.A.N
Clinical Instructor
Check the patency of Through A Syringe
the tube: (open system)
- Aspirate stomach - Introduce feeding
contents and check the slowly To prevent flatulence,
pH, which should be - Height of feeding is cramps , and reflex
acidic 12 inches above the vomiting
point of insertion.
- Introduce 10-30 ml of - Instill 60- 100 ml of
air into the NGT and water to NGT after To cleanse the lumen of
auscultate at the the tube
epigastric area, gurgling - Clamp the cover of
sound is heard. the feeding before all To prevent leakage and
Assess residual water is instilled air from entering the
feeding contents. To tube.
assess absorption of Note:
the last feeding, if 50 Gastric contents must Ensure client comfort
ml or more, verify if be re-instill to the and safety :
the feeding will be stomach to prevent
given. electrolyte imbalances - Pin the tubing to the Minimizes pulling of the
client’s gown tube thus preventing
Note: discomfort
If the client is on
continuous feeding, - Ask the client to This facilitate digestion
check the gastric remain in position for at and prevent potential
residual 4-6 hours least 30 min. aspiration.
Administer the feeding Monitor patient for
 Check the feeding, Spoiled feeding cause possible problem and
time it was diarrhea and complications on
prepared, its abdominal pain to the tube feedings
expiration client. Make relevant
 Warm the feeding at Excessively cold documentation
room temperature feeding may cause
cramps Feeding Through a Syringe
Through A Feeding
Bag
- Hang the bag from an
infusion pole about 12
inches above the point
of insertion.
- Clamp the tubing and
add the formula to the
bag.
- Open the clamp, run
the formula to the tube,
to prevent instillation of
air to the client’s
stomach.
- Attach the bag to the
NGT and regulate the
drip.

5. Lecture Notes on Enteral Nutrition ( Nasogastric Tube )
Prepared By: Mark Fredderick R Abejo R.N, M.A.N
Clinical Instructor
Special Considerations: apparatus if connected
- Unpin the tube to the
 Administering a Tube Feeding to: client’s gown
Infants - Remove the adhesive
tape securing the tube
Feeding tubes may be reinserted at each to the nose
feeding to prevent irritation of the mucous Remove the Tube
membrane, nasal airway obstruction and  Wear gloves
stomach perforation.  (optional) Instill 50 This clears the tube of
Children ml of air into the any gastric contents
Position a small child or infant in your lap, tube
provide a pacifier, and hold and cuddle the  Ask the client to This closes glottis,
child during feedings. This promotes comfort, take deep breath preventing aspiration of
supports the normal sucking instinct of the and hold it gastric contents
infant and facilitates digestion  Pinch the tube with This prevent gastric
Elders he gloved hand contents inside the tube
 Quickly and from draining into the
Decreased gastric emptying may smoothly, withdraw clients throat
necessitate checking frequently fir gastric the tube.
residual.  Dispose the tube To prevent possible
Diarrhea from administering the feeding immediately transfer of
too fast or at too high concentration may cause microorganism
dehydration Provide oral care if
desired
If feeding has a high concentration of
Assist the client to To remove accumulated
glucose, assess hyperglycemia
blow the nose secretions
Document relevant
information
Removing a Nasogastric Tube
Equipment: Common Problems of Tube Feedings
- Disposable pad 1. Vomiting
- Clean gloves 2. Aspiration
- 50 ml syringe (optional) 3. Diarrhea
- Disposable bag 4. Constipation
5. Hyperglycemia
6. Abdominal Distention
Steps / Procedure Rationale
Confirm the
physician’s order.
Identify and inform
the client and explain To allay anxiety
the procedure.
Assist the client into
a sitting position if
health permits
Place the disposable To collect any spillage
pad across the of mucous and gastric
client’s chest secretions from the tube
Wash hands
Detach the tube:
- Disconnect to suction

6. Lecture Notes on Enteral Nutrition ( Nasogastric Tube )
Prepared By: Mark Fredderick R Abejo R.N, M.A.N
Clinical Instructor
After feeding, remain in sitting position or
Administering a Gastrostomy or slightly elevated right lateral position for at
least 30 mins. To prevent gastric reflux and
Jejunostomy Feeding possible aspiration.
Assess status of peristomal skin for signs and
symptoms of infection.
Gastrostomy Tube Feeding Make relevant documentation
Total Parenteral Nutrition (TPN)
Intravenous Hyperalimentation (IVH)
TPN or IVH, is provided when the
gastrointestinal tract is nonfunctional because of
an interruption in its continuity or because its
absorptive capacity is impaired.
Parenteral Nutrition, is administered
intravenously such as through a central venous
catheter into the superior vena cava.
Because TPN solutions are hypertonic
( highly concentrated in comparison to the solute
concentration of blood), they are injected only
into high – flow central veins, where they are
diluted by the client’s blood
Clients suggestive for TPN
Severe malnutrition
Severe burns
Procedure: Bowel disease disorders
Acute renal failure
Assess and prepare the client Hepatic failure
Insert a feeding tube into the ostomy opening Metastatic cancer
10-15 cm (4-6 inches) if one is not already in Major surgeries ( where NPO is taken for more
place. Lubricate with water soluble lubricant than 5 days)
before insertion to prevent friction.
Check the patency of a tube suture in place.
Pour 15-30 ml of water into the syringe and
allow water to flow into the tube.
Check the residual formula. If 50mls or more,
verify if the feeding will be administered.
Administer feeding slowly. Hold the syringe
7-15 cm (3-6 inches) above the ostomy opening.
To prevent flatulence, crampy pain and reflex
vomiting
Flush the tube with 30 ml. Flushing the tube
preserves its patency.