naso gastric feeding

1. NASO GASTRIC FEEDING
SUBMITTED TO : Ms. Rajlaxmi, Tutor,
Rufaida College of Nursing,
Jamia Hamdard
SUBMITTED BY: Ms. Arushi Negi ,
M.Sc. Nursing Ist year

2. INTRODUCTION
Gastric gavage feeding is an artificial
method of giving fluids and nutrients
through a tube, that has passed into the
esophagus and stomach through the
nose, mouth or through the opening
made on the abdominal wall, when oral
intake is inadequate or impossible.

3. DEFINITION:
Tube feeding is a process of giving liquid nutrients or
medications through a tube into the stomach when the oral
intake is inadequate or impossible
Feeding can be given with a nasogastric tube ,orogastric tube
(esophageal feeding) and a gastrostomy tube (through a tube or
catheter which is introduced into the stomach through the
abdominal wall and is called Gastrostomy feeding (gastro=
stomach, ostomy = making an opening into).

5. WHAT COULD BE
THE
INDICATIONS
FOR GASTRIC
GAVAGE?

6. INDICATIONS FOR GASTRIC GAVAGE
• Unable to take food by mouth- unconscious patient
• Who refuses food- psychosis patient
• When swallowing is difficult or impossible, e.g.fracture
of the jaw,
• When patient weak to swallow food - infections, burns,
malnutrition
• When patient is unable to retain the food - anorexia
nervosa, vomiting

7. WHAT ARE THE
ADVANTAGES
FOR GASTRIC
GAVAGE?

8. ADVANTAGES OF TUBE FEEDING
• Adequate amount of all types of nutrients and
medications can be supplied.
• Large amount of fluids can be given.
• Dangers of parenteral feeding (e.g., venous thrombosis)
are avoided.
• Can be continued for 6 weeks without any danger.
• Overloading of the stomach can be prevented by a drip
method (Pediatric set ).

9. PRINCIPLES OF GASTRIC GAVAGE
Knowledge of the anatomy and physiology of the digestive tract ensures safe
induction of the tube.
The length of the tube should correspond to the length of the digestive tract
It is about 10 to 12 inches.(25-30 cm)
Aspiration of the gastric juice
All equipment used for feeding should be clean.
The nurse should wash her hands thoroughly before preparing the feeds and
feeding the client. Provide frequent mouth care to patient.

10. Mental and
physical
preparation of
the client
Explain the
procedure to
the client to
win the
confidence
and
cooperation.
Swallowing
the saliva on
command
facilitates the
downward
movement of
the tube.
Placing the
client in a
Fowler's
position or in
a sitting
position with
the head
inclined
forward
Systematic
ways of
working
Place the
client in a
comfortable
position.

11. Check the tube
for patency.
Prepare the
client
physically and
mentally for the
tube feeding.
Assemble and
arrange articles
before starting
the procedure.
Protect the
personal
clothing and
the bed linen.
Apply lubricant
for the easy
insertion of the
tube.

12. Insert the tube
gently but
quickly in a
backward and
downward
direction.
Do not use any
force.
Do not use
excessive
amount of oil
for lubrication.
Every time
before giving
the feed make
sure that the
tube is in the
stomach.
Rinse the tube
with plainwater
at the end of
the feeding to
wash of any
feed left in the
tube.
Accurate
recording.

13. DIFFERENTIATING THE PLACEMENT
DIGESTIVE
TRACT
During insertion
client will
experience no
distress in
breathing.
Client will have no
difficulty in talking
Listen to the distal
end of the tube. No
noise will be heard
except a gurgling
sound
RESPIRATORY
TRACT
Client may
experience
dyspnoea, violent
cough and cyanosis
The client will not be
able to talk, if the
tube has passed
through the vocal
cord.
A whistling sound is
heard, If the tube is
in the respiratory
tract.

14. DIFFERENTIATING THE PLACEMENT .....
DIGESTIVE
TRACT
Attach the distal end of the
tube to a syringe barrel and
invert it into a glass of
water. A few bubbles
initially or no bubbles
Attach a syringe to the
distal end of the tube and
aspirate. Some gastric fluid
may be withdrawn.
Listen over the stomach
with a stethoscope while
injecting a small quantity
(10 ml) of air into the tube.
Air can beheard entering
the stomach.
RESPIRATORY
TRACT
A steady stream of air
bubbles
No fluid will be withdrawn
the tube
No sound will be heard.

15. GENERAL INSTRUCTIONS
Tube feeding is given only
after doctor's prescription
If patient is conscious,
explain the procedure
Remove the dentures, if any
Lubricate the tube with water
soluble jelly.
All equipment used for
feeding should be clean.

16. Every time before giving the feed, make sure
that the tube is in the stomach by aspirating a
small quantity
Feedings may be given at interval of 2,3 or 4
hours and the amount should not exceed 150-
300 ml/feed.The total amount in 24 hours
varies between 2000 to 3000 ml. in adults.
Intake and output is recorded
Watch for complications as nausea, vomiting,
distension, diarrhea, aspiration
pneumonia,asphyxia, fever and water &
electrolyte imbalance

17. • For adults
12 to 16 Fr.
Levin tube
can be used

18. Prevent air entry into the tube
Keep suction apparatus ready
Avoid introducing air into the stomach
during each food.
Expel the air from the tube by lowering
the tube below the level of the stomach.
Pinch the tube before the fluid run into
the stomach completely from the tube.

19. ARTICLES REQUIRED
A tray containing:
1. Sterile Levine tube or Ryle's tube preferably in a bowl of ice
2. Lubricant such as water soluble jelly or glycerine and liquid paraffin
3. Cotton swab sticks
4. Adhesive plaster and scissors
5. Gauze pieces in a bowl
6. Paper bag and Kidney tray.
7. Clean syringe 10 ml size for testing the location.
8. Clean syringe of 20 ml to 50 ml size to give feed
9. A glass of feed in a bowl of warm water
10. Ounce glass/feeding cup
11. A bowl with water
12. Clamp, mackintosh and towel, stethoscope, a face towel
13. Suction apparatus
Screen

20. PROCEDURE
1. Explain the procedure to the patient to gain his confidence
2. Bring all the articles at the bed side
3. Provide privacy
4. Provide a safe and comfortable position for the patient. If general
condition of the patient permits, make the patient sit on the chair or place
him in a Fowler's position.
If the general condition is weak, raise the head with extra pillows.
5. Place the mackintosh and towel across the chest and under the chin to
protect the garments and the bed linen.
6. Remove dentures, if any
7. Clean the nostrils with water soaked swab sticks
8. Wash hands

21. 9. Take the tube and check whether it is in good order
10. Measure the distance on the tube from
(a) bridge of the nose to the umbilicus,
(b) bridge of the nose to the ear lobe and then from ear lobe to
xiphoid process.
Make the distance on thetube with a small strip of adhesive
plaster.
11. Apply lubricant on the tip of the tube with a gauze piece for
about 6 to 8 inches. Lubricant should be minimum.

22. 12. Introduce the tip into the nostril, pass the tube gently but quickly backwards and
downwards.
13. When the tube reaches the pharynx the patient may gag. Allow him to take rest for
amoment. Have patient take sips of water and swallow on command. Advance the tube
3 to 4inches each time patient swallows continue the same until the designated mark. If
patient chokes, coughs or develops dyspnea immediately withdraw the tube.
14. Check the placement of the tube in the stomach by any one of the following
methods:Aspirate for gastric contents with a syringePlace the end of the tube with a
syringe barrel or funnel into a bowl of water and note therhythm of escaping bubble.Ask
the patient to hum or speak. If the tube is in trachea, patient will not be able to
speak.Introduce 5 to 10ml air with a syringe and hear for the sound with a stethoscope,
over theepigastric region.

23. 15. Once it is confirmed that the tube is in place, tape it to the side of the face and wait
for sometime before giving the feed.
16. Measure the feed in ounce glass. The feed can be given by two methods.
Syringe method: Give the feed through the barrel of the syringe or a funnel. While
giving the feed, do not let air enter the tube. Before the air can enter either pour more
feed or pinch the tube.
Siphon method: lower the feed container. Dip the end of Ryle's tube into this
container.Raise the container above the patient's shoulder level. The feed will
continuously go through the tube.
17. When the feed is finished pour a little warm water to remove the fat getting
deposited and then clamp the tube firmly to prevent leakage.

24. • 18. Clean the face and dry it
• 19. Remove mackintosh and towel
• 20. Make the patient comfortable in bed
• 21. Discard the wastes and clean the articles with soap and
water. Dry them, Replace them intotheir proper places
• 22. Wash hands and record the time, amount of feed, the nature
of the feed, the reaction of thepatient, if any, in the nurse's
record as well as in the intake and output chart.
• 23. Remove the tube when the tube feeding is to be stopped

25. GASTROSTOMY/
JEJUNOSTOMY
FEEDING

27. GASTROSTOMY/ JEJUNOSTOMY FEEDING
DEFINITION:
Gastrostomy feeding is the feeding of a patient through the
gastrostomy opening.
A gastrostomy is permanent or temporary opening into the
stomach through the abdominal wall through which a feeding tube
( a self-retaining catheter) can be passed so that food may be
introduced as high up in the alimentary tract as possible.

28. ARTICLES REQUIRED
A tray containing the following articles:
1. Liquid food in a container for feeding (in a bowl of warm water)
2. A sterile glass barrel or glass funnel
3. A rubber tubing and glass connection to be attached to the glass funnel
or barrel and a clamp
4. Small gauze pieces in a bowl
5. A glass of water
6. Mackintosh and towel
7. Kidney tray and paper bag
8. Sterile paraffin or zinc oxide ointment
Screen

30. 1. Explain the procedure to
the patient
2. Maintain privacy with the
screen
3. Give patient a comfortable
position
4. Wash hands and proceed
as follows
5. Place the mackintosh and
treatment towel around the
gastrostomy tube and watch
the surrounding skin. Clean
the site and apply Vaseline if
needed.
6.Connect the rubber tubing
with the funnel or the barrel.
Attach the rubber tubing with
gastrostomy tube by means
of a glass connection.

31. 7. Pour small amount of water
to test patency of the tube and
open the clamp.
8. Pour the feed slowly
9. Talk to the patient, making
the meal time as pleasant as
possible
10. Introduce a small amount
of water after the feed.
Disconnect the apparatus from
the gastrostomy tube and
cover the free end of the
gastrostomy tube with a piece
of gauze piece clamping it.
11. As the gastric contents are
very irritating to the skin, apply
a little sterile liquid paraffin or
Vaseline around the opening
before and after the feed. Make
the patient comfortable.
12. Clean and clear away the
articles. Record the time,
nature and amount of feed
given mentioning all significant
observations made.

32. SPECIAL POINTS TO REMEMBER
1. The patient should be
encouraged to chew a little
fruit( apple, pear or
pineapple) as he often
suffers from thirst and
dryness of the mouth. This
enhances the appetite and
gives certain amount of
satisfaction to the patient
2. Sterile dressing may be
applied on the skin around
the tube if necessary
3. The gastrostomy tube
should only be replaced by
a doctor if it becomes
loose.
4.The feeds given should
always be sterile and easily
digestible till the wound is
healed. A balanced diet with
a daily calorie value of 2500
to 3000ml for an adult.

33. 5. For
permanent
gastrostomy,
articles and
feed should
be clean
6. Do not hold
the tube very
high. Height
should not be
more than 5
to 6 inches.
7. The patient
should
frequent
mouth care to
prevent oral
infection.

34. NURSE’S RESPONSIBILITIES
Preliminary Assessment
1. Identify the client with name, bed no., O.P. No., etc.
2. check the doctor's orders for any specific precautions if any, regarding
the tube feeding,movement of the client, positioning of the client etc.
3. Check the level of consciousness and the ability to follow directions.
4.Check, the abilly for self care, ability to move and to maintaina desired
position during the insertion of the tube.
5. Check whether the feed is ready at hand.
6. Check the articles available in the client's unit
7. preparation of articles

35. 8. Preparation of the
Client and the Unit
• 1.Explain the procedure to the
client, If the client isconscious, to
gain his confidence and
cooperation.
• 2.Explain the sequence of
procedure and explain how
theclient can cooperate with you.
After Care of the Client and Articles
• 1. Offer a mouthwash. Clean the face and hands and dry them
• 2. Remove the mackintosh and towel.
• 3. Make the client comfortable in bed.
• 4.Incase of unconscious or seriously ill clients, apply suction if secretions are
collected in the mouth.
• 5. take all articles to the utility room. Discard the wastes and clean the articles
with soap and water. Dry them. Replace them into their proper places.
• 6. Wash hands.
• 7. Record the time ,date amount of feed, the nature of the feed, the reaction of
client if any, in the nurse’s record as well as intake and output chart.

36. REMOVAL OF TUBE :
 Tube feeding may be necessary for several days.
 Protect the garments with a towel placed under the chin
 Remove the tape that was used to fix the tube in position.
 Clamp the tube firmly to prevent the fluid within the tube from escaping and being
aspirated by the client. Instruct the client to take a deep breath and exhale slowly to
relax the pharynx.
 While the client exhales, pull out the tube with one continuous and moderately rapid
motion.
 Place the tube in the kidney tray to take It to the utility room.
 Use a small amount of ether solution to remove the adhesive markings from
theclient's skin.
 Clean. the face with soap and water. Give the oral and nasal hygiene.
 Record the time the tube was removed, on the nurse's record.

37. WHAT ARE
THE VARIOUS
DIETS IN
HOSPITAL ?

38. VARIOUS DIETS IN HOSPITAL :
Cardiac DietThe cardiac (heart) diet is low in fat and salt. Less than 30 percent of the
calories in this diet come from fat. Onecan have egg substitutes and low-fat meats. Fried
foods and caffeine are not allowed.
Clear Liquid DietOn this diet, foods that are liquid at room temperatureare given . These
foods will leave little or no residue after digestion. Physician may order this diet before
some tests and before or after some surgeries.e.g- water, fruit juices without pulp.
Diabetic DietThe diabetic diet is a low-fat diet that will vary in calorie level based on your
age, size, and activity level. It limits carbohydrates, protein and fat. It will have no
concentrated sweets. Sugar substitutes are allowed.
Full Liquid DietThe full liquid diet is used when you have problems with chewing,
swallowing or digesting solid food. This diet is often ordered when you are going from a
clear liquid diet to solid foods.
High Fiber DietA high fiber diet can be very helpful with certain health problems. It helps
to relieve constipation and helps reduce hemorrhoids. For a high-fiber diet, eat more fresh
fruits and vegetables each day. Eat more whole grains, nuts, beans and peas. Drink at least
eight glasses of water every day.

39. • Lactose-Free DietThis diet avoids milk or milk products and lactose. This includes
milk, ice cream, sherbet, yogurt and frozen yogurt, cookies, pies, cakes, or pastries
made with milk, butter or margarine containing milk, or milk products.
• Low Fat/Low Cholesterol DietThis diet lowers the total fat in the diet to 50 grams
per day. Eat less fat, oils, butter and margarine. Fried foods are not allowed. Do not
eat fatty meats, whole milk products, rich desserts, sweetened breads and pastries.
Eat egg substitutes and low-fat meats.
• Low ProteinThis diet will restrict the amount of meat, milk, starches and starchy
vegetables that you eat per day. It ranges from 20 grams to 60 grams of protein.
• Low Sodium DietThe low sodium (salt) diet limits salt to 2 grams of salt or 2000 mg
of salt per day. Foods will be prepared without added salt.
• Pureed DietThe pureed diet is used for patients who have trouble chewing or
swallowing. Solid foods are changed to the consistency of mashed potatoes. This diet
should decrease the amount of chewing and help foods be swallowed more easily

40. • .Regular DietFor good health, it contains many types of foods
with moderate levels of salt, fat and sugar. A supply of milk,
juice, cereal and crackers are also available on the patient care
unit. If you need a small snack between meals, check with your
nurse.
• Renal DietThe renal diet limits potassium, salt, phosphorus,
protein and sometimes fluid
• .Soft DietsSoft/Bland A regular Soft Diet is ordered for you if
you need foods that are easy to digest and are mild in
seasoning. This diet gives a variety of healthy foods that have
only a moderate amount of fat and fiber and do not contain
caffeine.

41. DIABETIC DIET

43. RENAL DIET

45. CARDIAC DIET

48. SUMMARY
Through this topic we came to know about gastric
gavage , its indications, advantages, principles
method of placement, general instructions,
procedure, nurses responsibilities, and gastrostomy
feeding.

49. CONCLUSION
Gavage (gastric) feeding is an artificial method of
givingfluids and nutrients through a tube, that has passed
into theesophagus and stomach through the nose, mouth or
throughthe opening made on the abdominal wall, when
oral intake isinadequate or impossible.

50. Bibliography
Nancy Sr, Stephanie’s Principles and Practices of
nursing , 6thedition, 2014, N.R publishing house,
page no- 398 to 410.
Nursing procedure manual, Rufaida college of
nursing, Jamia Hamdard, pg no -102-106