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Tube Feeding (Gastric Gavage)

Gavage (gastric) feeding is an artificial method of giving fluids and nutrients through a tube, that
has passed into the oesophagus and stomach through the nose, mouth or through the opening
made on the abdominal wall, when oral intake is inadequate or impossible.
Indications for Tube Feeding
 When the client is unable to take food by mouth. For example, unconscious,
semiconscious and delirious clients.
 For a client who refuses food, e.g. client with psychosis.
 When condition of mouth oroesophagus make the swallowing difficult or impossible. For
example, fracture of the jaw, repair of the cleft palate and cleft lips,surgery of the mouth,
throat and oesophagus, paralysis of face and throat, stricture of the oesophagus.
 When the client is too weak to swallow food or when the conditions make it difficult to
take a large amount of food orally, example acute and chronic infection, sever burns,
terminal malignancy, malnutrition and prematurity.
 When the client is unable to retain the food, example- anorexia nervosa and vomiting.
Advantages of tube feeding
 An adequate amount of all types of nutrients including distasteful foods and medication
can be supplied.
 Large amount of fluids can be given with safety.
 The dangers of parenteral feeding ( eg venous thrombosis) are avoided.
 Tube feeding may be continued for weeks without any danger to the client.
 The stomach may be aspirated at any time if desired.
 Overloading of the stomach can be prevented by a drip method.
Principle involved in the NGtube feeding
Principle Action and explanation
Tube feeding is a process of Feeding can be given with a
giving liquid nutrition or nasogastric tube – a tube that is
medications through a tube into passed through the nose and
the stomach when the oral intake esophagus; so that the food may
is inadequate or impossible. reach the stomach and it is
called nasal feeding.
A thorough knowledge of the There are many pouches in the
anatomy and physiology of the respiratory and digestive tract
digestive tract and respiratory where the tube may remain
tract , ensures safe induction of kinked. E.g. nasal cavity, oral
the tube( avoid misplacement of cavity etc. Therefore, it is
the tube). necessary to pass the tube along
the curve of the digestive tract.

General Instructions
 Tube feeding is given only by a doctor’s order.
 If the client is conscious, explain the procedure and reassure the client to win his
confidence and cooperation.
 Remove the dentures if any, to prevent it from dislodging and blocking the respiratory
tract.
 A rubber tube may be placed in a bowel of ice to cool and stiffen.
 Lubricate the tube with a suitable lubricant preferably with a water soluble jelly. If
mineral oils (glycerin, liquid paraffin) are used, it should be applied to the tube to the
minimum with a paper square. Adrop of mineral oil, if dropped into the respiratory
passage acts as a foreign body because it is not absorbed by the lung tissue.
 If the tube is dipped in a liquid or lubricant before the insertion, make sure that the blind
end is not left filled with the fluid or lubricant, because this may drop into the larynx and
strangulate the client.
 All equipment used for feeding should be clean. The food has to be prepared, handled
and stored under “hygienic conditions” because many organisms enter the body through
the food and drink.
 Every time before giving the feed, make sure that the tube is in the stomach by aspirating
a small quantity of (5 to 10 ml) stomach contents.
 While removing the tube, pinch the tube and pull it out gently and quickly so that the
fluid may not trickle down the trachea.
 During the introduction of the tube, never use force as it may cause injury to the mucus
membrane.
 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.
 Restraints used if any, should be limited to the minimum. For infants and irrational
clients, some from of restraints may be necessary, but they should not feel that they are
punished.
 Feeding may be given at intervals of 2,3 or 4 hours and the amount is not exceeding 150
to 300 ml per feed. The total amount in 24 hours varies between 2000 and 3000 ml. If
drip method is used, the speed of flow should not exceed 30 to 60 ml per minute. This
minimizes the distension, nausea, regurgitation and excessive peristalsis usually
associated with too much and too rapid administration.
 Intake and output is recorded accurately.
 Watch for complications such as nausea, vomiting, distension, in diarrhoea, aspiration
pneumonia, asphyxia, fever, water and electrolyte imbalance. The water andelectrolyte
imbalance may be reflected in changes in the skin, thirst,vital signs, intake and output,
level of consciousness, body weight, moisture of the mucus membrane and serum
analysis.If the dehydration is not corrected, it may result in high fever, disorientation,
drying of the mucus membrane etc.
 Clients receiving tube feeding should receive frequent mouth care to prevent
complications of a neglected mouth.
Nurse’s Responsibility in Administering a Tube Feeding
Preliminary Assessment
 Identify the client with name, bed no., O.P. No., etc.
 Check the doctor’s orders for any specific precautions if any, regarding the tube feeding,
movement of the client, positioning of the client etc.
 Check the level of consciousness and the ability to follow directions.
 Check the ability for self care, ability to move and to maintain a desired position during
the insertion of the tube.
 Check whether the feed is ready at hand.
 Check the articles available in the client’s unit.
Preparation of the Articles

Preparation of the Client of the Unit


 Explain the procedure to the client, if the client is conscious, to gain his confidence and
cooperation.
 Explain the sequence of procedure and explain how the client can cooperate with you.
 Provide privacy.
 Provide a safe and comfortable position for the client. If the general condition of the
client permits, make the client sit on the chair or place him in a Fowler’s position. If the
general condition is weak, raise the head with extra pillows.
 Place the mackintosh and face towel across the chest and under the chin to protect the
garments and the bed linen.
 Allow the client to adjust the kidney tray according to his convenience or keep the kidney
tray next to the client ready to use if he vomits.
 Remove the dentures, if any, and place it in a bowl of clean water.
 Arrange the articles conveniently on the bedside locker.
 Give a monthwash and help him to clean the teeth.
 Clean the nostrils, if there is secretion or crust formation, using swab stick dipped in
saline or soda-bicarbsolution.
Procedure
After Care of the Client and Articles
 Offer a mouthwash. Clean the face and hands and dry them .
 Remove the mackintosh and towel.
 Make theclient comfortable in bed.
 In case of unconscious or seriously ill clients, apply suction if secretion are collected in
the mouth.
 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.
 Wash hands.
 Record the time, date, amount of feed, the nature of the feed, the reaction of the client if
any, in the nurse’s record as well as in the intake and output chart.
 Remove the tube when the tube feeding is to be stopped.
Tube feeding may be necessary for several days. There are several steps involved in the removal
of the nasogastric tube. 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 the client’s
skin. Clean the face with soap and water. Give the oral and nasal hygiene.
Take the tube to the duty room. If it is a re-usable tube clean it in cold water first and then with
warm soapy solutions. Pushing water several times through the lumen of the tube clean the tube
well. Boil it, dry it and replace it in its proper place (see the chapter on care of the rubber tubes).
Record the time the tube was removed, on the nurse’s record.