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General Care of the Patients

Tube Feeding

Not yet clinically reviewed

This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.

Indications

  1. Unconscious patients
  2. Patients who refuse foods
  3. Patients with nasal regurgitation
  4. Patients with dysphagia
  5. Patients too sick and unable to take oral feeds.

Equipment Nasogastric tube—usually plastic and available in presterilized packs—about 60 cm long.

Method

  1. Expel the water if any from the tube and check the patency. Water in the tube may dribble into the trachea.
  2. Measure the length of the tube from the bridge of the nose to the ear lobe and from there to the tip of the xiphisternum which is the appropriate length of the tube to reach the stomach. Keep the patient in a semi recumbent position.
  3. Lubricate with minimum amount of jelly—if excessive, may dribble into the trachea.
  4. Introduce the tip into the nostril and pass it backwards and downwards along the floor of the nasal cavity to reach the nasopharynx.
  5. If resistance is felt, flex the head, withdraw one inch, rotate the tubes side to side and gently advance to the pharynx.
  6. The patient may gag, allow him to rest and ask to take panting breath to relax the pharynx.
  7. Then ask the patient to swallow and advance the tube gently, till it reaches the designated mark.
  8. Check the placement of the tube in the stomach by:
  • Aspiration of gastric contents which is acidic. Entry of air into the stomach heard with the aid of stethoscope when 10 ml of air is injected rapidly into the tube. This indicates that the tube is in the stomach.
  • Dyspnea, cough and cyanosis while introducing the tube, inability to talk, whistling sound heard at the distal end of the tube, steady stream of air bubbles when the tip immersed into a glass of water (Caution: water may be sucked in while doing this procedure) are the indications that the tube has entered into the trachea.

​9. Tape it to the side of the face.

​10. Keep the tube closed when not in use to prevent the gastric contents being siphoned out.

Precautions

All equipment should be clean.

  • Each time before feeding, ensure that the tube is in the stomach by aspirating the gastric contents.
  • Rinse the tube with plain water at the end of feeding to wash off any feed left in the tube.
  • While removing the tube, pinch the tube and pull it out gently and quickly section-by-section at the end of each swallowing so that fluid may not trickle from the tube into the trachea.
  • Remove the dentures before intubation.
  • Avoid introducing air into the stomach, do not inject the feeds through the tube. Allow the feeds to go into the stomach by the effect of gravity only.
  • Expel any air in the tube by keeping it below the level of the stomach.
  • Total amount of feed varies from 200–3000 ml per day, not exceeding 150–300 ml per feed.
  • Rapid feeding may cause rapid stomach distention and nausea and regurgitation.
  • Feeds should be at 38° C or at around body temperature.
  • Food should be nutritious and in liquid form containing rice water, vegetable soup, milk, egg, cream, glucose or readymade tinned food.
  • The tube should be changed every 7 days.