4.Position client with the head of bead elevated at least 30 degrees angel or as near normal position for eating as possible.
Rationale: Minimize possibility of aspiration into trachea.
5.Unpin tube from client’s gown and check to see that the gastric tube is properly located in the stomach.
Rationale: Even when initially positioned correctly, a gastric tube left in place can become dislodged between feedings. The instillation of water or nourishment could lead to serious respiratory problems if a gastric tube is in the trachea or a bronchus, rather than in a stomach.
6.Aspirate all gastric contents with syringe and measure. Return immediately through tube and proceed with feeding if amount of residual does not exceed policy of agency or physician’s guidelines. Disconnect syringe from tubing.
Rationale: This indicate gastric emptying time. A residual of more than 50% of the previous hour’s intake is significant and must be reported to physician. Fluid should be returned to stomach so as not to cause any fluid or electrolytes losses.
7.When using Asepto sringe or Toomey syringe:
a.Remove plunger or bulb from syringe and attach syringe to nasogastric tube which has been pinched with finger and introduce the prescribed amount slowly.
Rationale: The syringe acts to receive the nourishment. Introducing the nourishment slowly gives the stomach time to accommodate the fluid and decreases gastrointestinal distress.
b.Hold the syringe approximately 12 inches above the stomach. Allow solution to run in by gravity. Raise the syringe to increase the rate of flow, and lower the syringe to decrease the rate of flow.
Rationale: Nourishment enters the stomach by gravity when gastric gavage is used.
c.Do not let the syringe empty while introducing the nourishment.
Rationale: This technique prevents air from being forced into the stomach when the syringe is refilled.
d.Introduce 30ml – 60mL (1 oz – 2 oz) of water into the tube after the nourishment is introduced.
Rationale: Washing the gastric tube with water forces remaining nourishment in the tube into the stomach and prevents nourishment from adhering to the tube and souring.
e.Clamp the gastric tube immediately after nourishment and water are instilled. Disconnect the syringe and cover end of tubing with gauze secured with rubber band.
Rationale: Clamping the tube prevents nourishment from draining back into the tube and air from entering the stomach. Cover on end of the tube deters entry of microorganisms and protects client and linens form any fluid leakage from tube.
8.When using a feeding bag:
a.Hang bag on IV pole and adjust to about 12 inches above the stomach. Clamp tubing and pour formula into the bag. Release clamp enough to allow formula to run through tubing. Close clamp.
Rationale: Formula displaces air in the tubing
b.Attach tubing to nasogastric tube, open clamp and regulate drip according to physician’s order.
Rationale: Introducing the formula at a slow, regular rate allow the stomach to accommodate the feeding and decreases gastrointestinal distress.
c.Add 30 ml – 60 ml (1 oz – 2 oz) of water to feeding bag when feeding is almost completed and allow to run through tube.
Rationale: Water rinse the feeding from the tube and helps to keep it patent.
d.Clamp the tubing immediately after water has been instilled. Disconnect from nasogastric tube and cover gauze secured with a rubber bad.
Rationale: Clamping the tube prevents air from entering the stomach. Cover on end of nasogastric tube deters entry of microorganisms and protects client and linens from any fluid leakage from tube.