Essential Preparations Before You Begin
Before you begin any feeding session, proper preparation is essential to ensure safety, hygiene, and the patient's comfort. Gathering all necessary supplies and ensuring a clean environment are the first steps.
Supplies You Will Need
- Your patient's prescribed formula or liquid feed
- Clean 60mL enteral syringe (often with an ENFit connection)
- A smaller 5-10mL syringe for flushing or medication
- Lukewarm water for flushing
- Clean towels or cloth to protect the patient
- pH testing strips (if placement is not confirmed by X-ray)
- Prescribed medications, if needed
Patient Positioning and Hygiene
Proper positioning is critical to prevent aspiration and promote good digestion. The patient should be in a semi-Fowler's position, with their head and shoulders elevated at a 30- to 45-degree angle, and remain in this position for at least 30 to 60 minutes after the feeding is complete. Ensure your hands and all equipment are clean, as good hygiene prevents infection.
The Step-by-Step NG Tube Feeding Procedure
Following a precise procedure is vital for safe and effective feeding. Always check tube placement before administering anything.
Checking for Correct Placement
This step must be performed before every single feeding and medication administration to ensure the tube is still in the stomach and has not become dislodged into the lungs.
- Check the External Mark: Look at the mark on the NG tube where it exits the patient's nostril. This mark was made by a healthcare professional during insertion. Compare it to the original length to ensure it hasn't moved.
- Aspirate and Test pH: Connect a syringe to the NG tube and gently pull back to aspirate a small amount of stomach contents. The pH of this fluid should be 5.5 or lower, indicating it's safely in the stomach. Do not proceed if the pH is higher than 5.5, and contact a healthcare provider.
- Visual and Physical Assessment: Observe the patient for any signs of respiratory distress, such as coughing, choking, or difficulty breathing. The patient's verbal confirmation can also help ensure proper placement in conscious patients.
Administering the Feed
Once placement is confirmed, you can proceed with the feeding.
- Wash Hands: Perform hand hygiene again before handling the feed.
- Prepare Feed: Ensure the formula is at room temperature. Do not warm in a microwave, as this can cause uneven heating and potential burns.
- Flush: Flush the NG tube with 30mL of lukewarm water to clear it before feeding. Some protocols may specify 15mL, so always follow specific instructions.
- Administer Formula (Bolus Feeding): For a bolus feed, remove the plunger from the syringe and attach it to the NG tube. Pour the formula into the syringe, allowing it to flow in by gravity. Control the flow rate by raising or lowering the syringe. Refill the syringe as needed until the full amount is administered. A typical feed should take 15-20 minutes.
- Flush Again: After the formula is administered, flush the tube with another 30mL of water to prevent clogging.
- Secure: Clamp or cap the tube and secure it appropriately.
Post-Feeding Care and Hygiene
After feeding, maintain the patient's elevated position for at least 30 minutes. Perform mouth care by brushing teeth or using a swab, as the patient will not be eating orally. Clean the equipment with warm, soapy water and allow it to air dry.
Bolus vs. Continuous Feeding
The two primary methods of NG tube feeding are bolus and continuous. The choice depends on the patient's tolerance and clinical needs.
| Feature | Bolus Feeding | Continuous Feeding |
|---|---|---|
| Equipment | Syringe, warm water | Feeding pump, formula bag, IV pole |
| Delivery Method | Administered by gravity over 15-30 minutes, resembling meal times. | Administered by a pump at a constant, slow rate over a long period (up to 24 hours). |
| Schedule | Given several times a day, often 4-6 hours apart. | Runs continuously, day and/or night. |
| Patient Mobility | Offers freedom between feedings, allowing for more mobility and activity. | Limits mobility as the patient is connected to the pump for extended periods. |
| Gastrointestinal Symptoms | May increase the risk of bloating, cramping, and gastrointestinal symptoms due to larger volume at once. | Reduces the rate of gastrointestinal symptoms because smaller amounts are delivered over time. |
| Suitability | Often used for patients with good gastric emptying and better tolerance for larger fluid volumes. | Best for patients who cannot tolerate large volumes or are at risk of aspiration. |
Troubleshooting Common Issues
What to do if the NG tube clogs?
Prevention is key, so regular flushing with water is crucial. If a clog occurs, first check if the tube is kinked. If not, try flushing with warm water using a gentle push-pull motion with a 60mL syringe. If this doesn't work, wait 15 minutes, allowing the water to soak, and try again. If the clog persists, do not force anything; contact the healthcare provider. Never use sharp objects to clear a clog.
What if the patient vomits or gags?
Immediately stop the feeding. Position the patient on their side to prevent aspiration. If symptoms persist, stop the feed entirely and contact a healthcare professional. After the vomiting has stopped, re-check tube placement before attempting to restart the feed at a slower rate.
Conclusion
Feeding a patient with an NG tube requires careful attention to detail, adherence to established procedures, and constant vigilance. By following the steps outlined in this guide—from meticulous preparation and correct patient positioning to verifying tube placement and post-feeding care—you can significantly minimize risks and ensure the patient receives the proper nutrition and medication. For ongoing care and specific instructions, always follow the guidance of a healthcare professional. For additional resources on NG tube management, refer to the NHS Ayrshire and Arran guidelines.
