Administering Nutrition Through an NG Tube
The primary use of an NG tube is for enteral nutrition when a patient cannot consume sufficient calories orally. There are several types of nutritional formulas available, each suited for different patient needs.
Types of Enteral Formulas
- Polymeric formulas: These are the most common and are suitable for patients with normal or near-normal digestive function. They contain a mix of carbohydrates, proteins, and fats in their whole form and come in various energy and fiber contents.
- Elemental formulas: Composed of predigested proteins (amino acids) and carbohydrates, these are used for patients who have difficulty with digestion and absorption. They are typically more expensive than polymeric feeds.
- Disease-specific formulas: These are tailored for patients with specific conditions, such as renal or hepatic failure, and are used primarily in intensive care settings.
- Blenderized foods: In some cases, and with a healthcare provider's approval, whole foods can be blended into a liquid consistency for tube feeding. An industrial-strength blender is recommended for this. This approach requires careful monitoring to ensure proper nutritional content and prevent tube blockages.
Feeding Schedules and Administration
Feeding schedules vary based on the patient's condition. Bolus feeding involves giving larger volumes several times a day, mimicking meal times, and is common with stomach placement. Continuous feeding administers smaller, constant amounts over longer periods, often via a pump, and is preferred for tubes terminating in the small intestine.
Administering Medications Through an NG Tube
Medications given via an NG tube require careful preparation to prevent clogs and ensure proper absorption. Liquid formulations are always preferred, but some tablets and capsules can be adapted.
Preparing and Administering Medications
- Check with a pharmacist: Always confirm if a medication can be administered via an NG tube. Some forms, like enteric-coated, sustained-release (SR), extended-release (XL), or modified-release (MR), must never be crushed.
- Crush and dissolve tablets: Only crush tablets approved by a pharmacist. Tablets should be crushed into a fine powder and dissolved completely in warm water before administration.
- Open capsules: Most capsules can be opened, and the powder or granules inside mixed with water. Follow specific guidelines, as some granules should not be crushed.
- Use a syringe: Administer medications one at a time using a syringe with the plunger removed, allowing gravity to assist.
- Flush between meds: Flush with 10-15 mL of water between each medication to prevent interactions and tube occlusion.
- Final flush: Follow the last dose with a larger flush (30-60 mL) of water.
Table: Comparison of NG Tube Feedings and Medication
| Feature | Enteral Formulas (Feeding) | Medications | Water (Flushing) |
|---|---|---|---|
| Purpose | Provide complete nutritional support | Treat or manage medical conditions | Maintain tube patency and hydrate |
| Consistency | Liquid (polymeric, elemental) or blenderized | Liquid, dissolved powders, or dispersed granules | Liquid |
| Preparation | Follow manufacturer instructions or blend carefully | Confirm with pharmacist; crush/dissolve as approved | Use sterile or cooled boiled water |
| Administration | Bolus (meals) or continuous (pump) | Administered one at a time via syringe | Before and after feeding/meds |
| Frequency | As prescribed by a healthcare provider | As prescribed by a healthcare provider | Before/after feeds and medications; regularly throughout the day |
| Precautions | Ensure formula is at room temperature to prevent cramping | Never crush extended/enteric-release; flush between doses | Use gentle pressure; never force a flush |
Maintaining Patency with Flushing and Hydration
Proper flushing is the cornerstone of NG tube care. Regular flushing prevents clogs from forming due to formula residue or medication particles.
- Flush frequency: The tube should be flushed with water before and after each feeding, before and after every medication, and every four hours if continuous feeding is running.
- Flush volume: For most adults, a 30 mL water flush is standard, but check with a healthcare provider for specific recommendations.
- Flush technique: Use gentle, steady pressure with a syringe. If resistance is met, do not force it. Gentle push-pull actions or allowing the water to 'soak' can sometimes dislodge minor clogs, but significant blockages require professional help.
What to Never Put Through an NG Tube
Not all substances are suitable for administration via an NG tube. Certain actions and materials can cause serious harm to the patient or damage the tube.
- Whole or improperly crushed pills: Large, undissolved medication fragments will quickly clog the narrow tube.
- Modified or extended-release medications: These are designed to release medication slowly over time and must never be crushed. Crushing them can lead to an unsafe, immediate overdose.
- Feeding formulas not designed for tubes: Thick, unprepared foods or dietary supplements not specifically formulated for enteral use should not be administered, as they can cause tube blockages.
- Medications that cannot be crushed: A pharmacist will confirm which medications should not be crushed due to their formulation or risk of drug interactions when mixed.
- Forcing a flush: Excessive force can rupture the tube and cause patient injury.
Conclusion
Safe and effective use of an NG tube requires a clear understanding of what can be administered and what to avoid. By properly preparing liquid nutrition and medications, flushing the tube regularly with water, and adhering to strict safety protocols, healthcare providers and caregivers can minimize risks. Always consult with a healthcare professional to establish the correct regimen for nutrition, medication, and flushing, ensuring the best possible care for the patient. For reliable, patient-centered resources, consider reviewing reputable sources like the Cleveland Clinic.
