Gastric Gavage

OR
Enteral: Naso/Orogastric
Gastrostomy
Mrs .Jenifer kaliso
Tutor
INTRODUCTION:-
Gastric Gavage is a means of
supplying nutritional substance via a small plastic
tube direct to the stomach. This post will help you
understand on how to perform feeding via gastric
gavage.

DEFINITION:-
Gastric gavage is an artificial method of
giving fluids and nutrients through a tube that has
been passed into the oesophagus and stomach
through the nose, mouth or through an opening
made on the abdominal wall.
TYPES OF GASTRIC GAVAGE:-
Gastric gavage
may be divided as follows, based on the route of
insertion and method of administration.

ROUTE OF INSERTION:-
 Nasogastric tube feeding:- A tube is
passed through the nose and oesophagus into
the stomach. It is also called nasal feeding.
Oro-Gastric Feeding:- A tube is passed
through the mouth and oesophagus. So the food
reaches the stomach.
Nasogastric Feeding

Orogastric Feeding

Gastostomy Feeding
Gastrostomy Tube feeding:-
Giving a liquid diet
through a tube or catheter, which is introduced into
the stomach through the abdominal wall, is called
gastrostomy feeding ( gastro = stomach, ostomy =
making an opening into).

Methods of Administration:-
 Continuous Feeding Method:- Used for
critically ill clients. Continuous drip-feeding helps to
minimize cramping, nausea and diarrhoea; the gravity
flow or fluid by an infusion pump is used at the rate of
50ml/hr.
Intermittent Feeding Method:-
Feeding given
periodically. Each time 400ml over 30 minutes
duration and four to five times a day by the drip
method.

Bolus Feeding Method:-

Pour a prescribed
amount of fluid (250-400ml) slowly into the barrel
of a syringe or funnel attached to the end of the
tube. The fluid flows by gravity into the stomach.
Indications of Gastric Gavage:-

Gastrointestinal diseases and surgery.

Hypermetabolic states (burns, multiple trauma,
sepsis, cancer).
Certain neurologic disorders (stroke and coma).
Following certain types of surgery (head and neck,
esophagus).
When the patient is unable to ingest, chew, or swallow
food but is still able to digest and absorb nutrients, a
tube feed is indicated e.g. unconcious and semi
conscious patient etc.
When the patient is too weak to swallow food or when
the conditions make it difficult to take a large amount
of food orally e.g. acute or chronic infection, sever
burns, malnutrition and prematurity.
When the patient is unable to retain food e.g.;
vomiting , anorexia nervosa,etc.
For the patient who refuses food e.g. patient with
depression.
Contra-indication:-
Gastric surgery- Gastric bypass is surgery that helps to
lose weight by changing stomach and small intestine
handle the food. After the surgery, stomach will be
smaller. Patient feels full with less food.
Tracheo Oesophageal fistula- Tracheoesophageal
fistula is an abnormal connection in one or more places
between the esophagus.
Paralytic Ileus- Obstruction of the intestine due
to paralysis of the intestinal muscles.
Acute abdomen- A condition of severe abdominal
pain, usually requiring emergency surgery, caused by
acute disease of or injury to the internal organs.
Oesophageal fistula
General Instructions:-
Screen the patient for privacy.
[Link] feeding is given only by a doctor’s order.

2. If the client is conscious, explain the procedure and

reassure the client to win his confidence and cooperation.

3. Remove the denatures if any, to prevent it from

dislodging and blocking the respiratory tract.

4. A rubber tube may be placed in a bowl of ice to cool and

stiffen.
5. 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. A drop of
mineral oil, if dropped into the respiratory passage acts as
a foreign body because it is not absorbed by the lung
tissue.
6. 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.
7. 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.
8. 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.
9. While removing the tube, pinch the tube and pull it
out gently and quickly so that the fluid may not trickle
down the trachea.
10. During the introduction of the tube, never use force
as it may cause injury to the mucus membrane.
11. 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.
12. Restraints used if any, should be limited to the
minimum. For infants and irrational clients, some form
of restraints may be necessary, but they should not feel
that they are punished.
13. Feedings 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 nausea,
regurgitation and excessive peristalsis usually associated with
too much and too rapid administration.

14. Intake and output is recorded accurately.

15. Watch for complications such as nausea, vomiting, distension,

diarrhea, aspiration pneumonia, asphyxia, fever, water and
electrolyte imbalance. The water and electrolyte imbalance
may be reflected in changes in the skin, thirst, vital signs,
intake and output, level of consciousness, body weight,etc.
16. Clients receiving tube feeding should receive
frequent mouth care to prevent complications of a
neglected mouth.
17. Warm the feed or room temperature before
administration.
18. Use gloves as per universal precaution.
Nurse’s Responsibility in Administering a Tube Feeding:-
Preliminary Assessment:-

1. Identify the client with name, bed no., O.P. No., etc.

2. Check the doctor’s orders for any specific precautions if any,

regarding the tube feeding, movement of the client, positioning of
the client etc.

3. Check the level of consciousness and the ability to follow

directions.

4. Check the ability for self care, ability to move and to maintain a
desired position during the insertion of the tube.
5. Explain the procedure to the patient to gain confidence and co-
operation.
5. Screen the patient to provide privacy.
6. Place the patient in a sitting or fowler’s position
during insertion of the tube.
7. Place mackintosh with cover to protect garments
and bed linen.
8. Give mouth wash to clean the mouth.
9. Clean nostrils if there are secreations or crust
formation of naso-gastric insertion
10. Check whether the feed is ready at hand.
11. Check the articles available in the client’s unit.
Preparation of the articles:-
Articles Rationale:-
A tray containing:
A small mackintosh with a to protect the garments and
towel bed linen.
Feeding cup with water. To rinse the mouth and clean
before and after the feed.
To clean the nostrils
Cotton tipped application,
rubber or disposable rubber
 Ryle's tube in a bowl of
cold water To make the tube hard for easy
A lubricant such as water insertion
soluble jelly or glycerine or To lubricate ryles tube to
liquid paraffin. prevent friction between
mucous membrane and tube
Adhesive plaster and scissors To fix the tube in position
Gauze pieces in a container
Clean syringe or a funnel To wipe the secreations

A glass of feed in a bowl of 

To aspirate gastric contents
warm water or warm feed. and to give feeding
An ounce glass
To give the feed at the body
A bowl of water
temperature
To measure the fluid intake
To test the location of the tube
Stethoscope
To test the location of the tube
Saline or soda bicarb solution.
To clean nostrils

A kidney tray and a paper bag

to collect wastes
Steps of the procedure
Wash hands with soap and water To prevent cross-
Spread the mackintosh and the infection.
towel To protect bed
Clean the nostril with a cotton- linen.
tipped applicator soaked in
saline. To clean nostril.
Take the Ryle’s tube and
measure the distance for
To determine
insertion of the tube from bridge
of the nose to ear lobe to the tip approximate
of the xiphoid process of the length of the tube
sternum and mark with adhesive to reach the
stomach.
Lubricate the tube for Lubrication reduces
about 6-8 inches with thin friction between mucus
coat of water soluble jelly. membrane and the tube.
Hold the tube coiled in the Nasal septum is deviated
right hand to introduce the into the right side
tube.
Tilt back the patient’s head Passage of the tube is
before inserting the tube facilitated by following
into the nostril and gently the natural contours of
pass the tube into the the body.
posterior nasopharynx
quickly backwards and
downwards.
When the tube reaches Gag reflex is triggered by
the pharynx, the patient the presence of the tube.
may gag: allow him to rest Helps to prevent the
for a few moments. aspiration of the fluids or
passing the tube into
trachea.
Hold the patients head in Flexed head position
a partially flexed position makes swallowing easier
and advance the tube as he and the tube less likely to
swallows sips of water. enter the trachea.
Swallowing facilitates
passage of the tube by closin
the epiglottis. Helps in easy
passing of the tube and
avoids coiling it at parynx.
Continue to Mark on the tube indicates that it
advance the tube has reached the stomach.
until it reaches the
previously
designated mark. Fluids cannot be freely aspirated
Aspirate for gastric from the lungs. Glands of mucous
contents with a membrane lining the oesophagus
syringe. and stomach produce mucus, and
gastric juices.
If the tube is in trachea air
Place the end of bubbles will coincide with the
the tube into a expiration of each breath. Normal
bowl of water and respiration takes place in lungs. As
note the rhythm of a result, air will be expelled out
escaping bubbles. with expiration.
Ask the patient to The patient will be unable to
speak. speak or hum if the tube is in the
trachea. Any injury to vocal cords
of larynx causes difficulty in
speech and hum and sounds will
not be produced.

Confirmation of 
Hushing sound will be heard on
the tube’s place can
th stomach while air is pushed
be done by using a
while air is pushed by force
stethoscope. Take
produces a hushing sound.
5-10 ml of air and
push in distal end
of the tube.
After the tube is in place, Prevents the patient’s
tap it to the nose/forehead. vision from being
Take 5cm of tape, split disturbed, prevents
length-wise and only tubing from rubbing
halfway, attach up split end against nasal mucosa.
of the tape to the
nose/forehead and cross
split ends around tubing. A few minutes rest will
Wait for some time before help to subside the
giving the feed. peristalsis and prevent
nausea and vomiting.
Peristalsis is stimulated
by any irritation to
stomach or by a bolus of
food.
Before giving the feed Expelling air from the tube
connect funnel and before the feed is given
syringe, pour some does not allow the fluid to
water through it and run. Air is lighter than
lower the funnel slowlywater, liquid experts
so as to expel air. pressure because of their
weight.
Hold the funnel or To prevent the damage of
syringe 8 inches above mucus membrane in
the bed. stomach. The height of a
colum of fluid determines
the amount of pressure
exerted at the point of
application.
Slowly introduce To prevent distension, nausea
feeding into the funnel and excessive peristalsis and
or syringe barrel. Keep it to prevent air entry into
full until total amount stomach. Helps in preventing
has been introduced. injury to gastric mucosa by
reducing pressure.
When the quantity of To prevent the blockage of
feed is over, clear the tube. As the food remains in
tube but introducing a tube , it blocks the lumen and
small amount of water. causes obstruction to flow.
Disconnect funnel or To prevent the leakage of
syringe barrel and clamp tube. As the food remains in
the tube to prevent tube, it blocks the lumen and
leakage of fluids. causes obstruction to flow.
Tube may be removed or To prevent aspiration of
left in the place. To contents into trachea.
remove the tube pinch it
by pulling it out
continuously with a
moderate rapid motion.
To clean mouth and
Offer a mouth wash,
prevent tartar formation
clean face and hands.
and to moisten the
mouth. As the patient is
not taking food by
mouth there will be less
secretion of saliva and
dryness.
Remove the mackintosh To keep the unit clean.
and the towel.
Make the patient To give a sense of well-being,
comfortable in bed. comfort.
To take the articles to To clean them thoroughly. To
the utility room. Discard prevent cross-infection.
water and clean with Helps in checking growth of
soap and water. Dry the micro-organisms.
them and replace in their
proper place.
Wash hands. To prevent cross-infection.
Record the time, date, To have good
amount of feed, nature of commuication in team
feed, reaction of the and to maintain fluid
patient, if an, I the nurse’s balance for future
notes and intake-output reference.
chart.
If the tube is reusable,
Usually disposable ones
clean it with cold water
first then with a warm can be discarded. Rubber
soapy solution. Pushing tubes are kept ready for
water several times the next use.
through the lumen boil it,
dry it and replace.
Disposable tubes to be
discarded.
Charting of Gastric Gavage:-
Describe and record procedure
Time of feeding
Type of Gavage feeding
Type and amount of fluid given
Amount retained or vomited
Patient’s reaction to the procedure.
After Care of Gastric Gavage:-
Wash or let the significant other of the patient do the
washing of the materials used in feeding.
Keep all the materials used in its proper place.
Refrigerate the osterized (remaining)feeding.