Nasogastric Tube
A. Definition
The Nasogastric tube (NGT) is a tube that is passed through the nose and down
through the nasopharynx and esophagus into the stomach. This is used to
administration of medication/feeding via the NGT for the patient who is unconscious,
too weak or unable to take medicines/feeding daily.
B. Purpose/ Indication
1.) To improve or maintain the nutritional status
2.) To administer prescribed medication
C. Principles
1. Elevate the head of the bed 30-90 degrees before feeding and leave it up for
30-60 minutes after the feeding.
2. Keep the head of the bed elevated at least 30 degrees at all times if the
patient is receiving continuous feeding.
3. Assess bowel sounds at least once in 8 hours.
4. Assess abdomen for distention
5. Check the tube position within the GI tract before each feeding is started or at
least once each shift.
6. Check for gastric residual by aspirating via the gastric tube before each
intermittent feeding or at least every 4 hours if the client is receiving
continuous feeding. If the gastric residual is greater than one-half the volume
given in the last feeding or greater than 150cc, re-instill the residual and delay
the next feeding for 1-2 hours.
D. Equipment
- medicine ticket
- asepto syringe for adults; 2cc or 5 cc for children
- mortal and pestel
- medicine glass
- sterile tongue depressor for stirring
- drinking water
- prescribed feeding
E. Assessment
1.) Clinical signs of malnutrition or dehydration (Unintentional weight loss,
decreased muscle mass, recurrent infections, swallowing difficulty, etc.)
2.) For allergies to any food in the feeding. If the client is lactose intolerant, check
the tube feeding formula. Notify the primary care provider if any
incompatibilities exist.
3.) For the presence of bowel sounds.
4.) For any problems that suggest lack of tolerance of previous feedings (e.g.,
delayed gastric emptying, abdominal distention, diarrhea, cramping, or
constipation.
F. Procedures
ACTION RATIONALE
1. Check the physician’s order for It ensures that correct feeding will be
medication/feeding. administered.
2. Wash your hands then assemble Handwashing prevents the spread of
equipment. microorganisms.
3. Identify and explain the procedure Proper identification of client prevents
to the client. medication error.
4. Provide privacy for this procedure Tube feedings are embarrassing to some
if the client desires it. people.
5. Assess signs and symptoms that It can be an indication to delay feeding or
would suggest lack of tolerance in providing other management such as
the previous feeding (e. g. giving prokinetic agents.
abdominal distention).
6. Raise the bed to working height. It prevents the nurse to have back pain,
promoting proper body mechanics.
7. Elevate the client’s head 30 This position enhances the gravitation
degrees or as near normal flow of the solution and prevents the
position for eating as possible. possibility of aspiration into the lungs.
8. Pinch off the tube and remove the Pinching or clamping the tube prevents
plug, cap or clamp and attach the excess air from entering the tubing and
aspeto syringe. causing distention.
9. Apply clean gloves. To prevent contact of client’s body fluid
to the nurse
10. Check the placement of the NGT
using either of the following
techniques:
a. Aspirate a small amount of Obtaining gastric or intestinal contents is
(5-10 mL) of gastric the best evidence of proper tube
contents into a syringe. placement. Returning the contents to the
Return the residual stomach prevents fluid and electrolyte
contents to the stomach. imbalance.
b. Place the diaphragm of the A whooshing, gurgling or bubbling sound
stethoscope just below the is heard while auscultating the
xiphoid process. Using a epigastrium or left upper abdominal
syringe, slowly introduce 5- quadrant.
20 mL of air into the tube
while listening with the
stethoscope for the entry of
air into the stomach.
11. Administer the drug through a This gives the stomach time to
syringe barrel or aspeto syringe accommodate the fluid and decreases GI
connected to the tubing. Hold the distress.
barrel of the syringe approximately
6 inches higher than the client’s
nose and allow the medication to
flow into the stomach by gravity.
Only in cases when there is
difficulty of the medication flowing
through should the plunger or bulb
of the syringe be used. If the
medication does not flow properly,
do not force it. It may be too thick.
If so, dilute with water.
12. Follow medication with small Irrigation clears the drug from the sides
amount of liquid: of the tube reducing the risk of clogging.
- 2-5 mL for newborns
- 20-25 mL for children
- 30-50 mL for adults
13. Close the tube. Maintain the To facilitate down-flow of medication into
client's position for 20-30 minutes. the stomach and prevent reflux into the
esophagus; to prevent leakage and
gastric reflux into the esophagus and
enhance the normal digestive process in
case of gastrostomy, duodenostomy, and
jejunostomy feeding.
Do the aftercare of equipment and wash Promotes an environment conducive for
hands. client’s comfort; prevents the spread of
microorganisms.
Document the procedure done including Proper documentation prevents
pertinent observations. medication error.
A. Documentation
Date Time Entry
11/28/2020 11:30am 200 cc of Isocal feeding given via NGT. Checked for residual
prior to feeding. 25 cc gastric content is aspirated and
reinstilled. Abdomen soft, bowel sounds present in all
quadrants. Tolerated feeding without evidence of
discomfort. Head of bed maintained at 30 degree angle.
