This is the act of meeting the daily nutritional requirement of a hypoactive patient through the gastric/nasogastric tube. It is usually carried out in instances where the psychiatric patient refuses food/unable to swallow safely.
Aims
· Maintain right amount of patient’s daily nutritional status
· Keep patient hydrated
· Boost the energy level of patient
· Promote recovery
Types
· Gastrotomy feeding
· Nasogastric feeding
· Nasojejunal feeding
Requirements
Trolley containing the following:
a. Top shelf: A clean tray containing:
· Nasogastric tube e.g. Ryles tube in a sterile receiver ii. Sterile syringe (10mls)
· Glass of water
· Liquefied food
· Measuring mug
· Clean swabs
· A jar of water
· Intake and output chart
· Disposable tissue paper
· pH strips/blue litmus paper to test gastric aspirate
· Oral medication – if due for administration
· Lubricant
· Sterile gloves
· Food thermometer
b. Bottom shelf
· Hand washing bowl
· Hand washing soap
· Receiver for used swabs
· Mackintosh/protective covering
c. Assisting nurse(s)
Steps
1. Establish rapport (Refer procedure)
2. Explain procedure to the patient
3. Provide privacy and send prepared feeding trolley to patient’s bedside in the company of the assisting nurse(s)
4. Assist patient into a fowler’s position in bed or a sitting up position in a chair or a slightly elevated right side lying position
5. Ask the assisting nurse(s) to support the patient’s head
6. Perform hand hygiene and assist patient to do same
7. Cover the patient’s chest with a protective material
8. Check for proper placement of tube in the stomach by:
· aspirating abdominal contents for a typical gastric fluid appearance (grassy-green, colourless with mucus shreds) OR
· injecting 5 -20cc of air through the tube and auscultate epigastric region with a stethoscope and listen for the whooshing sound simultaneously indicating proper positioning of the tube
9. Test the aspirate with a blue litmus paper which changes to red indicating the aspirate is coming from the stomach - acidic
10. Check temperature of food using a food thermometer/by dropping a little amount on the back of hand (food should be at room temperature of 20-250C)
11. Pinch tube and remove spigot/stopper of NG-tube, push 10 – 15mls of water through the tube just before food is introduced
12. Connect syringe with food to tube, release the pinch and allow the food to run by gravity
13. Ensure tube is never allowed to empty completely to prevent air from entering patient’s stomach
14. Continue feeding and observe patient for signs of discomfort till feeding is completed
15. Run water (10 –15 mls) through the NG-tube after feeding
16. Remove the syringe, clean the tip of the tube and fix the spigot/stopper and secure the NG-tube on the patient’s cheek
17. Monitor for the retention of the NG-tube to prevent the patient or other patients from removing the tube
18. Assist patient to remain in the sitting up position for at least 30 minutes after feeding
19. Remove protective material and put patient in a desired position
20. Assist patient to perform hand hygiene and express appreciation
21. Clear the trolley and perform hand hygiene
22. Document procedure and any observations made in intake and output chart, nurses’ notes/patient’s folder
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