Position for Patient Woth Continous Feeding Tube
 | Fundamentals of Nursing Practice | © Rhodora Cruz |
1. Place the patient in semi-fowler�s position. This position will help gravity to empty the stomach after feeding and prevent aspiration.
2. Test the placement of the tube and aspirate the residual formula. Record the amount aspirated. If it is over 100 ml, notify the physician. He may want to reduce the amount being fed. When there is large residual, the patient is more likely to have regurgitation of the formula through the gastric sphincter into the esophagus and from there it is aspirated into the lungs causing an aspiration pneumonia. Gastric contents of any amount should always be returned to the stomach, so as not to disturb the chemical balance
3. The position of a feeding tube in continuous use is checked every 8 hours. Although unlikely, it is possible for the tube to shift in position.
4. Depending on the equipment used in your facility, administer a small amount of water first to ensure that the tube is patent, then any medications ordered and the formula. Follow with the remainder of the water, which rinses formula out of the tubing. The amount of water irrigated before and after the formula should be ordered by the physician. Remember to count the intake especially for those patients who are on strict I and O (intake and output monitored closely and with limited amount).
A. Reservoir MethodIn most facilities where a reservoir is used, it is used more than once. Therefore, it must be kept thoroughly cleaned between feedings, so that microorganisms are not harbored in the bag.
1. Hold the top of the bag open as you instill a portion of the water ordered.
2. Open the stopcock until the water has displaced the air left in the tube.
3. Attach the tube to the patient�s nasogastric tube, and allow the water to enter.
4. Clamp before air enters into the bag.
5. Pour the formula into the bag and regulate the drip using the stopcock.
Gastric distress may occur if too much formula is given at a fast rate. It is
recommended to give 3-6 cc per minute.
6. Before the formula is completely emptied, introduce the remainder of the water
to prevent air from being instilled and to rinse the feeding out of the tube.
7. Close the stopcock and detach the reservoir tubing from the nasogastric tube.
8. Clamp the nasogastric tube.
9. Clean the bag or bottle thoroughly with water.
B. Asepto Syringe MethodWhen you use this method, hold the syringe manually, and fill and refill it in the sequence used with the reservoir method. This method may be used for instilling medications and water when given at a time separate from feedings.
C. Prefilled Tube Feeding SetThese sets are available commercially and consist of premeasured formula in a plastic container or a minibottle with a drip chamber and tubing.
1. Remove the sealed screw cap and screw in its place the cap with the drip chamber and tubing.
2. Hang the bottle on an intravenous pole.
3. Irrigate the tube with an asepto syringe to make sure the tube is patent.
4. When the formula has filled the tubing, attach the set to the patient�s nasogastric tube and begin the feeding.
5. Flush with water using asepto syringe.
Use of a Pump for Tube FeedingsIn order to deliver tube feedings accurately, a rate-controlled pump is sometimes used. These pumps provide constant positive pressure to the feeding tube.
Even when feedings are provided continuously, the position of the tube should be rechecked each time additional formula is added to the reservoir. Follow the facility�s policy and procedure regarding changing the reservoir.
Complications of Tube Feeding/Opening an Occluded Feeding TubeThe most common complication of tube feeding is diarrhea. Because of this, you should monitor fluid and electrolyte imbalance. In addition, assess the skin for breakdowns. High osmolarity, lactose content, too rapid feeding, and too cold a formula have all been identified as possible causes of diarrhea. Therefore, when faced with this problem, the nurse should begin by correcting those possible causes. If there is no improvement, notify the physician
Another possible problem that you may encounter with tube feedings are dry mouth, sore throat, thirst and feelings of deprivation. Dry mouth can be improved by frequent mouth care. The use of a silicone rubber tube helps to prevent sore throat. Deprivation may be somewhat alleviated by attention to esthetics and interpersonal relationships that may provide some compensation.
A feeding tube may become occluded with coagulated formula or particles of tablets that were not completely dissolved. Instillation of a carbonated beverage may be helpful. With the physician�s order, an enzyme may be used to break down the material in the clog and allows it to be flushed out with water. The enzyme used is broken down by the gastrointestinal system and therefore, will not harm the patient.
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Source: https://www.peoi.org/Courses/Coursesen/nursepractice/ch/ch12b2.html
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