Administration of Enteral Nutrition via Nasogastric tube

Question 1

why must we flush the tube?

Answer 1

In order to clear the tube of formula or medications to prevent clogging and to ensure tube patency.

Question 2

gastric residual volume is used to determine

Answer 2

how quickly a patient is tolerating tube feeding formula or if there is a problem with peristalsis.

Question 3

Purpose of administration of enteral nutrition

Answer 3

to provide nutrients to patients who are unable to ingest orally

Question 4

type of patients

Answer 4

unconscious patients
neuromuscular swallowing disorder
upper gastrointestinal obstruction

Question 5

why should the total volume of feeds not exceed 300 ml for each bolus feed?

Answer 5

To prevent abdominal distension and discomfort

Question 6

Why should a patient be position at semi-fowlers or high fowlers position ?

Answer 6

enhances the gravitational flow of the feeding and prevents aspiration of gastric contents

Question 7

why is regular assessment of the NGT tube important?

Answer 7

It is important because a tube can be partially pulled out during movement or tugged by the patient. Tube malposition can be caused by upward dislocation after bouts of coughing or vomiting.

Question 8

why must we aspirate gastric content and determine the amount of GRV?

Answer 8

determines residual volume to assess tolerance to feed

Question 9

why must we hold the syringe at the level of patient’s forehead?

Answer 9

this position is necessary to avoid an increase in pressure of fluid entering the stomach

Question 10

Why do we have to prevent air from entering the stomach ?

Answer 10

entry of too much air in the stomach will cause stomach distension

Question 11

signs and symptoms of distress

Answer 11

restlessness, breathlessness, coughing

Question 12

why must the patient’s head of bed should be elevated at least 30degrees for atleast 1 hour?

Answer 12

necessary to prevent gastro-esophageal reflux and pulmonary aspiration

Question 13

what do we do when the GRV is < 1/2 of the previous bolus feed ?

Answer 13

1. return the GRV to the stomach as returning the aspirated contents back to the stomach can prevent electrolyte imbalance. however, do not return the GRV into the stomach when the patient is showing signs of breathlessness, nausea, vommiting, diarrhoea or abdominal distention.
2. flush the tube with 10-20 ml of water to ensure the patency of tube before
3. only top up the amount of feed to the required volume of bolus feed/
4. flush the tube with remaining prescribed amount of water
5. Kink the tube and disconnect the syringe
6. Swab or clean the hub the spigot before re-attaching the spigot re-attaching the spigot.
7. Do not turn patient or lay patient flat for at least 1 hour.

Question 14

what do we do when the GRV is >1/2 of the previous bolus feed

Answer 14

1. return the GRV to the stomach

2. Omit the current feed and withhold till 2 hours later or the next feeding