Enteral Nutrition Support Nasogastric feeding Tube

Enteral Nutrition SupportNasogastric feeding TubeAngela Kenyon / Amy CorrisNutrition Support NursesW U T H

• Whenever possible enteral access isthe preferred route• Helps maintain mucosal integrity• Reduces the risk of bacterialcolonisation and translocation(NICE 2006)

Contraindications• Nasal injuries• Base of skull fractures

Post Pyloric Placement• High risk of aspiration• Gastric stasis - motility agent• Upper gastrointestinal stricture

Safe Placement and ManagementThe patient:• Assessment to identify if NG feeding isappropriate• clear explanation of the procedure• patients role in supporting placement• gain verbal consent

Safe Placement and ManagementWho should Place?• Tubes should be inserted by a healthcareprofessional with the relevant skills and training(NICE 2006/NPSA 2011)• Placement requires skill and competence inorder to minimise risk including the number ofintubation attempts the patient has to undergo(NPSA 2011)

Safe Placement and ManagementTube Selection:

Safe Placement and ManagementTube Selection:• fine bore polyurethane less than 9fg with guide wire• minimises the risk of Rhinitis, pharyngitis and oesophagealerosion• 120cm in length to support post pyloric placement• radio opaque throughout their length• Externally visible length markings• suitable placement for 4-6 weeks

EquipmentBedsidedocuments +

Procedure• Position up rightsupported• Measure NEX

Procedure• Intubation viaeither nostril

Procedure• Introduced to stomach

Procedure• Aspirate gastric juice

Procedure• Test using Ph graded paper ( CE marked)• Only flush with water and remove guide wire when the tipposition is confirmed

Procedure• Secure discreetlywith fixation device

Confirming Tube Position onPlacementpH testing is the first line method with pH between 1 and 5.5as the safe range.follow guidance on record of NG feeding tube insertiondocument

X ray Confirmation• Absence of a positive aspirate test• Ph readings more than 5.5 fornasogastric feeding• Post pyloric placement

Unsafe Unreliable Methods• Whoosh test• Observing for air bubbles• Absence of respiratory distress• Blue litmus paper (The medicines andhealthcare products regulatory agency2004)

Care Following Safe PlacementFlushing• must be flushed regularly to prevent build up of feed andmedication on the inner lumen using 30 -50 ml syringe30 - 50 ml flush• before commencing feed• on completion• before and after administration of medication10 - 15 ml flush• between each medication

Care Following Safe PlacementTube displacement after initial safeplacement can occur:• mark tube at the nostril with indeliblepen• measure length of visible tube anddocument• check fixation tapes daily

Care Following Safe PlacementRecheck Ph• before administration of feed following a break or ifbolus feeding• before the administration of drugs• after episodes of vomiting, retching or coughing• after the use of oropharyngeal suction• if the visible part of the tube has changed in length• if patient complains of feed reflux• at least once daily during continuous feeds

Disadvantages• Persistent removal by restless orconfused patients• Tubes placed atsurgery/endoscopically/radiologicallybecoming displaced• Home nutrition

Nasal Loop or Bridle

Indications for Use• Patient has displaced 2 feeding tubeswithin 48 hours• Electively for endoscopically singlelumen feeding tubes• Electively for xray guided placement• Electively for some surgical procedures

Advantages• May avoid more invasive access• Supports delivery of full nutrition withoutdisruption• Avoids further difficult placement• Reduces the need for parenteralsupport

Contraindications• Patient refusal• Severe trauma to face, nose or skullfracture• Mechanical obstruction in the nasalairway

Thank youReferences• National Institute of Clinical Excellence(2006)• National Patient Safety Agency (2011)