Guide to Nasogastric Tube Feeding

Guide to Nasogastric Tube Feeding Who needs Nasogastric Tube (NGT) Feeding?

Individuals who are unable to swallow safely, and can benefit from artificial nutrition and hydration through tube feeding.

Items used for NGT Feeding • Nutritional formula •

Cooled boiled water

•

One clean spoon and one measuring cup (if using powder feeding formula)

•

“Smart Kit” consisting of: - One 50 ml cathetertip syringe - pH indicator strips - One roll of hypoallergenic tape - Cup for aspirate

How to prepare Tube Feeding Nutritional Formula • Wash your hands with soap • Prepare nutritional formula as follows: Liquid Form • Rinse the top of the can or container under running tap water • Shake off the excess water • Shake can or container well before opening Storage • Cover up the can well and keep leftovers refrigerated after opening (use within 24 hours) • When ready to consume the remaining feeds, take can out of the refrigerator and leave it at room temperature for 10 minutes

Powder Form • Mix well with water until no lumps are present • If powder is difficult to dissolve, try mixing powder with a small amount of water first into a paste before pouring remaining water in (refer to mixing instruction on the can of the feeding formula) DO NOT •

Serve nutritional formula straight out from the refrigerator

•

Heat up nutritional formula

•

Mix feeding formula with other food, drinks or medication (Unless specified by doctor, dietitian or pharmacist)

Giving Medication • Please follow your pharmacist’s instructions - Most medication can be crushed and mixed with the feed to be given through the NGT - Some medication cannot be crushed and can only be mixed with water through the NGT • Flush 20ml of water down before and after giving the medication.

Caring for Skin & Mouth • Ensure oral care at least 3 times a day • Keep lips moist – if necessary use lip balm • Change the anchoring tape daily Monitor Weight • Weigh (before first feeding of the day) weekly or at least monthly If you notice more than 5% weight loss in one month, contact your healthcare provider

Problems encountered with NGT Feeding (A) Constipation Signs & Symptoms: (either one of below) •

Did not pass motion for more than 3 days

•

Hard stools

•

Difficulty passing motion

What to do?

Feed an additional 250-300ml of water 3 hours after the last feeding of the day. Contact your healthcare provider (B) Diarrhoea Signs & Symptoms: •

Passing loose and watery stool more than 3 times a day

What to do?

Check that the preparation and storage of nutritional formula are hygienic. Contact your healthcare provider if it persists for more than 3 days.

(C) Dehydration Signs & Symptoms: •

Concentrated and dark yellow urine; reduced output

•

This may result from persistent diarrhoea and/or vomiting, prolonged fever, insufficient fluid intake or diuretic medications

What to do?

Feed an additional 250-300ml of water 3 hours after the last feeding of the day and contact your healthcare provider (D) Stomach Discomfort Signs & Aymptoms: •

Nausea, vomiting, belching, bloating or heartburn

What to do?

Make sure your loved one is seated or propped up to at least 30-45° angle during and 30min after feeding. If there is vomiting, STOP feeding. Contact your healthcare provider

(E) High Aspiration Signs & Symptoms: •

Two consecutive aspiration of 100ml, aspirated from stomach content.

What to do?

Stop next feeding. Return (by syringing) the stomach contents back into stomach and flush down 20ml water. Wait for the next feeding timing and check again. If aspiration remains for two consecutive episodes, contact your healthcare provider.

Make sure your loved one is seated or propped up at least 3045° angle during and 30min after feeding. If you notice vomiting and a bloated abdomen, STOP feeding. Contact your healthcare provider.

(F) Dislocation of NGT Signs & Symptoms: •

NGT is longer than usual

What to do?

Test stomach contents with pH indicator. If the reading is not within the range of 1 to 5, stop feeding and contact your healthcare provider.

Frequently Asked Questions (FAQ) Who can change the tube or re-insert the tube if it is dislodged?

Only a licensed nurse will be able to re-insert the feeding tube.

Do not attempt to change or reinsert the tube yourself What’s the average cost of the tube?

It is approximately $18 per tube.

What if my loved one keeps pulling out the feeding tube?

Discuss with your doctor whether a feeding tube is the best solution for his/her condition. Covering her hands with a pair of mittens may help.

Can I feed any other fluids other than the nutritional formula (e.g. barley water, chicken essence, tea) through the tube?

No. You should never attempt to give any other fluids through the feeding tube other than the nutritional formula that the doctor or dietitian has prescribed.

Nutritional Feeding Details Type and size of tube: _____________________ Date: _____________ Change the feeding tube every: ________________________________ (Do not change the tube yourself) Recommended Regime Feed Time no.

Fuild

1.

Volume

Additional Supplements

Others (e.g. medication instruction)

ml Water flushes

2.

ml ml

Water flushes 3.

ml ml

Water flushes 4.

ml ml

Water flushes 5.

ml ml

Water flushes 6.

ml ml

Water flushes

ml

Healthcare Provider:_________________ Contact No.______________

Nutritional Feeding Details

Wash hands with soap and water.

Sit or lift up the bed to at least 30-45o angle.

Attach 50ml syringe to feeding tube.

Suck out 5-10ml of stomach contents.

Pinch feeding tube and remove syringe.

Test with pH indicator. pH reading should be 1-5. Do not feed if out of range.

Suck out remaining contents from stomach, collect them in the same cup. Do not feed if content is more than 100ml.

How do I use NGT Feeding

Pinch feeding tube.

Attach 50ml cathetertip syringe to feeding tube and raise to forehead level.

Pour formula slowly.

Flush feeding tube with Apply cap and release pinch. water (as ordered).

Remove syringe while pinching tube.

Slowly release pinch and make sure there is more than 30ml of formula in syringe.

Keep syringe above forehead level.

Sit or lift up the bed to at least 30-45o angle for at least 30min after feeding.

Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group.

Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg The information is correct at the time of printing and subject to revision without further notice.

GRM.PE.03.0620