7.5: Checklist for NG Tube Enteral Feeding By Gravity with Irrigation
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- Ernstmeyer & Christman (Eds.)
- Chippewa Valley Technical College via OpenRN
Use the checklist below to review the steps for completion of the “NG Tube Enteral Feeding by Gravity with Irrigation.”
Steps
Disclaimer: Always review and follow agency policy regarding this specific skill.
- Verify the provider’s order.
- Gather supplies: stethoscope, gloves, towel, irrigating solution (usually water), and irrigation set with irrigating syringe, pH tape, and prescribed tube feeding.
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Perform safety steps:
- Perform hand hygiene.
- Check the room for transmission-based precautions.
- Introduce yourself, your role, the purpose of your visit, and an estimate of the time it will take.
- Confirm patient ID using two patient identifiers (e.g., name and date of birth).
- Explain the process to the patient and ask if they have any questions.
- Be organized and systematic.
- Use appropriate listening and questioning skills.
- Listen and attend to patient cues.
- Ensure the patient’s privacy and dignity.
- Assess ABCs.
- Don the appropriate PPE as indicated.
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Perform abdominal and nasogastric tube assessment:
- Assess skin integrity on the nose and ensure the tube is securely attached.
- Use a flashlight to look in the nares to assess swelling, redness, or bleeding.
- Ask the patient to open their mouth and look for curling of the tube in the patient’s mouth. The tube should go straight down into the esophagus.
- Lower the blankets and move the gown up to expose the abdomen. Inspect from two locations.
- Auscultate bowel sounds and then palpate the abdomen. If the patient is receiving NG suctioning, turn off the suction prior to auscultation.
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Check for tube placement:
- Verify tube measurement at insertion site based on documentation.
- If agency policy dictates, test the pH of the aspirate. The pH should be equal or less than 5.5.
- If agency policy dictates, measure and document residual amount. Instill residual back into gastric tube if placement was confirmed.
- Draw up 30 mL of water in a 60-mL syringe. (If applicable, use sterile water according to agency policy.)
- Connect the syringe to the tubing port (not the blue pigtail).
- Instill 30 mL water.
- Reconnect the plug tube or clamp tube.
- Remove the plunger from the syringe and attach the syringe to the NG tube.
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Complete tube feeding administration:
- Verify the order for the type of formula, amount, method of administration, and rate.
- Check the expiration date on the formula.
- Verify if the tops of the containers need cleaning or if feeding needs mixing/shaking.
- Add the formula to the syringe until the ordered amount is administered. Hold the syringe above the insertion site and allow it to enter via gravity.
- Assess the patient for tolerance of the feeding. Slow infusion as necessary. Do not allow air to enter the tube when refilling the syringe.
- After formula is administered, flush the NG tube with 30 mL of water.
- If a patient is unable to tolerate the feeding, slow or stop the infusion. Document and report the intolerance.
- Disconnect the syringe and plug the NG tube.
- Maintain the patient at or above a 30-degree angle for a minimum of one hour to prevent aspiration. Ask the patient if they have any questions and thank them for their time.
- Perform hand hygiene.
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Ensure safety measures when leaving the room:
- CALL LIGHT: Within reach
- BED: Low and locked (in lowest position and brakes on)
- SIDE RAILS: Secured
- TABLE: Within reach
- ROOM: Risk-free for falls (scan room and clear any obstacles)
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Document assessment findings and report any concerns according to agency policy. When documenting the procedure, include the following:
- Time performed
- Irrigation solution used
- Quantity instilled
- Residual amount, color, odor, and consistency
- Method for checking the placement (including pH of gastric contents, if performed)
- Related assessments
- Amount of tube feeding
- Patient tolerance for the procedure