OROGASTRIC FEEDING

• Equipment's

  • Feeding tube F # 8 or 10
  • Asepto syringe / 10cc syringe
  • Leucoplast
  • Sterile gloves/Clean Gloves
• Determine

  The size of tube to be inserted
• Inserting A Nasogastric Tube

  1. Preparation

  2. Introduce self to the mother and verify the client's identity

  3. Loosely swaddle the infant using a mummy restraint

  4. Wash hands and wear gloves observe other appropriate infection control procedures

  5. Position clients in high Fowler's position and put towel to drape the chest

  6. Provide for privacy

  7. Assess the client's nares. Select nostril through which air passes easily

  8. Wear gloves

  9. Measure the space from the bridge of the infants' nose to the earlobe then to a point halfway between the xiphoid process and the umbilicus using a #8 or #10 feeding tube

  10. Mark the tube at the measured point with a small clamp or piece of tape. Lubricate the tip of the catheter with water

  11. Pass the catheter with gentle pressure to the point of the clamp or tape

  12. Assess the catheter for position (confirm that it is not in the trachea) before administering a feeding

  13. Aspirate the stomach contents to assess amount

  14. If the tube is to be left in place, tape it below the nose and to the cheek

  15. After being certain that the catheter is in the stomach, attached a syringed or a special feeding funnel to the tube. Elevate the infants head and chest slightly

  16. Add the specific kind and amount of feeding prescribed to the syringe or funnel and allow it to flow by gravity into the infant's stomach

  17. Offer a pacifier (non-nutrient sucking) during the feeding if the infant appears to enjoy this

  18. When the feeding has passed through the tube, re-clamp the tube securely

  19. If the tube is to remain in place, flush it with 1-5ml of clear water and cap it

  20. Burped the baby after an enteral feeding the same as you would after bottle or breastfeeding

  21. Un swaddle and place the infant on the right side with the head slightly elevated or hold and rock the infant in this position

  22. Assess the infant appears comfortable. If a parent observed the procedure, answer any questions or concern

  23. Wash hands and remove gloves

  24. Documentation
• Purposes:                              

   

  It is a way to deliver nutrients through a tube if the infant cannot take food or drink through the mouth.
• Reasons why infant need tube feeding:

  •   Lack of weight gain or irregular weight gain patterns
  •   Absence or weak suckling ability or swallowing reflex
• Preparation: Prepare all the equipment needed and secure consent (if you are going to insert feeding tube).

  ·  Promote efficiency during procedure
• 1. Introduce self to the mother and verify the client’s identity. Explain the procedure and review medical record for formula, amount and time

  ·  Ensure doing procedure to the right client and will increase client’s cooperation. Verifies health care provider’s prescription for appropriate formula and amount
• 2. Loosely swaddle the infant using a mummy restraint

  ·  Mummy or blanket restraints effectively contain arms and legs without causing any unwarranted pressure on the infant.

   
• 3. Wash hands and wear gloves observe other appropriate infection control procedures.

  ·       Reduces transmission of microorganism
• 4.  Position clients in high Fowler’s position and put towel to drape the chest

  ·       Upright position is more natural for swallowing and protects clients against aspiration
• 5. provide for privacy

  Places client at ease
• 6.     Assess the client’s nares. Select nostril through which air passes easily.

  ·       Tube passes more easily through the nostril with the largest opening
• 7.   Wear gloves

  ·       Reduces transmission of microorganism
• 8.3.     Measure the space from the bridge of the infants’ nose to the earlobe then to a point halfway between the xiphoid process and the umbilicus using a #8 or #10 feeding tube. If the child is older than 1 year of age, measure from the bridge of the nose to the earlobe to the xiphoid process.

  ·       Measuring the tube ensures it will be long enough to enter the stomach. If the tube is passed too long it will curl and end up in the esophagus, if not passed far enough, it will also be in the esophagus. Both situations could lead to aspiration of the feeding.
• 9.    Mark the tube at the measured point with a small clamp or piece of tape. Lubricate the tip of the catheter with water

  ·       Water lubrication helps the tube pass through the esophagus without trauma. Don’t use an oil because, although the tube is going to be left into the stomach, occasionally it can unintentionally pass into the trachea.

   
• 10. Pass the catheter with gentle pressure to the point of the clamp or tape. If the catheter is inadvertently passed into the trachea rather than the esophagus, the infant usually will cough and become dyspneic. If this happens, withdraw and replace the catheter.

  ·       Using gentle pressure helps to ensure safety

   
• 11. Assess the catheter for position (confirm that it is not in the trachea) before administering a feeding

  ·       Assessing for proper placement helps to ensure the feeding will enter the stomach not on the respiratory tract.
• 12. Aspirate the stomach contents to assess amount. If the amount aspirated is small, merely replace it at the beginning of the feeding. If large replace it through the tubing and reduce the amount of the feeding with that amount.

  ·       Assessing stomach content amount aids in determining if the previous feeding was absorbed. Replacing stomach secretions rather than discarding them helps prevent electrolyte loss

   
• 13. If the tube is to be left in place, tape it below the nose and to the cheek. Do not tape it to the forehead.

  ·       Taping tube to the forehead can put pressure on the anterior naris, leading to ulceration
• 14. After being certain that the catheter is in the stomach, attached a syringed or a special feeding funnel to the tube. Elevate the infants head and chest slightly to encourage fluid to flow downward into the t stomach.

  ·       The infants upper body allows the feeding to flow by gravity
• 15. Add the specific kind and amount of feeding prescribed to the syringe or funnel and allow it to flow by gravity into the infant’s stomach. Do not elevate the syringe end of the tube more than 12 inch above the infant’s abdomen.

  ·       Excessive elevation can cause feeding to flow too quickly, filling the esophagus and increasing risk for aspiration. Hurrying feeding by using the plunger of the syringe or a bulb attachment for more pressure also can lead to aspiration
• 16. Offer a pacifier (non-nutrient sucking) during the feeding if the infant appears to enjoy this

  ·       Non nutrient sucking can help satisfy the infants normal need to suck which would otherwise go unsatisfied with the enteral feeding
• 17. When the feeding has passed through the tube, re- clamp the tube securely it

  ·       Clamping the tube before it withdraws is important to prevent any milk remaining in the tube from flowing out as the tube is removed, thereby reducing the risk of aspiration
• 18. If the tube is to remain in place, flush it with 1-5ml of clear water and cap it

  ·       Flushing tube helps prevent plugging of the tube with the feeding solution. Capping a tube helps to prevent air and bacteria from entering
• 19.       Burped the baby after an enteral feeding the same as you would after bottle or breastfeeding. If a parent is present, encourage him or her to do this.

  ·       Burping helps to prevent air accumulation and regurgitation of the feeding. Encouraging parental participation aids in promoting close contact, which is essential to the baby’s development
• 20. Un swaddle and place the infant on the right side with the head slightly elevated or hold and rock the infant in this position.

  ·       Placing on the right side helps the feeding solution enter the pyloric valve, thus promoting stomach emptying
• 21.      Assess the infant appears comfortable. If a parent observed the procedure, answer any questions or concern.

  ´  Assessing infant after feeding aids in outcome evaluation. Helping parents feel comfortable with alternative feeding methods can promote bonding with the infant.
• ´  22. Wash hands and remove gloves

       To prevent cross contamination.
• ´  23.  Documentation

     Good documentation promotes continuity of care through clear communication between all members involved in patient care.

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