Feeding Tube or lavage may be oral or nasal. When the tube is passed through mouth, it is known as oral lavage and when it is passed through nose when mouth poses problem, it is known as nasal lavage.
Conditions for tube feeding
- Comatous patient.
- Paralysis of soft palate or pharyngeal muscle in diphtheria or other such conditions.
- After operation over mouth, pharynx or larynx.
- For premature or weak infants who are unable to suck.
- In case of insanity when patients always refuses to take food.
Principles of tube feeding
- Utmost care should be taken to ensure that the tube is in stomach neither in lungs or nor coiled in mouth or pharynx. It is better to check the position of the tube by a second nurse or by a doctor.
- Air should not be allowed to enter stomach while the feed is being given. So the apparatus should not be allowed to be empty until entire feed has been exhausted.
- To avoid discomfort caused by sudden stimulation of stomach nerve endings by cold fluid, the feed should be warned to body temperature. It should be tested by a lotion thermometer before administration.
- Sudden distension of stomach may cause stimulation of nerve endings and cause discomfort. This is avoided by giving feed slowly either by use of small apparatus or by pinching the tube slightly as the food is given to reduce its calibre.
- It is not necessary to remove the tube after every feed if it has passed by nasal route. If it is through oral route it is removed after feeding. The tube requires periodic removal for cleaning and to avoid tissue reaction. A rubber tube should be changed every 24 hours, and polythene tube on every 7 days.
- An unskilled hand while passing the tube into stomach can cause damage to the mucous membrane of the nose, naso-pharynx and oesophagus. If any difficulty is faced, forceful and frequent attempt by the same time should not be taken. The procedure should be abandoned and at later time again fresh attempt should be done using same or different tube.
Apparatus required for tube feeding
- For mouth wash or tray for cleaning ‘mouth if :he tube is required to pass through mouth.
- Sodabicarb swabs for cleaning nostrils if tube is required to pass by nasal route.
- A small g or polythene funnel.
- A oesophageal tube size 6 to 18 english gauze or 14-22 (French gauze). The larger size are used for oral route and smaller sizes for nasal route.
- A tray or bowl for keeping all apparatus.
- A measure containing water to clear the tube.
- A container with feed.
- A lotion thermometer.
- Adhesive tape.
- Towel, a piece of Mackintosh, tongue forceps, tongue spatula
- Mouth gag, if necessary.
- Lubricant solution for tube (Liquid paraffin).
- A 50 ml syringe.
- Emesis basin to collect if vomiting occurs?
Being A Nurse And Doctor You Must Know Feeding Tube Procedure And Its Placement
- Intimate the patient about the procedure.
- He should be told :
- The reason for procedure.
- Approximately how long it will take.
- What it will feel like.
- Hoc&j?co-operate better. Screen the patient for privacy
Feeding Tubes Through Oral route
- Place mackintosh and towel across pa dent’s chest.
- Wash your hands.
- Soak the tubs in ice water and apply glycerine or liquid paraffin.
- Any dentures should be moved.
- Stand to the side and slightly behind the patient.
- Insert the tube and ask the patient to swallow.
- Curve the tube and pass it along curve of palate and take care not to strike the larynx. Ask him to take deep breathing.
- Push the tube gently and steadily.
- If any difficulty is encountered, wait a while, never force the tube which may damage soft tissue.
- Watch for the breathing.
- When the 2nd marking is at the front teeth, the end of the tube is in stomach.
- If a patient bites the tube, insert a mouth gag.
Tube Feeding Through Nasal route
- Position the patient sitting him up with head slightly flexed (Semi-recumbent position).
- Clean the nostrils.
- Note approximate distance of 50*60 cm from stomach end of tube before the tube is inserted.
- Pass the tube gently along floor of larger nostril.
- Ask the patient to swallow when it strikes oesophageal orifice.
- When the 2nd marking comes to the opening of nostril, it is assumed that the tube is in stomach.
- Watch for breathing.
How to know that tube is in stomach
- Place a stethoscope over upper middle part of abdomen listening to the ear piece. About 5 cc of air is pushed by a syringe through the tube. If the tube is in stomach, air while pushed will be heard by the stethoscope.
- If the patient coughs, becomes restless, with flushed face, tears from eyes, the tube may be in air passage and not in stomach.
- withdrawn. If it is in stomach, some fluid will come out which will give an acidic reaction when tested by litmus paper.
- At some centres another controversial method is used to test whether tube is in stomach, or not. This method consists of connecting the external end of tube into bowl of water. Then it is observed if air bubbles come out in rhythmical way or not. If air comes out is rhythmical way then the tube is in air passage and not in stomach.
- The disadvantage of this method is that if the tube is in respiratory tract while testing by this method some water will be sucked into the respiratory tract. *
Suitable feeds for tube feeding
The liquid food for tube feeding is usually advised by the doctor treating the patient. Only nursing involvement remains for amount of feed at a time, temperature of feed, and use of correct hygienic and nursing procedure. Usually milk, strained soap, ready made milk food like Complan or Horlick, Juice etc. are given through tube feeding. The amount at a time should not exceed 500 cc. The temperature of feed normally should vary between 99°F to 100°F. Only in certain restricted case vary cold or ice-cold feeds are prescribed.
Feeding by Gastrostomy tube
Sometimes a surgeon performs gastrostomy operation for feeding a patient in cases of operation over oesophagus or soft palate or tumours or stricture in oesophagus. In such cases it becomes the prime duty of the nurse to feed the patient carefully through the gastrostomy tube. The tube is inserted through an opening in abdominal wall going into the stomach by piercing stomach wall. The catheter or tube is usually a self retaining one known as “De Pezzer catheter’*. The tube is taken out periodically and replaced by a new one.
For the first few days it is important to observe the slipping out of the tube from the incision in which case it should be replaced immediately otherwise it will be very difficult to introduce the tube and the purpose of the operation becomes defeated.
- Funnel. 2. Piece of tubing. 3. Tubing clip. 4. Connector. 5. A catheter. 6. Mackintosh. 7. Sterilized dressing and bandage. 8. Bowl of water. 9. A tray containing all such item. 10. Sterilized plug to close the tube after feeding.
- The patient is intimated about the procedure for better cooperation.
- The mackintosh is put over bed to prevent soaking and protect dressing .
- The plug from the opening of tube is removed if gastrostomy tube is already inserted.
- Otherwise the gastrostomy plug is removed from abdomen and a sterilized tube is carefully inserted through the gastrostomy opening.
- The end of connector is fixed to the catheter in the gastrostomy opening.
- The tube is pressed to remove air.
- By means of a 50 cc syringe, the feed is slowly introduced through the tube.
- It is important to flush in by introducing some water into the tube to wash or clean the stomach end of the tube to prevent blocking.
- The feed can be introduced by means of a funnel fixed at the tube.
- The funnel and connector tube is removed.
- The skin around the tube is applied with a protective cream to prevent irritation of skin by contact with food particle.