NVQ evidence

Tube feeding

Enteral feeding is used when a client is unable to swallow or is unable to meet dietary needs orally.

There are two main types of enteral feeding methods:-

• Nasogastric
• Percutaneous endoscopic gastronomy (PEG)

Nasogastric tube feeding

• A tube with a weight on the end of it is passed thought the nose and then need be swallowed by the patent when it reaches the back of the throat. This then is then passed into the stomach. An x-ray need to be taken to establish if the tube is in the stomach and not in the lungs or anywhere where is should not be.
• This method of feeding is only suitable if the client can comply with the procedure and weather they are able to physically swallow the device.
• This is the most common form of enteral feeding
• Short term, usually post surgery
• The tube can be very narrow and can be highly susceptible to blocking. If this occurs, carbonated water or fizzy drinks can be used to un-block it.

PEG feeding

• A small hole is made in the wall of the abdomen and into the stomach into which a catheter is passed.
• This usually requires a general anaesthetic. This has risks attatched to it in itself so, as a second option, a local anaesthetic may be considered.
• The lumen of the tube is larger than that of a nasogastric tube. However, there is still a risk of blockage which can be unblocked as mentioned above.
• The entry site in the abdomen has now been proven best to be left uncovered as using a dressing as normal practice has been found to cause more infections than it prevents. Dressings should only be used in remedial circumstances.

Procedure

1. Establish with Registered Practicioner when and what the client need to be given.
2. Gain informed conscent with the client by explaining the procedure and ensuring that the client understands
3. Check that the feed is well mixed and is in date and is the feed that has been prescribed.
4. Turn off the feeding pump and unscrew the joint between the PEG catheter and the giving set.
5. Remove the used bottle.
6. Unscrew the top of the new bottle and place the giving set on the end of the new bottle. Ensure that the thread is located correctly on the bottle as incorrect location can cause air to enter the bottle and the pump failing.
7. invert the bottle and allow an small amount of fluid to fall into the viewing chamber.
8. Prime the tube so that no air enters the clients stomach when the feed commences.
9. Re-attatch the tube to the PEG tube and place the inverted bottle into the pump as required
10. Ensure that the speed to the pump is set at the prescribed speed.
11. Ensure that the giving set is set to fully on as this will cause the pump to fail.
12. Turn on the pump and regularly observe to monitor if it is working correctly and to not any problems
13. Record actions and what has used/initiated in the relevant part of the client’s care plan.

Flushing the tube

The tube needs to be flushed before and after feeds. Within the regimens of the feeding regime may be the need to give an amount of water prescribed.

This can be done between steps 4 and 5 above.

Procedure

1. Attach an inverted catheter-tipped 50ml syringe to the end of the PEG (or Nasogastric) tube
2. Ensure, at this point, that the gate on the tube is off.
3. Pour the required amount of fluid into the syringe and open/close the gate as open.
4. Remove the syringe and either close the end of the tube or reattach feed and re-commence as necessary
5. Record all activity and amounts in the relevant part of the client’s care plan (ie on a fluid chart.)

posted by alanpjack  # 5:40 AM