• Keep the tube patent or unobstructed ,
• Label the tube if double or triple lumens tubes are used(aspiration, feeding, baloon inflation).
• Promoting and restoring patency with intermittent suctioning
• • Assess tube patency frequently by monitoring the volume and characteristics of drainage.
  • Flush feeding tubes with 30-60 ml of water immediately before and after administering tube feeding .
  • Observe for sign and symptoms suggesting obstruction(nausea, vomiting and abdominal distention).
  • Irrigate to maintain or restore patency . Routinely assess the patients gastric residual (volume of liquid within the stomach),overfilling the stomach can cause gastric reflux, regurgitation, vomiting aspiration and pneumonia. Gastric residual volume should not be more than 20% of the previous hours feeding volume.
• When beginning enteral feedings, monitor the patient for feeding tolerance. Assess the abdomen by auscultating for bowel sounds and palpating for rigidity, distention, and tenderness. Know that patients who complain of fullness or nausea after a feeding starts may have higher  gastric residual volume. On an ongoing basis, monitor patients for gastric distention, nausea, bloating, and vomiting. Stop feeding and notify the senior staffs if the patient experiences acute abdominal pain, abdominal rigidity, or vomiting.
• Clearing an obstruction: Clear the tube with solution. When obstruction cannot be cleared, the tube is removed and another tube is inserted rather than compromising nutrition.
• Reduce risk of aspiration: Elevate head of bed at least 30-45 degree during feeding and for at least 1 hour after feeding. Monitor residual volume.
• Provide adequate hydration that is increase fluid intake.
• Maintain oral and nasal hygiene.
  • Keep the nares clean, especially around the tube where secretion tend to accumulate.
  • Inspect the skin for irritation, change the tape in 2 to 3 days. Apply lubricants to the patient’s lips and nostril. It will help to control local irritation from the tube in the throat. Allow the patient to verbalize their feelings.
  • Provide oral care that is flushing and cleansing of mouth by plain water or chlorhexidine mouth wash.

Monitoring and managing potential complications

Complication may arise. If so immediately inform senior staffs.

• Fluid volume deficit
• Pulmonary complication
• Aspiration
• Vomiting
• Tube related irritation may occur in nostril, oral mucosa, oesophagus and trachea