In an emergency, get medical help immediately. This guide is general information and doesn't replace advice from a doctor or nurse.
- Keep the tube patent or unobstructed.
- Label the tube if double or triple lumen tubes are used (aspiration, feeding, balloon inflation).
- Promote and restore 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 signs and symptoms suggesting obstruction (nausea, vomiting and abdominal distention).
- Irrigate to maintain or restore patency. Routinely assess the patient's 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 hour's 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 staff if the patient experiences acute abdominal pain, abdominal rigidity, or vomiting.
- Clearing an obstruction: Clear the tube with solution. When an obstruction cannot be cleared, the tube is removed and another tube is inserted rather than compromising nutrition.
- Reduce the risk of aspiration: Elevate the head of the bed at least 30-45 degrees 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 secretions tend to accumulate.
- Inspect the skin for irritation and change the tape in 2 to 3 days. Apply lubricants to the patient's lips and nostrils. This 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 the mouth with plain water or chlorhexidine mouthwash.
Monitoring and managing potential complications
Complications may arise. If so, immediately inform senior staff.
- Fluid volume deficit
- Pulmonary complications
- Aspiration
- Vomiting
- Tube-related irritation, which may occur in the nostril, oral mucosa, esophagus and trachea