/ Policy Title: Feeding Tubes
Category:
Number
Date Originated:
January 2014 / Effective Date:
Last Review Date:

PURPOSE:

The narrow bore nasogastric feeding tube is designed for trans-nasal passage into the stomach, duodenum, or proximal jejunum for continuous pump/tube feeding. The purpose of this procedure is to provide guidelines for safe insertion and maintenance of narrow bore nasogastric feeding tubes.

POLICY:

Placement:

  1. All patients who are ordered on internal feeding via narrow bore nasogastric feeding tubes will have tube placed under fluoroscopy by a licensed health care professional during normal working hours (M-F 8 a.m.- 5 p.m. also Saturday, Sunday and holidays 8 a.m. - 12 noon), as ordered by the attending physician.
  2. If a patient's tube is pulled out after normal working hours, re-insertion will not take place until the following day. If the tube is pulled out during normal working hours, imaging services will be contacted for re-insertion, if ordered by the attending physician.
  3. The following criteria are utilized to identify a highrisk patient:
  4. Unable to follow swallow commands due to dysphagia or neurologic impairment.
  5. Diminished gag reflex.
  6. Anatomical abnormality along placement pathway (e.g. tumor, post radical neck surgery, post esophageal surgery)
  7. Patients with tracheostomy and/or E.T. tube.
  8. The nursing staff must take adequate precautions to prevent the patient from pulling out the tube or from the tube being pulled out inadvertently while caring for the patient. This may include obtaining an order to restrain the patient, assuring the tube is adequately taped to the nose, and securing the tube to the face.
  9. If a narrow bore post pyloric tube becomes dislodged in the evening or night hours, the tube may remain out until it can be reinserted by Imaging services the following day. The attending physician should be contacted regarding the interruption of the tube feeding.
  10. If the patient is at extreme risk for dehydration and is not receiving fluids by other means or the feeding tube is needed to administer essential medications, the attending physician must be contacted at the time the tube is dislodged to determine if thisdelay is appropriate. A radiologist may be called in by the attending physician if deemed absolutely necessary that the narrow bore post pyloric tube be replaced immediately.
  11. When a tube is accidently pulled out, the tube may be rinsed with warm water and reused for this patient. Inspect the tube and stylet to assure it is intact, safe and patent prior to

re-insertion.

In addition to this policy, the following guidelines have been established by the Radiologists at Inland Imaging:

-No request for placement of a nasogastric feeding tube during normal business hours will be denied without first consulting a Radiologist.

-If a mid-level provider has initiated placement of a nasogastric feeding tube and cannot complete the placement for any reason – a Radiologist must be asked to assist with the placement before the attempt is aborted.

-If a mid-level provider has used 5 minutes of fluoro in an attempt to place a nasogastric feeding tube, a Radiologist will be asked to assist with the placement.

-After placement of a nasogastric feeding tube for the third time on any patient, a Radiologist will be asked to contact the referring physician and recommend a more permanent solution to the patient’s nutritional needs.

Maintenance:

  1. Administer tube feeding or medication as ordered.

- it is highly advised that trying to flush crushed solid medication down a feeding tube

be avoided

  1. Do not use an infusion pump that can deliver pressures greater than 40 psi since excessive pressure can cause the feeding tube to rupture
  2. Do not use a syringe smaller than 50cc to irrigate or aspirate with, since it is possible to exceed pressure limits with smaller syringes. Use only a 50cc syringe that has a regular tip, not an irrigating or luer lock.
  3. To maintain patency, irrigate feeding tube with 20-25cc of sterile water at least every 3-4 hours when patient is receiving intermittent feedings. Irrigate every 6 hours for continuous feedings.
  4. Irrigate with every bag change or as ordered.
  5. Keep stylet in patient’s room in case it is needed for tube reinsertion.
  6. Maintain patient in a semi-Fowler’s position to reduce risk of aspiration.

REVISION HISTORY
Date of Revision / Revision Explanation / Author

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