Umm Al-Qura University Applied Medical Sciences Nursing Department Pediatric Nursing Course

1. Umm Al-Qura UniversityApplied Medical Sciences Nursing DepartmentPediatric Nursing Course GAVAGE FEEDING Ms. Ahdab Faisal Eskandar

2. -Objectives: At the end of this lab the student will be able to : • Define the Gavage feeding • Enumerate the indication and contraindication for Gavage feeding • List possible Gavage complication • Practice Gavage feeding (check placement-feeding-flushing-follow up care) • Document findings in nursing chart process

3. Outlines:- • Definition of Gavage feeding • Indications & contraindication for Gavage feeding • Potential Complication • Feeding process • Nursing care • Documentation

4. Definition: Gavage feeding is providing food via a nasogastric Tube catheter(NGT) passed through the nares, past the pharynx, down the esophagus, and into the stomach, slightly beyond the cardiac sphincter.

6. Feeding via NGT Nasogastric tube are used more frequently than orogastric tubes. It is inserted to provide nutrition , to decompress stomach , or to empty stomach of its contents in preparation for surgery or lavage.

7. Indications:- • To provide a method of feeding or administering medication that requires minimal patient’s effort, when the infant is unable to suck or swallow. • To prevent fatigue or cyanosis that occur from nipple feeding. • To provide a route that allows adequate calories or fluid intake.

8. Contraindication:- • In case of Absent bowel sounds

9. -Complications: • nasal airway obstruction • Aspiration pneumonia • Ulceration or stomach perforation • irritation of the mucous membrane • incompetence of esophageal-cardiac sphincter • epistaxis

10. Nursing Alert! Administration of feeding solution into an improperly placed tube may cause aspiration of the feeding into the lungs.

11. Differences between Types of feeding:

13. Enternal Feeding Pump Tubing for Feeding Pump

14. Feeding Procedure

15. Equipment: • Suction machine and catheter • Stethoscope • Feeding fluid (formula) as prescribed . • Clear calibrated reservoir for feeding fluid or • Catheter tip syringe 20 ml • Cup of water • PH paper

16. Steps:- • Check feeding order e.g. (Gavage 30ml Pediasure+ 10 ml flushing q6h) • Explain the procedure to child (pre school age , school age or adolescent). Family member if infant. • Provide privacy • Perform hand washing • Have the suction apparatus readily available. • Don disposable gloves

17. Steps:- • Position : high Fowler's position if child. If an the infant on his side or back with a diaper roll placed under his shoulder, a mummy restraint may be necessary to help maintain this position. • Assess child respiratory status and color.

18. Steps:- • Check placement of tube before each feeding using on of these method: a. Inject 3-5 ml air into the catheter and the stomach. At the same time listen to the typical growing stomach sound with a stethoscope placed over the epigastric region. b. chest X-ray to confirm the correct placement read by physician .

19. Steps:- c. Put the end of the catheter in cup filled with water , if you see bubbles the tube is in the lung . d. Aspirate small amount of stomach content and test acidity by pH tape.( 3 or under) e. Observe and gently palpate abdomen for the tip of the catheter. Avoid inserting catheter into the infant’s trachea.

20. Steps: • Aspirate tube before feeding begins: a. If over ½ the previous feeding is obtained, withhold the feeding. b. If small residual of formula is obtained discarded it and subtract that amount from the total amount of the formula to be given.

21. Steps: • Pour the feeding formula .Be careful no air should go in the catheter.

22. Feeding • The flow of feeding should be slow: Do not apply pressure. Elevate syringe 15-20cm, above the patient’s head. Rationale: The rate of flow is controlled by the size of feeding catheter: the smaller the size, the lower the flow.

23. Feeding <Food taken too rapidly will interfere with peristalsis, causing abdominal distention and regurgitation.>

24. Feeding • Feeding time should last approximately as long as when a corresponding amount is given by nipple 5ml/5-10 minutes or 5-20 minutes total time.

25. Feeding • When the feeding is completed, the catheter may be flushed with clear water. Before the fluid reaches the end of the catheter clamp it off Rationale: If air enters the stomach and causes abdominal distention.

26. Feeding • Tube need to be changed every 48-72 hours (use alternate side of the nares).

27. Follow up care • Burp the baby Rationale: Adequate expulsion air swallowed or ingested during feeding will decrease abdominal distention and allow for better tolerance of feeding. • Place the patient on right side or on abdomen for at least 30 minutes. Rationale: To facilitate gastric emptying and minimize regurgitation and aspiration.

28. Follow up care • Observe condition after feeding: bradycardia and apnea may still occur. • Note any vomiting or abdominal distention. Rationale: Due to over feeding or too rapid feeding. Regurgitation of 1-2ml may occur in the premature infant as the sphincter of the GIT is relaxed and allow for easy reflux.

29. Follow up care • Note infant’s activity. Rationale: Fatigue or peaceful sleep

30. -Documentation: a. Accurately describe and record procedure including : • time of feeding • type of Gavage feeding • type and amount of fluid given • amount retained or vomited • how the patient tolerated feeding • activity before, during and following feeding.

31. Conclusion • Definition • Indication and contraindications • Possible complications • Tube insertion • Feeding • Follow up care • Documentation

32. References: • Nurses guide to clinical procedures 5th edition written by jean smith temple and Joyce young Johnson 2007 Chapter feeding • Clinical skills manual for pediatric nursing. Binder and Ball 2003. third edition. Pages 117-118 • http://en.wikipedia.org/wiki/Feeding_tube • http://www.nursing-nurse.com/procedure-for-gavage-feeding-pediatric-120/

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