12.14 : Enteral Nutrition I: Orogastric and Nasogastric Feeding

Enteral nutrition delivers nutrients directly to the stomach or small intestine through a tube. This method is appropriate for patients who cannot eat but still have a functioning digestive system. It is also beneficial for individuals with swallowing difficulties, anorexia, malabsorption, or those who have undergone gastrointestinal (GI) surgery.

Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over parenteral nutrition (directly into the bloodstream) when the GI tract is functional because it helps maintain gut integrity and function.

Orogastric (OG) Feeding

Orogastric feeding involves the placement of a feeding tube through the mouth into the stomach. This method is typically used for infants or patients in emergencies due to its relative ease of insertion and the discomfort it causes in adult patients when awake. It is also often used for short-term feeding when nasal passages are obstructed, or nasogastric feeding is impossible due to nasal injuries. The process includes:

1. Tube Placement: A flexible tube is gently inserted through the patient's mouth, the esophagus, and the stomach. The placement is typically confirmed by measuring the pH of stomach contents or through imaging techniques.
2. Nutrient Delivery: Once the tube is in the correct position, liquid nutrition formulas or blended diets can be administered directly into the stomach. The feeding schedule can be continuous or at set intervals, depending on the patient's needs. OG tubes can also be used for decompression (removal of air or fluids) of the stomach in certain medical conditions.

OG feeding is generally less comfortable for awake patients due to the tube's presence in the mouth and throat, making it less suitable for long-term use in conscious patients.

Nasogastric (NG) Feeding

Nasogastric feeding involves the insertion of a feeding tube via the nose, down the esophagus, and into the stomach. It is generally more comfortable and less obtrusive than OG feeding, allowing for better speech and oral hygiene. The NG feeding process includes:

1. Tube Placement: A thin, flexible tube is inserted through the nostril, advancing through the esophagus until it reaches the stomach. Proper placement is crucial and is verified through the same methods as OG feeding.
2. Nutrient Delivery: Specialized liquid nutrition formulas are administered through the tube. Like OG feeding, the administration can be continuous or scheduled, depending on the individual's nutritional requirements and tolerance. NG tubes can also be used for decompression (removal of air or fluids) of the stomach in certain medical conditions.

Considerations and Monitoring

Nursing interventions for tube feeding are crucial for ensuring the safety and effectiveness of enteral nutrition through orogastric (OG) or nasogastric (NG) tubes, focusing on accurate tube placement, patient safety, and preventing complications.

1. To verify tube placement, nurses measure the tube's external length to detect any shifts, examine the aspirate's color and pH to confirm stomach placement (pH ≤ 5 indicates gastric placement), and assess bowel sounds to ensure the GI tract's readiness for feeding.
2. Safety during feeding is enhanced by using enteral-safe drugs, ensuring medications are compatible and do not clog the tube, and elevating the bed head 30-45 degrees to minimize the risk of aspiration pneumonia.
3. Monitoring for complications involves vigilance for signs of aspiration, such as coughing or wheezing, and monitoring for abdominal distention or discomfort, nausea, vomiting, or diarrhea, which may indicate intolerance to the feed. Nurses adjust the feeding regimen or conduct further evaluations as needed.
4. The patient's nutritional needs must be regularly assessed and adjusted based on their clinical condition.

This comprehensive approach promotes a safe and effective enteral feeding process, contributing significantly to patient care and recovery.