1 GAVAGE FEEDING Ms. Ahdab Faisal Eskandar Umm Al-Qura University Applied Medical Sciences Nursing Department Pediatric Nursing CourseGAVAGE FEEDINGMs. Ahdab Faisal Eskandar
2 -Objectives: At the end of this lab the student will be able to : Define the Gavage feedingEnumerate the indication and contraindication for Gavage feedingList possible Gavage complicationPractice 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 feedingPotential ComplicationFeeding processNursing careDocumentation
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 NGTNasogastric 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 perforationirritation of the mucous membraneincompetence of esophageal-cardiac sphincterepistaxis
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: usually with syringe and by gravity onlyNeed caution to prevent air from entering stomachAlso called GavageIntermittentWith Pump machine and order rate and timeAir sensorAlso called bolusContinuous infusion
15 Equipment: Suction machine and catheter Stethoscope Feeding fluid (formula) as prescribed .Clear calibrated reservoir for feeding fluid orCatheter tip syringe 20 mlCup of waterPH 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 privacyPerform hand washingHave 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 syringe15-20cm, 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 FeedingFeeding time should last approximately as long as when a corresponding amount is given by nipple 5ml/5-10 minutes or minutes total time.
25 FeedingWhen the feeding is completed, the catheter may be flushed with clear water. Before the fluid reaches the end of the catheter clamp it offRationale: If air enters the stomach and causes abdominal distention.
26 FeedingTube need to be changed every 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 careObserve 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 feedingtype of Gavage feedingtype and amount of fluid givenamount retained or vomitedhow the patient tolerated feedingactivity before, during and following feeding.
31 Conclusion Definition Indication and contraindications Possible complicationsTube insertionFeedingFollow up careDocumentation
32 References:Nurses guide to clinical procedures 5th edition written by jean smith temple and Joyce young Johnson 2007 Chapter feedingClinical skills manual for pediatric nursing. Binder and Ball third edition. Pagesgavage-feeding-pediatric-120/