Gastric Gavage is a means of supplying nutritional substance via a small plastic tube direct to the stomach. This post will help you understand on how to perform feeding via gastric gavage.
Objective of Gastric Gavage
- To provide a means of alimentation when the oral route is inaccessible.
Indications of Gastric Gavage
- Gastrointestinal diseases and surgery
- Hypermetabolic states (burns,multiple trauma,sepsis,cancer)
- Certain neurologic disorders (stroke and coma)
- Following certain types of surgery (head and neck, esophagus)
Contraindication of Gastric Gavage
- Absent bowel sounds
After Care of Gastric Gavage
- Wash or let the significant other of the patient do the washing of the materials used in feeding.
- Keep all the materials used in its proper place.
- Refrigerae the osterized feeding.
Charting of Gastric Gavage
- Describe and record procedure
- Time of feeding
- Type of Gavage feeding
- Type and amount of fluid given
- Amount retained or vomited
- Patient’s reaction to the procedure.
Equipment Needed for Gastric Gavage
- Feeding fomula
- Calibrated drinking glass
- Acepto syringe
- Medicine glass with tap water
Gastric Gavage Nursing Interventions & Rationale
|Explain procedure to client.||Facilitates cooperation and provides reassurance for client.|
|Assemble equipment. Check amount, concentration, type and frequency tube feeding on client’s chart.||Provide for organized approached to task. Ensures the correct feeding will be administered.|
|Wash your hands.||Handwashing deters the spread of microorganisms.|
|Position client with the head of bead elevated at least 30 degrees angel or as near normal position for eating as possible.||Minimize possibility of aspiration into trachea.|
|Unpin tube from client’s gown and check to see that the gastric tube is properly located in the stomach.||Even when initially positioned correctly, a gastric tube left in place can become dislodged between feedings. The instillation of water or nourishment could lead to serious respiratory problems if a gastric tube is in the trachea or a bronchus, rather than in a stomach.|
|Aspirate all gastric contents with syringe and measure. Return immediately through tube and proceed with feeding if amount of residual does not exceed policy of agency or physician’s guidelines. Disconnect syringe from tubing.||This indicate gastric emptying time. A residual of more than 50% of the previous hour’s intake is significant and must be reported to physician. Fluid should be returned to stomach so as not to cause any fluid or electrolytes losses.|
|When using Asepto sringe or Toomey syringe:
a.Remove plunger or bulb from syringe and attach syringe to nasogastric tube which has been pinched with finger and introduce the prescribed amount slowly.
b.Hold the syringe approximately 12 inches above the stomach. Allow solution to run in by gravity. Raise the syringe to increase the rate of flow, and lower the syringe to decrease the rate of flow.
c.Do not let the syringe empty while introducing the nourishment.
d.Introduce 30ml – 60mL (1 oz – 2 oz) of water into the tube after the nourishment is introduced.
e.Clamp the gastric tube immediately after nourishment and water are instilled. Disconnect the syringe and cover end of tubing with gauze secured with rubber band.
|a. The syringe acts to receive the nourishment. Introducing the nourishment slowly gives the stomach time to accommodate the fluid and decreases gastrointestinal distress.
b. Nourishment enters the stomach by gravity when gastric gavage is used.
c. This technique prevents air from being forced into the stomach when the syringe is refilled.
d. Washing the gastric tube with water forces remaining nourishment in the tube into the stomach and prevents nourishment from adhering to the tube and souring.
e. Clamping the tube prevents nourishment from draining back into the tube and air from entering the stomach. Cover on end of the tube deters entry of microorganisms and protects client and linens form any fluid leakage from tube.
|When using a feeding bag:
a.Hang bag on IV pole and adjust to about 12 inches above the stomach. Clamp tubing and pour formula into the bag. Release clamp enough to allow formula to run through tubing. Close clamp.
b.Attach tubing to nasogastric tube, open clamp and regulate drip according to physician’s order.
c.Add 30 ml – 60 ml (1 oz – 2 oz) of water to feeding bag when feeding is almost completed and allow to run through tube.
d.Clamp the tubing immediately after water has been instilled. Disconnect from nasogastric tube and cover gauze secured with a rubber bad.
|a. Formula displaces air in the tubing
b. Introducing the formula at a slow, regular rate allow the stomach to accommodate the feeding and decreases gastrointestinal distress.
c. Water rinse the feeding from the tube and helps to keep it patent.
d. Clamping the tube prevents air from entering the stomach. Cover on end of nasogastric tube deters entry of microorganisms and protects client and linens from any fluid leakage from tube.
|When using pre-filled tube feeding set-up:
a.Remove screw-on cap and attach administration set-up with drip chamber and tubing. Hang set on IV pole and adjust to about 12 inches above the stomach. Clamp tubing and squeeze drip chamber to fill one-third to one-half of capacity. Release clamp and run formula through tubing. Close clamp.
b.Follow steps 8b and 8d. Feeding pump may be used with the tube feeding set-up to regulate drip.
|a. Formula displaces air in tubing.|
|Observe client’s response during and after tube feeding.||Pain may indicate stomach distention which may lead to vomiting.|
|Have client remain in upright position for at least 30 minutes after feeding.||This position minimizes risk of backflow and discourage aspiration should any vomiting occurs.|
|Wash and clean equipment or replace according to agency policy. Wash your hands.||Prevents contamination and deters spread of microorganisms.|
|Record type and amount of feeding and client’s response. Monitor urine or blood glucose if ordered by physician.||Provides accurate documentation or procedure. Many feedings contain high loads of carbohydrates.|