Can anyone give me advice on NG feeding?

[lostinlace]

Can anyone with experience of this give me some advice/reassurance? I'm looking after someone who uses a gastronasal tube & am struggling to operate it properly when checking pH levels. On one occasion, tried to draw up liquid from the stomach and felt as though there was a vacuum (sp) and had to pull really hard to get anything. Have read on some nhs factsheets that this is common but are there ways to prevent in when the person being fed is very immobile?

Also, is there a trick to attaching the feed to the tube, when I tried to do it first time the feed came through with loads of air bubbles, then when I did break it properly I forgot to tighten up the plastic screwy bit & it leaked (oops).

Sorry for all the waffle and hope there is someone who can advise. I'm all fingers and thumbs with it and really want the person I'm helping to feel confident in me.

Thanks.

My daughter had a ng tube for 7 months and now has a peg. The vacuum you discuss is normal, you should try changing the persons position, roll them onto their side usually works. Sometimes by putting some air down the tube will help move it, this will then give you a ph reading too.

Im not quite sure of the way you are delivering your feed, so wouldnt want to advise you on that.

The fingers and thumbs will pass, and it becomes almost second nature to you.

Hi there, my daughter was NG fed for 18 months and I am a nurse so might be able to help.

Getting nothing on aspiration, or feeling that the tube is stuck usually means the end of the tube is against the stomach wall. Has it been a while since the last feed? The stomach shrinks some hours after a feed.

Don't pull back too hard if you get the vacuum, as you could irritate or even damage the stomach lining. Either change the person's position - rolling them onto their side usually helps - or put 5 mls of water down the tube and then aspirate. Putting the water down usually moves the end of the tube away. The aspirate will be more dilute but should still turn the litmus paper pink.

Not sure what you mean about the feed - what system are you using? Bags or bottles? A few bubbles don't matter if they are small but big ones can give the person wind! Bubbles also prevent the feed going through at a regular rate.

agree with what mulsey says and it really does become second nature i'm always saying i should become a nurse now.

Hi, thanks for your help. (Think you're all wonderful by the way, I'm doing this as part of my job & can't imagine what it would be like if it was one of my children.) Told myself to think & stay calm & have managed to get the hang of it now. You're right, putting a bit of air in made all the difference & have started to notice that doing a pH test straight after a feed is never a problem but several hours later is when I need to try different tactics.

Worked out what I was doing wrong with the feed bag - was trying to pierce the film with the wrong bit of plastic. We only had a very quick demonstration from the nurse & I learn better by doing than watching.

Can I ask another couple of questions? When you do the pH test do you do a water flush afterwards to rinse the tube out? And if the tube has risen out of the stomach a tiny bit (it's got a line marked where it should be next to the nostril) is it ok just to push it back in (that's what I've been told to do but would like a 2nd opinion)?

Thanks again, lostinlace.

Hi again,

The pH test should be done before the feed, not after, so you don't need to flush the tube as the feed will do that.

And if the tube has shifted slightly, you can only push it back down if it has only moved a very small amount. If it has moved a fair bit then technically it should be removed and replaced with a fresh tube, as it could have shifted and the end could be out of the stomach. Especially if you are tube feeding a baby or infant as the tube is pretty short anyway, and it won't take much to pull it out of the stomach.

If you need some more help you ought to ask the nursing team to show you again as you need to be confident with what you are doing. I'm sure they will be more than happy to go through it again with you if need be.