FINE BORE NASOGASTRIC FEEDING TUBES

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FINE BORE NASO-GASTRIC FEEDING TUBES

• Linda Kenny
• Matron
• Nutrition Service

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OBJECTIVES OF THE SESSION

• Discuss current placement practice
• Review of care post insertion
• Daily care of the tube (NPSA Feb 2005)
• Contact details on discharge
• Current process for replacing Naso gastric tubes
  www.yorkshire-cancer-net.org.uk or
  www.leedsth.nhs.uk/

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CLINICAL RISK MANAGEMENT

• National Patient Safety Agency (NPSA Feb 2005)
• Reported 11 deaths in 2 yrs from
• Nasogastric tube misplacement

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TYPES OF NG TUBES IN USE for feeding

• Short term feeding (lt 30 days)
• Fine bore feeding tube Corflo 8FR 92cm

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IMMEDIATE AFTERCARE

• Aspirate gastric content pH 0 5.5
• If raised pH check drugs ie PPI,H2 antagonists,
  antacids
• X-ray BTH policy gold standard
• Mark measure tube to see any movement
• Remove guide wire
• DOCUMENT DATE,TIME,TYPE,LENGTH,PH,DR CONFIRMING
  POSITION

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CONFIRMING POSITION

• Tube position should be checked and risk
  assessment carried out
• On insertion
• Before feed/medication
• Following vomiting/coughing/suction
• At least once during continuous feed
• If external length of tube changed
• Ever a concern could not be in stomach

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ONGOING PATIENT CARE

• Clinical judgement, experience risk assessment
  for each patient ( see draft care plan)
• Follow NPSA Feb 05 flow chart
• pH indicator test
• Measure external tube length
• DOCUMENT each time

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• CARE OF NASOGASTRIC (Fine Bore) FEEDING TUBE
  draft 07/05
• Name
  Hospital No Ward
  Cons
• STATEMENT Patient is unable to meet their
  nutritional requirements via oral route,
• so requires Fine Bore Nasogastric
  Feeding.
• GOAL To ensure Nasogastric Feeding is
  administered safely according to the Trust
  Nutrition Policydocument and DOH guidelines NPSA
  05
• ACTION
• Please check that at Initial Insertion an
  X-ray has verified gastric location of tube and
• this is documented in the medical notes.
• The tube is marked with a permanent black
  marker and document in cms length of tube
• insertion in box below
• The patient is assessed by a dietitian
  and feeding regimen written
• Initial placement confirmed at patients
  nose.....cm
• pH if obtainable.

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ADMINISTRATION

• Patient comfort/reassurance -dry/cracked
  nostrils/mouth wash
• Check tape fixation/allergies
• Flushing tube pre-post feeds
• Flush 4-6hrly if not using
• Drugs in liquid form
• Position of patient 45

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CONTACT DETAILS ON DISCHARGE BTHNHSFT

• Advice on type of feeds, regimes problems
  relating to feeds
• Dietitan 01274 364097
• Advice on any aspect of care of NG
• Your District Nurse
• Diane Bickerdyke 07818427877(Abbott
  Nutrition Nurse)
• Discharging ward
• Advice on delivery dates, request giving sets
  problems with pumps
• Hospital To Home
• Monday to Friday 9-00-5.30pm Tel 0800
  0183799
• Out of Hours 5.30pm-9.00pm anytime over
  weekend
• Tel [phone]

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REPLACING NASOGASTRIC TUBES

• Head Neck Cancer patients in the Yorkshire
  Cancer Network
• Leeds - contact discharging ward/hospital
• Bradford-ENT Sr/Nurse in Charge ,Wd 18 BRI Tel
  01274 364396
• - MAX FACs Sr/Nurse in Charge
  ,Wd 19 BRI Tel [phone]
• York Harrogate
• Sister/Nurse in Charge ,Wd 27,York District
  Hospital Tel [phone]
• Calderdale Huddersfield
• Sr/Nurse in Charge, Ward 8C,Calderdale Royal
  Infirmary Tel[phone]
• Wakefield-Sister/Nurse in Charge ,Ward
  3,Pinderfields General Hospital
• Tel[phone]
• Dewsbury
• Sister/Nurse in Charge ,AE Department
  ,Dewsbury District Hospital,Tel[phone]
• Airedale
• -Ring Airedale General Hospital(01535
  652511) and ask for the Bed Manager

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FUTURE DEVELOPMENTS

• Await updated guidance for Head Neck Cancer
  patients ( due Oct 06) in NG tube replacement
• www.yorkshire-cancernet.org.uk
• Review current process for NG tube replacement