NG feedings are delivered through a feeding tube introduced through the nose into the stomach, while NI feedings are delivered through a feeding tube introduced through the nose into the small intestine.
Placement should be assessed at regular intervals, typically every 4-6 hours, and before administering formula or medications.
Elevating the head of the bed reduces the risk of aspiration and subsequent pneumonia by preventing reflux of the formula into the oropharynx and lungs.
Use the formula within 2 hours of removal from the refrigerator, employ clean techniques when handling the formula, and minimize handling during preparation.
Radiographic confirmation is the gold standard for verifying the placement of any blindly inserted enteral feeding tube before its initial use.
Proper oral hygiene promotes patient comfort and can help reduce complications such as infections or sores.
Signs of displacement include changes in the external length of the tube, respiratory distress, and unexpected changes in the patient's condition such as coughing, dyspnea, or decreased oxygen saturation.
Nasal feeding tubes can cause sinusitis, otitis, vocal cord paralysis, and medical device-related pressure injuries to the nose.
Surgically or endoscopically placed tubes into the stomach or intestine are preferred for long-term feeding because they offer a more stable and secure method for patients who require prolonged enteral nutrition.
Consider the anticipated duration of feeding, gastric emptying, GI anatomy, and the risk for gastric reflux.
ENFit connectors improve patient safety by preventing misadministration of enteral feeding or medication by the wrong route, as they are not compatible with Luer-Lok connections or other small-bore medical connectors.
A prokinetic agent, like metoclopramide, may be given to assist with the advancement of the tube beyond the pylorus, especially if placement into the small intestine is desired.
The main risks include pulmonary complications, such as improper placement into the esophagus or pulmonary system, and potential aspiration of gastric contents.
Concerns may include the impact on quality of life, loss of social interaction during meals, and the emotional burden of managing long-term tube feeding.
The tube should be flushed with 30 mL of water before, between, and after each medication and before an intermittent feeding is administered.
The site should be cleaned with warm water and mild soap or saline, kept dry, and protected with a thin layer of protective skin barrier if necessary. A drain-gauze dressing should be applied if ordered.
