Registered Mental Health Nursing (RMN)
TUBE FEEDING A HYPOACTIVE PATIENT
This is the act of meeting the daily nutritional requirement of a hypoactive patient through the gastric/nasogastric tube. It is usually carried out in instances where the psychiatric patient refuses food/unable to swallow safely.
Purpose
- Maintain right amount of patient’s daily nutritional status
- Keep patient hydrated
- Boost the energy level of patient
- Promote recovery
Equipment
- Trolley containing the following:
- Top shelf: A clean tray containing:
- Nasogastric tube e.g. Ryles tube in a sterile receiver ii. Sterile syringe (10mls)
- Glass of water
- Liquefied food
- Measuring mug
- Clean swabs
- A jar of water
- Intake and output chart
- Disposable tissue paper
- pH strips/blue litmus paper to test gastric aspirate
- Oral medication – if due for administration
- Lubricant
- Sterile gloves
- Food thermometer
- Bottom shelf
- Hand washing bowl
- Hand washing soap
- Receiver for used swabs
- Mackintosh/protective covering
- Assisting nurse(s)
Procedure steps
- Establish rapport (Refer procedure)
- Explain procedure to the patient
- Provide privacy and send prepared feeding trolley to patient’s bedside in the company of the assisting nurse(s)
- Assist patient into a fowler’s position in bed or a sitting up position in a chair or a slightly elevated right side lying position
- Ask the assisting nurse(s) to support the patient’s head
- Perform hand hygiene and assist patient to do same
- Cover the patient’s chest with a protective material
- Check for proper placement of tube in the stomach by:
- aspirating abdominal contents for a typical gastric fluid appearance (grassy-green, colourless with mucus shreds) OR
- injecting 5 -20cc of air through the tube and auscultate epigastric region with a stethoscope and listen for the whooshing sound simultaneously indicating proper positioning of the tube
- Test the aspirate with a blue litmus paper which changes to red indicating the aspirate is coming from the stomach - acidic
- Check temperature of food using a food thermometer/by dropping a little amount on the back of hand (food should be at room temperature of 20-250C)
- Pinch tube and remove spigot/stopper of NG-tube, push 10 – 15mls of water through the tube just before food is introduced
- Connect syringe with food to tube, release the pinch and allow the food to run by gravity
- Ensure tube is never allowed to empty completely to prevent air from entering patient’s stomach
- Continue feeding and observe patient for signs of discomfort till feeding is completed
- Run water (10 –15 mls) through the NG-tube after feeding
- Remove the syringe, clean the tip of the tube and fix the spigot/stopper and secure the NG-tube on the patient’s cheek
- Monitor for the retention of the NG-tube to prevent the patient or other patients from removing the tube
- Assist patient to remain in the sitting up position for at least 30 minutes after feeding
- Remove protective material and put patient in a desired position
- Assist patient to perform hand hygiene and express appreciation
- Clear the trolley and perform hand hygiene
- Document procedure and any observations made in intake and output chart, nurses’ notes/patient’s folder
References and further reading
Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.
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