Eating with NGT?

KBICU · Feb 12, 2013

Ok I am working on my care plan for tomorrow morning and I'm having a hard time figuring out what a lot of the information I got from the chart means. My patient has a NGT and I kept seeing Boost VHC and juice listed as their PO intake. Then I read somewhere else that the pt. goal was to have PO added to boost VHC. Since I have never even seen an NGT, other than in the lab, I have no clue if they are feeding this patient the boost through the NGT or what. One of my main questions is why are they feeding a patient who has a NGT? I thought that patients with NGT can't eat/drink, because of risk of aspiration. I'm very confused, stressed, and tired...so any help with this would be appreciated.[/quote']
NGTs are used for a variety of reasons...it may help to read more about what conditions require NGTs. To give meds to your patient who was NPO with a NGT youd have to crush them (if crushable) and mix in sterile water. Patients can eat/drink with them in place. Many patients have NGTs for gastic decompression/obstruction/ileus so alot of the time they are NPO, but the diet gets advanced as tolerated. Why did your patient have the NGT? It is possible to give tube feedings through the NGT (although central line access is preferred where I work), but it would be helpful to know why your patient had the tube.
Hope this helps :)

Double-Helix, BSN, RN · Feb 12, 2013

Let's think about this clinically for a moment. What goes an NG tube do? And NG tube goes from the nose to the stomach and can put things into or take things out of the stomach (suction). What things go through an NG tube? Medications go through the tube. So do enteral feedings. Since the NGT deposits food in the stomach, and eating deposits food in the stomach, why would an NGT be a contraindication to PO feeds? Over-distension of the stomach from a tube feeding that is too high in volume or rate can increase gastric reflux and increase the risk for aspiration, (which is why residual volume should be checked periodically and when changing the rate or volume of a feeding) but simply having an NGT does not contraindicate PO feeds.

Having an NGT that is to suction for gastric decompression, however, makes PO feeding rather pointless, since what goes in will come back out. Sometimes a doctor will allow ice chips of sips of water when a patient has an NGT to suction, purely for patient comfort.

There's lots of reasons that someone might have an NGT. When it's not placed post/intra-operatively, one of the most common reasons is for supplemental feeding when the patient isn't able to ingest adequate calories on their own. Find out why your patient has an NGT and this will all make more sense.

:-)

mlauren · Feb 12, 2013

Ok, thank you both! The NGT is in place, because the pt. is malnourished. The only reason I was confused was because an instructor told me that patients couldn't eat with NGTs. Thank you for the clarification.

dah doh, BSN, RN · Feb 12, 2013

Sometimes patients get ngt feedings as their main nutrition but just take additional oral diet for pleasure. Other patients just don't eat enough so they get supplemented by the ngt. But yes they can eat with an ngt.

KelRN215, BSN, RN · Feb 12, 2013

Not all patients with an NG tube are at risk for aspiration. If aspiration is the reason why they have the tube, then they would probably be NPO or only allowed to eat foods with a certain consistency.

Many patients have an NG tube to supplement. This is very common in babies with cardiac conditions. They often tire easily during feeding and cannot take a sufficient volume so they have an NG tube placed. The goal is still for them to eat and then if they don't finish their bottle, the remainder goes down the tube.

KelRN215, BSN, RN · Feb 12, 2013

It is possible to give tube feedings through the NGT (although central line access is preferred where I work)

Tube feedings through a central line? Yikes... :nono: I hope you mean either a G-tube for tube feedings or TPN through a central line... I believe there have been cases of patients dying due to inadvertent tube feed administration via the intravenous route.

KBICU · Feb 12, 2013

Yes TPN lol i just assumed you guys knew what i meant

nurseprnRN, BSN, RN · Feb 12, 2013

Yes TPN lol i just assumed you guys knew what i meant

Oh, if you'd seen some of the gawdawful things we've seen, you'd never be able to make that assumption. :rolleyes:

mlauren · Feb 12, 2013

So after making it through my rotation today I realized why we were misunderstanding each other. Excuse me for being an idiot for a moment. I was very very tired. Still am actually, but anyways the patient was on intermittent cyclic feedings for supplemental nutrition and eating PO during the day. I had not read the part that said his NGT was intermittent, so that's why I was questioning PO foods/liquids. Of course you guys knew what that meant without me having to say, but I (being new to this :) did not assume that it was intermittent. So I was just completely and utterly confused by him eating PO. Thanks for helping me last night! It was a rough one, but I'm learning :)

brillohead, ADN, RN · Feb 15, 2013

To give meds to your patient who was NPO with a NGT youd have to crush them (if crushable) and mix in sterile water.

Just wanted to address this little bit -- unless the patient is on neutropenic precautions, you do not need to use STERILE water to administer meds via NG or PEG tube -- tap water is sufficient.

You don't sterilize the water that you drink or the food that you eat, so the stuff that goes in an NG or PEG tube doesn't need to be sterilized, either.

So after making it through my rotation today I realized why we were misunderstanding each other. Excuse me for being an idiot for a moment. I was very very tired. Still am actually, but anyways the patient was on intermittent cyclic feedings for supplemental nutrition and eating PO during the day. I had not read the part that said his NGT was intermittent, so that's why I was questioning PO foods/liquids. Of course you guys knew what that meant without me having to say, but I (being new to this :) did not assume that it was intermittent. So I was just completely and utterly confused by him eating PO. Thanks for helping me last night! It was a rough one, but I'm learning :)

Do you mean that they put the NGT down and pulled it back up every time they needed to do a supplemental feeding? Or do you mean that the FEEDINGS were intermittent, while the NGT remained in place all the time?

The term "NGT" does not mean "feedings" -- it just pertains to the hose itself, the NasoGastric Tube. As was stated before, NGTs can be used to put stuff down into the stomach *or* to suction stuff up out of the stomach. You're going to confuse yourself in the future (and on exams!) if you just associate NGTs with "feeding tubes" because that is not their sole function.

NGTs are JUST a hose to the stomach -- nothing more. What the patient needs them for is what decides what we do with the hose, whether we are using it to put stuff in or take it out. NGTs can be hooked up to suction, or they can be hooked up to feeding bags, or they can be capped off and not hooked to anything at all until they are needed.

Changing the way your mind interprets the phrase "NGT" will help you think of ALL of the possible reasons/uses for the device in a patient's treatment.

mlauren · Feb 17, 2013

Yes, I meant they were taking it out and putting it back in at night for feedings. I understand what you mean about NGTs not just being for feedings. I looked that up over my break, because we didn't talk anything about suction during my 1st semester. Seems like I'm teaching myself most of the time. :/ Thank you for the help though. All of you are awesome!