NG tube and NPO question

Nurses General Nursing

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Hi everyone,

I'm a student nurse in my last semester, and I was hoping for some help with a question. Today at clinicals a docter ordered supplemental feeding via NG tube for a pt. The reasoning was that the pt is at risk for aspiration and because her intake has been poor the last two days. However the doctor also wanted the pt to remain on a solid diet as tolerated instead of NPO. All of the nursing staff was very worried about this and nursing management became involved. The concern was that the pt would be at an even higher risk of aspiration with the tube in place and eating solid foods. Everyone agreed that they thought when a pt was being feed via NG tube that NPO was indicated. No one of the floor had ever encountered a similar situation nor had my clinical instructer. We consulted literature to try and solve the problem. None of the text books or the hospital policy stated if the pt had to be NPO or not. My text for class says that the pt is normally NPO. When I left clinicals the situation had not been resolved. I was wondering if anyone has ever encountered something similar, or what the policy is at their work place? And if anyone can point to any literature on the subject.

Thanks in Advance

Specializes in Surgical, quality,management.

We often continue to all diet with pt with feeding NGT. If the nurses are worried about the risk of aspiration get the speech pathologist to assess the pt re aspiration risk. The current thinking is that if it is safe to continue eating the pt should so that they maintain the habit and reduce the risk of oral thrush by keeping the mucus membranes moist.

Specializes in Acute Care, Rehab, Palliative.

I reently had a pt that had an NG feeding as well as a regular diet.The NG feeding supplemented his diet to increase his intake d/t a malabsorption problem. He tolerated the situation quite well for several weeks.

Specializes in Pediatric/Adolescent, Med-Surg.

Lots of pts, for example anorexics, often have NG tubes in as well as being allowed to take PO. However, if the md ordered to NG tube because he was worried about aspiration then allowing the pt to PO does not make sense. I agree with the previous poster that speech pathology definitely needs to be involved with this pt prior to this pt being allowed to PO feed.

Thanks for the quick input. My clinicals is in a pretty small hospital, so I am glad to get input into situations that a pt was being feed with a oral feeding and NG tube. The whole thing started yesterday with a nurse asking for a consult with speech therapy for possible aspiration. The docter said the consult was not needed and that he would just have the pt feed via NG tube.

Specializes in Trauma/Tele/Surgery/SICU.

I agree with the other posters if a pt. is a risk for aspiration they should most definately be NPO until evaluated by speech. That was a bad call by the doc and one that should have been taken up the chain. I have had several pts. receiving feeds through an ng or og with po diets ordered for supplement or comfort, but never a pt that was an aspiration risk.

Specializes in MS.

its better to call the doctor and ask for clarification rather than assuming and performing the procedure. though its seems complicated PO with NGT, what then NGT for.. lavage only? btw. whats the patients diagnosis? :nurse:

actually, the doctor came in ordered the ngt, and then inserted it himself because he said that he didn't trust the nurses. the pt is 92 and came in after a fall two weeks ago and has steadily deteriorated. i believe she was admitted for her mental state after the fall, because she did not sustain any injury from the fall. she has stage two renal failure, dm that has been poorly managed, while in care the pt developed a uti, yeast infection and c-dif, and her orientation has been progressively becoming worse while in the hospital.

as of today the docter refused to order a consult from speech therapy. nursing talked to speech therapy and they said they thought that pt should be puried at least.

Specializes in Pediatric/Adolescent, Med-Surg.

Sorry, but this dr sounds full of himself and this needs to be taken up the ladder. At my facility there are protocols as far as what sort of pts should be seen by Speech,or PT/OT and this pt would definitely be one of them.

Specializes in Med Surge, Tele, Oncology, Wound Care.

At this point the pt. Is probably so ill that she isn't going to eat anyhow. She is 92, I say if she wants to eat say a piece of cake at her age let her, pureed foods are not what I would want in

My last days.

You didn't mention her code status, which may indicate the dr's attitude towards her po status.

If she was full code, you had better not feed her until you get that clarified or else have an ambu bag and suction ready!

I agree with the other posters if a pt. is a risk for aspiration they should most definately be NPO until evaluated by speech. That was a bad call by the doc and one that should have been taken up the chain. I have had several pts. receiving feeds through an ng or og with po diets ordered for supplement or comfort, but never a pt that was an aspiration risk.

If the doctor ordered the NG feeding due to aspiration risk, then NO PO feedings are allowed until the pt. passes a swallow study. He can't have it BOTH ways.

actually, the doctor came in ordered the ngt, and then inserted it himself because he said that he didn't trust the nurses. the pt is 92 and came in after a fall two weeks ago and has steadily deteriorated. i believe she was admitted for her mental state after the fall, because she did not sustain any injury from the fall. she has stage two renal failure, dm that has been poorly managed, while in care the pt developed a uti, yeast infection and c-dif, and her orientation has been progressively becoming worse while in the hospital.

as of today the docter refused to order a consult from speech therapy. nursing talked to speech therapy and they said they thought that pt should be puried at least.

speech therapy cannot recommend anything until they have made an evaluation. enough said.

the md sounds like a jerk who is covering his bases with a family who wants the pt. to eat; while he knows they cannot.

do oral care dilligently. note the pt's gag reflex, secretions etc; but do not feed until a swallow evaluation is done, or your behind may be food for lawyers.

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