NG flush

Hi, 2 questions actually on this topic:

1. When you go to bathe a pt with a tube feeding, do you put the machine on pause until you bathe the patient and change the bed. How far up do you leave his head?

2. Can someone explain the NG flush to me?

And also explain checking for residual please? And how often? Thanks

Yes, turn the tube feeding off, and you can put the bed flat while making the bed as it's difficult to make a made bed with the head up (poor body mechanics as well), unless there's an order never lower the bed. Afterwards it's a good idea to leave the HOB up 30 to 45 degrees in a tube fed patient, but this might vary from institution to institution.

Flushing NGs is basically just instilling a certain amount of water to clean the tube out or flush the meds in after med administration. Sometimes there's an order to flush with a certain amount of free water a shift for hydration. I usually flush with 30 cc's of water after giving meds.

Checking residuals is done q4h on our unit (I work med-surg, I'm sure in LTC it's not every four hours), and there is a protocol what do with it If it's 1 1/2 the rate of the drip then we shut off for 30 minutes and recheck. If it's less than 100 cc's we put it back into the patient as these are his digestive enzymes.

There should be a policy on the unit regarding these things. These are just what I do.

Good luck.

I would put the feed on hold while bathing the pateint and changing the sheets.

Check your protacol, because the dietitians always get nasty if you don't follow it. ours is if you aspirate more than 200mls, then reduce the feeding to 30mls/hr then check again in 4 hours if less than 200ml increase by 30mls every hour.

Of course we all know why we shut off the feedings during bathing or activities that require the head down....reduces the chances of aspiration.

You know technically though, if the feeding tube is in the right place (first part of the duodenum) the chances of aspiration of feeding tube contents is next to nothing unless the pyloric sphincter is non-existent or there is some kind of reflux through the faulty muscle. This is if the feeding tube is in the right position like I mentioned - the first part of the duodenum.

Also, unless there is something wrong with peristalsis in the duodenum, there shouldn't be any residual except a couple of mls you pull from the tubing while aspirating.

I am much more careful with g-tubes and ngs as these tubes are in the stomach and aspiration could very easily happen. There's always a bit more residual here.

Of course we never know for sure where the feeding tube is and that's why we take the precaution. But once the tube is through the pylorus as shown by a kub, it rarely goes back up into the stomach unless it's inadvertantly pulled back.

Just some food for thought.

:)