NG tube feeding

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Question: A patient is receiving NG tube feeding. During assessment, bowel sound is absent, which of the three answers should be done first by the nurse? I selected answer # 2, and was thinking it could be #1 as well. What is the correct answer and rationale? Thanks in advance for your response.

1. Stop the NG tube

2. Check for placement of the tube

3. Notify the HCP

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Specializes in Critical Care.

I'd hope you already checked placement if you're feeding via the NGt

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Specializes in OR, Nursing Professional Development.

What makes you think #2 is the correct answer? I'd like to see your rationale and then I'll give you mine for my answer.

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I am thinking that if the tube isn't placed in the right place, that there would be a risk for aspiration.

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Specializes in OR, Nursing Professional Development.

If the tube is in the wrong place, would you check the placement first or stop the tube feeding so that if it isn't in the right place, you wouldn't further increase the risk of aspiration?

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The question didn't say so, but I am assuming placement was checked before beginning the feeding.

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I would stop the feeding if I know for sure the tube is in the wrong place.

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Specializes in OR, Nursing Professional Development.
I would stop the feeding if I know for sure the tube is in the wrong place.

The correct answer would be #1 because if you have any reason to suspect something is wrong, you remove that factor to prevent anything else from happening. Checking the placement does nothing to stop an adverse event if the tube is in the wrong place.

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Thanks for your answer and rationale Rose_Queen, which makes a lot of sense.

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The question didn't say so, but I am assuming placement was checked before beginning the feeding.

Also, be careful to never assume anything. If it's not stated in the question it wasn't done. Be careful not to add to the story.

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Specializes in Neuro, Telemetry.

Your thinking isn't completely wrong. You just didn't quite consider everything. My quick rationale for why I would choose to stop the feed is because placement of the tube is not the priority at this moment. Whether the tube is placed correctly or not doesn't matter at this moment. What matters at this moment is that the patient is not digesting their feed and the feed is not moving down the intestines. This leaves them at risk for aspirating the feed. Displaced end of the tube is not the only reason for absent bowel sounds.

But also just some NCLEX question advice for if you are not exactly sure. NEVER assume something was done if it was not in the questions. That is true for real practice too. There are lazy nurses. There are poorly educated nurses. Heck, this may not even be a fault of a nurse. The tube could either have not been checked for proper placement correctly or the tube could have moved due to the patient coughing, or sneezing, or pulling it out them self after the feed was started. So the tube could have started in the right place, and you yourself could have verified this, and then it moves anyway. You would want to stop the feed in case the tube is in the lung.

Another thing to consider is that the tube was in the correct place and you verified placement. A) How to you verify placement at the bedside without stopping the feed to aspirate gastric contents? B) If you were planning to check placement via CT, would you really leave the feed on while you wait for an order, then for transport to come get the patient, then for radiology to scan the patient, then for the radiologists to interpret and send the results to the doctor, and then for the doctor to call you and tell you where the tube is? That would be a couple hours. And C) what if the tube is in the right place and you still don't hear bowel sounds? Would you still keep the feed going just because the tube was placed correctly? I sure hope not because that leads me to my last point.

The tube could be in the correct place. The feed could not be clogged and going into the stomach. But the patient could have GI peristalsis, paralytic ileus, a blockage, necrotic GI tissue, whatever. And whatever is keeping the feed from digesting is also keeping it from moving along the GI tract. This means the food is just sitting in the stomach and filling it up. Where does the feed go when the stomach is full? Up the esophagus and into the lungs. Aspiration.

Basically the question was not asking about placement at all. It was asking what you do to keep the patient from aspirating their feed.

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Specializes in Neurosciences, stepdown, acute rehab, LTC.

Bowel sounds are absent so the feed is going nowhere regardless of where the tube is. Stop the feed. Step one before step 2.

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