Enteral Feeding Tubes: Naso/Orogastric Placement and Management and Nasojejunal Management

Enteral Feeding Tubes: Naso/Orogastric Placement and Management and Nasojejunal Management

  • A healthcare prescriber’s order is required for enteral tube placement and discontinuation of the tube.

  • The registered nurse (RN) or licensed practical nurse (LPN) accomplishes naso/orogastric enteral feeding tube placement by passing a small-bore tube (which may have a weighted or nonweighted tip) through the nostril or mouth, into the oropharynx, and then through the esophagus to the stomach. Nasojejunal tubes, which originate at the nose and terminate in the jejunum, may be placed by physicians or skillvalidated RNs.

  • Nasogastric and orogastric enteral tube placement is used for both diagnostic and therapeutic purposes. Nasojejunal tubes are primarily used therapeutically for administration of nutrition.

  • Selection of an enteral tube depends on the intended purpose (Chart 39-1); choose the smallest size tube

    that will achieve the intended function while minimizing child discomfort. Tubes may have single, double, or triple lumens.

  • Enteral tubes are indicated for the following:

    • Decompression of the stomach and proximal small intestine

    • Evacuation of blood, secretions, gas, and ingested drugs or toxins

    • Control of bleeding from gastric and esophageal varices

    • Administration of medications, fluids, or nutrition

    • Sampling of gastric contents for analysis

    • Lavage or irrigation

  • Intake and output through the enteral tube is monitored every hour or as determined by institutional policy, the child’s clinical condition and intended purpose of the tube.

  • Enteral tube position and function are evaluated at least once every shift, before use for diagnostic or therapeutic reasons and to ensure the tube is patent without leaks, kinks, or occlusion.

  • Enteral feeding tubes placed through the nares are rotated to the other nostril every 3 to 7 days. This prevents necrosis of the nares tissue and nasal septum. Tubes for gastric decompression, lavage, nasojejunal tubes or those placed for gastrointestinal (GI) bleeding are not routinely changed unless the integrity of the tube is altered or occluded.

  • Enteral feeding tubes are irrigated with water as ordered by the healthcare prescriber every 4 to 6 hours to maintain patency. Some tubes may need to be flushed as often as every 2 hours.

imageNasogastric tubes are contraindicated in children with a basal skull fracture. Other conditions that warrant a risk-benefit assessment include a history of esophageal varices, facial trauma, postoperative cleft palate repair.


  • Assess child for history of nasal deformity, surgery, or trauma, which may provide information as to the patency of the nares, whether passage of the tube may be difficult or impossible, or whether the tube may complicate breathing for the child.

  • Assess for factors that may complicate the placement of the enteral tube, such as patency of nares, a history of varices, recent sinus, esophageal, or gastric surgery, or oxygen needs.

  • Assess the child for signs and symptoms of gastric distention or irritation.

  • Assess the child for presence of orthodontic appliances if tube is to be inserted through the mouth. Instruct the child to remove appliance because dislodgement during the procedure and possible aspiration may occur.

  • Assess the child for a history of drug or toxin ingestion.

  • Assess the child’s potential for aspiration, secondary to accumulated gastric secretions and fluids or impaired gag reflex.

  • Assess the child and family’s cognitive level, readiness, and ability to process information. The readiness to learn and process information may be impaired as a result of age, stress, or anxiety. Explain the child’s role in assisting with passage of the tube (as developmentally appropriate).

  • Reinforce the need for, and identify and discuss the risks and benefits of, tube placement, as appropriate, to both the child and family.

  • Explain the procedure, as age and developmentally appropriate, to both the child and the family. Invite the family member to remain with the child to provide comfort and/or diversionary measures.

  • Consult child-life specialist, when available, for preparation or developmentally based distraction techniques.

Jul 9, 2020 | Posted by in NURSING | Comments Off on Enteral Feeding Tubes: Naso/Orogastric Placement and Management and Nasojejunal Management

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