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Enteral Nutrition: Nasogastric Tube Feedings (603)

Enteral Nutrition: Nasogastric Tube Feedings (603) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Nutrition



Nasogastric Tube Feedings

Why do I need a feeding tube?
A nasogastric feeding tube is used to give fluids, tube feeds, and medicine to people who cannot
take them by mouth. The tube is placed through your nose into your stomach. An x-ray is taken
to make sure that the tube is in your stomach. The feeding tube is often used up to a few weeks.

My Tube Feed and Hydration Plan

Formula name: ______________________________________________________________

Amount of formula needed per day: ______________________________________________

Give ____ cans or ____ ounces or ____ milliliters (mL) ____ times per day

Amount of water needed per day in addition to goal tube feeds: ______________________

Flush tube with _______ milliliters (mL) of tap water after each feeding

How do I give tube feedings?
Gravity tube feedings are given multiple times per day, several hours apart and are delivered by a
feeding bag over 30 minutes or less. The feeding bag hangs above the head and the formula drips
in. Bolus (syringe) tube feeds may be given multiple times per day, several hours apart and are
given through a syringe over 15-30 minutes.

Gravity Tube Feedings
1. Wash your hands with soap and water. Dry them with a clean towel.
2. Use room temperature formula. Very cold formula may cause stomach discomfort.
3. Preparing the feeding: You will either use a ready-made formula or one that requires at home
preparation from powder.
A. Ready-made:
ξ If using a ready-made formula, wash the lid of the can and dry the lid with a clean
ξ Only open containers of formula that you will need for the feeding
ξ Shake the can(s) before opening
ξ Only place 8 hours’ worth of formula into the bag
ξ Leftover formula that is open can be stored in the refrigerator with a cover
ξ Discard formula that has been open for more than 24 hours
B. Prepared formulas from powder:
ξ Follow the mixing instructions given to you by your healthcare provider
ξ Only place 4 hours’ worth of formula into the bag
ξ Leftover formula can be stored in the refrigerator with a cover


ξ Discard formula that has been prepared more than 24 hours ago.
4. Prepare water flushes for before and/or after feedings as instructed by your healthcare
5. Check the roller clamp to ensure that the tubing is pinched closed.
6. Pour the formula into the feeding bag. Generally no more than 2 cans or 480 mL of formula
will be put into the feeding bag at a time. Close the lid on the feeding bag and hang the bag
on a pole/hook that is at least 12 inches higher than your stomach.
7. Open the cap on the feeding tube and using a syringe, insert water into your tube as
instructed by your healthcare provider.
8. Connect the tubing from the feeding bag to the feeding tube.
9. During feedings, sit upright so that your shoulders are higher than your stomach. Sit in a
chair or prop yourself up in a bed or on the couch. Never lay flat on your back during
feedings unless otherwise instructed by your healthcare provider.
10. Unclamp the tubing coming from the feeding bag. Control the flow rate by using the roller
clamp. A good rate to start at is generally 1-2 drips per second. You may control the speed of
flow per your comfort.
11. Once your feeding is finished, clamp the tube, remove the tubing from the feeding bag and
unhook the feeding from your feeding tube.
12. Flush your g-tube with at least 30 mL of warm water or as instructed by your healthcare
provider. Depending on fluid needs, you may need to put more water into the feeding bag
and allow it to flow into your feeding tube using the roller clamp to control speed.
13. Close the cap on your feeding tube.
14. Rinse the feeding bag and tubing with cool water and then swish with warm water and a
small amount of liquid dishwashing detergent. Rinse well and hang to dry. Use a new feeding
bag set every 3 days.

Bolus (Syringe) Feedings
If you have been tolerating tube feeds by the gravity drip method, you may try the syringe
method if you prefer.
1. Complete the steps 1-3 listed above.
2. Pull the plunger from the syringe. Open the cap on the feeding tube and place the tip of the
syringe into the feeding tube.
3. Flush the feeding tube with 30 mL of warm water or as instructed by your healthcare
4. Fill the syringe with formula and allow the formula to flow slowly. You may adjust the flow
by gently pinching the feeding tube. It is not recommended to use the plunger of the syringe
to force formula into the tube. This can cause bloating and discomfort. Repeat this step as
many times as necessary to complete your goal for this individual feed. It will take about 4
full 60 mL syringes to complete 1 can of formula. It should take about 15 minutes to
complete 1 can of formula.
5. After the feeding is complete, flush tube with 30 mL of warm water or as instructed by your
healthcare provider.
6. After all the water has gone through the tube, place cap on the feeding tube.
7. Clean syringe with warm, soapy water and allow to air dry completely between feedings.
Change the syringe each week.


Water Flushes
Your body needs enough fluid each day to stay hydrated. Your tube feeding formula will provide
some fluids. The rest of your fluid will be met by oral intake (if safe) and/or by doing water
flushes through your feeding tube. Avoid a lot of force when flushing your feeding tube. If you
are not feeling well and cannot tolerate your goal tube feeds, you will need more water through
your tube to stay hydrated. You may not be getting enough fluid if you have: dizziness, dry
mouth, dry lips, dark urine, or less urine than normal.

Giving Medicines
You can give medicine through the feeding tube if you are unable to swallow them. Follow
these instructions:

1. Do not add medicine directly to the formula
2. Give each medicine one at a time; do not mix together.
3. Flush the tube with 30 mL water before giving a medicine or as instructed by your healthcare
provider. If giving more than one medicine at one time, flush in between each dose with 10
mL water.
4. Crush and dissolve pills in at least 30 mL water prior to flushing them through the tube.
Never crush enteric-coated or time-release capsules. Sterilized water is the preferred method
for diluting medicine.
5. Flush the tube again with 30 mL water after administering the medicine, or as instructed by
your healthcare provider.

Call Your Doctor If…
ξ Occasionally your tube may clog. Medicines may cause clogs or it may clog if you are
not flushing your tube with water frequently. This is not an emergency situation. First try
to flush the tube with 30 mL of warm water. Never force fluid into the tube. If this does
not unclog the tube, call your doctor. If your tube clogs at night you can wait until
morning to call.
ξ If your tube falls out, it is important that you call your doctor immediately. Although this
is not harmful to you, replacing the tube becomes more difficult or impossible the longer
the tube is out.
ξ For adults: Weigh yourself 3 times a week at the same time of day on the same scale.
Early morning is best, after urinating. Keep a record of your weight. If you notice weight
gain or loss of more than 2-3 pounds per week contact your doctor, nurse or registered
ξ Nausea or upset stomach that continues for more than 24 hours.
ξ Diarrhea (3 or more loose, watery bowel movements) for more than 2 days.
ξ Constipation (lack of bowel movement) that continues more than 5 days.
ξ Anything that causes you to stop giving tube feedings for more than one day.


Teach Back
What is the most important thing you learned from this handout?

What changes will you make in your diet/lifestyle, based on what you learned today?

If you are a UW Health patient and have more questions please contact UW Health at one of the
phone numbers listed below. You can also visit our website at www.uwhealth.org/nutrition.

Nutrition clinics for UW Hospital and Clinics (UWHC) and American Family Children’s
Hospital (AFCH) can be reached at: (608) 890-5500.

Nutrition clinics for UW Medical Foundation (UWMF) can be reached at: (608) 287-2770.

Your health care team may have given you this information as part of your care. If so, please use it and call if you have any
questions. If this information was not given to you as part of your care, please check with your doctor. This is not medical advice.
This is not to be used for diagnosis or treatment of any medical condition. Because each person’s health needs are different, you
should talk with your doctor or others on your health care team when using this information. If you have an emergency, please call
911. Copyright © 9/2017 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Clinical
Nutrition Services Department and the Department of Nursing. HF#603