TUBE FEEDING

APPARATUS REQUIRED FOR TUBE FEEDING

• For mouth wash or tray for cleaning mouth if the tube is required t pass through mouth
• Sodabicarb swabs for cleaning nostrils if tube is required to pass by nasal route.
• A small glass or polythene funnel.
• An oesophageal tube size 6 to 18 english guaze or 14-22 (french guaze).the larger size are used for oral route and smaller size for nasal route.
• A tray or bowel for keeping all apparatus.
• A measure containing water to clear the tube. 
• A container with feed.
• A location thermometer.
• Adhesive tape.
• Towel a piece of makintosh,tongue forcep,tongue spatula.
• Mouth gag,if necessary.
• Lubricant soloution for tube (liquid paraffin).
• A 50 ml syringe.
• Emesis basin to collect if vomiting occurs.

PROCEDURE

Intimate the patient about the procedure.

He should be told:

• The reason for procedure.
• Approximately how long it will take.
• What it will feel like.
• How he can co-operate better.screen the patient for privacy.

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          feeding by mouth(oral route)

ORAL ROUTE

• Place makintosh and towel across patient,s chest.
• Wash your hands.
• Soak the tube in ice water and apply glycerine or liquid paraffin.
• Any dentures should be removed.
• Stand to the side and slightly behin behind the patient.
• Insert the tube and ask the to swallow.
• Curve the tube and pass it along curve of palate and take care not to strike the larynx.ask him to take deep breathing.
• Push the tube gently and steadly.
• If any difficulty is encountered.wait a while,never force the tube which may damage the soft tissue.
• Watch for the breathing.
• When the 2nd marking is at the front teeth,the end of the tube is in stomach.
• If a patient bites the tube,insert a mouth gag.

                            feeding by nasal tube

NASAL ROUTE 

• Position the patient sitting him up with head slighty flexed (semi recumbent position).
• Clean the nostril.
• Note approximate distance of 50-60 cm from stomach and of tube before the tube is inserted. 
• Pass the tube gently along floor of larger nostril.
• Ask the patient to swallow when it is strikes oesophageal orifice.
• When the 2nd marking comes to the opening of nostril,it is assumed that the tube is in stomach.
• Water for breathing.

HOW TO KNOW THAT TUBE IS IN STOMACH

• Place a stethoscope over upper middle part of abdomen listening to the ear piece.About 5cc of air is pushed by syringe through the tube.If the tube is in stomach,air while pushed will be heard by the stethoscope.
• If the patients coughs,becomes restless,with flushed face,tears from eyes,the tube may be in air passage and not in stomach.
• A syringe is attatched to tube and a specimen of fluid is which drawn.If it is stomach,some fluid will come out which will give a acidic reaction when tested by a litmus paper.
• At some centres another controversial method is used to test whether tube is in stomach,or not.This method consist of connecting the external end of tube in to bowl or water.Then it is observed if air bubbles comes out in rhythmical way or not.If air comes out is rhythmical way then the tube is in air passage and not in stomach.

The disadvantage of this method is that if the tube is in respiratory tract while testing by this method some water will be sucked in to the respiratory tract. 
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