The nurse is caring for a client who has a nasogastric tube for medication administration and tube feedings. How should the nurse care for the tube during her shift? Select all that apply.

  • flush tube every 4 hours with hot water to maintain patency
  • allow the feeding and tubing to hang until empty, up to 48 hours
  • maintain the head of bed in a high-Fowler’s position during feedings
  • check residuals and replace them unless the amount is greater than 300 mL
  • check under the adhesive tape on the nose daily to assess for skin breakdown
  • assess the bowel sounds before feeding, and feed at half the rate if bowel sounds are absent
Numbers 3 and 5 are correct.
In order to prevent aspiration, the head of the bed should be in a high-Fowler’s position whenever feedings are infusing. The tape on the nose should be removed daily and the skin assessed for breakdown; the tape should then be replaced, using care not to move the tube. The tube should be flushed every 4 hours using tepid water, not hot. Using hot water can cause discomfort and possibly burn the client. Tubing and feedings must be changed every 24 hours, even if there is still feeding left in order to prevent bacterial growth. Residuals should be replaced unless the amount is greater than 250 mL. In that case, discard the extra and consider slowing the feeding rate using the health care provider’s guidelines. If no bowel sounds are present, hold the feeding and contact the health care provider.