ICU GUIDELINE: CARE AND MANAGEMENT OF NASODUODENAL FEEDING TUBES
A) GENERAL CONSIDERATIONS:
Nasoduodenal feeding tubes (NDFT) allow for enteral nutrition (EN) when gastric stasis and/or
aspiration risk (e.g. gastroesphageal reflux) precludes the nasogastric (NG) route. NDFT can be
placed manually (for direction re bedside manual placement technique refer to resource entitled
“ICU Guideline: Manual ND Feeding Tube Placement”), endoscopically, or by fluoroscopic
technique. NDFT must be managed carefully in order to ensure safe and cost-effective EN.
B) GENERAL GUIDELINES
1) PREVENTING NDFT DISLODGMENT SECURING THE NDFT
1) Wipe nose with alcohol swab to remove oil.
2) Prepare nose with a barrier/adhesive product.
3) Prepare silk tape.
4) Place tape on nose (a); pinch (tent) tape at
nostril to reduce contact pressure.
5) Wrap legs (b) of tape along a 3-inch (8 cm)
length of tube.
6) Secure tape (a) on nose with 2nd piece of
tape (c).
7) Check tube security daily (tug tube).
8) Replace tape as indicated.
2) FEED INITIATION AND TITRATION:
Initiate feeds at 25 ml/hr and increase by 25 ml/hr Q4H to goal rate (refer to resource entitled
”ICU Guideline: EN Post-pyloric Feeding”). Do not automatically decrease the feed rate based
on gastric residual volumes (GRV) (refer to section #5).
3) PREVENTION OF ASPIRATION:
a) CONCURRENT GASTRIC DECOMPRESSION:
Gastric secretions account for approximately 2400 ml of the fluid handled by the gastrointestinal
tract (GIT) each day. If gastric stasis is a concern, place a decompression tube such as an
Argyle Salem Sump NG tube® (Sherwood Medical, St. Louis, MO, USA.) to allow for gastric
decompression. Clamp the NG tube; decompress and discard GRV Q4H. Do not place the NG
tube on suction as this may result in gastric mucosal irritation, fluid and electrolyte imbalance,
and decompress feed from the small bowel. If hourly decompression is required place the NG
on straight drainage. NG tubes can be removed once gastric decompression is no longer
required.
b) PATIENT POSITIONING:
Unless contraindicated, elevate the head of bed 45°. If this is not feasible, elevate the head of
bed as much as possible.
4) TUBE OCCLUSION:
a) PREVENTION: In order to keep the lumen and tip of the NDFT clear, always flush the NDFT with
20 ml water every 4 hours and anytime feeds are held. If NDFT repeatedly occludes, consider
instilling a pancreatic enzyme mixture (see section 5 page over) into the NDFT every 6 hrs.
b) MEDICATION FORM: Avoid liquid formulations (elixirs, solutions, suspension, and syrups) as
they may gel or form globular particles when in contact with feed, increasing the risk of NDFT
occlusion. Do not deliver bulk-forming agents via the NDFT; they congeal quickly and will obstruct
the NDFT. Tablets are preferred over liquid medications where possible. Crush tablets well and
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