This guide is general information for families, not medical advice. The type and amount of feed, how much water to give and when come from the patient’s doctor or dietitian. Follow their plan.
Key facts
- Before every feed, check the tube is in the stomach: NHS guidance uses a pH of 5.5 or below on a pH strip, with an unchanged length marking at the nose.
- Give nothing through the tube, not even water, until that check confirms the position.
- Feed the patient sitting at 30 to 45 degrees, and keep them upright for at least 30 minutes afterwards.
- Stop the feed at once if the patient coughs, chokes, struggles to breathe or vomits.
What is Ryle’s tube feeding?
Ryle’s tube feeding is another name families use for nasogastric tube feeding. The tube goes through the nose into the stomach. A nose feeding tube for an older person needs the same patient-specific feeding plan and training as any other NG tube; age alone does not tell a family which tube or feed to use.
Before bringing a feeding tube home
Ask the care team to show the person giving feeds how to check the tube, follow the feeding and water schedule, give approved medicines and care for the nose and mouth. Get the plan in writing, the required supplies and a contact for problems. This guide supports that training and does not teach families how to insert a tube.
Before every feed
- Wash your hands, and have the prescribed feed, clean water and a clean syringe ready.
- Sit the patient upright or semi-upright, at an angle of 30 to 45 degrees. Do not feed someone lying flat.
- Check that the tube is still in the stomach, the way the care team taught you: the length marking at the nose should not have changed, and a small sample drawn from the tube should test at pH 5.5 or below on a pH strip.
- Give nothing through the tube, not even water, until the check shows it is in the right place. If you cannot get a reading of 5.5 or below, do not feed; contact the nurse or doctor.
During and after the feed
- Flush the tube with water before and after every feed or medicine, using the amount the care team gave you. This stops the tube blocking.
- Give the feed at the speed you were shown, not faster.
- Keep the patient upright for at least 30 minutes after a feed or flush, to stop feed coming back up.
- Give medicines through the tube only if the doctor or pharmacist has said they can be given this way. Some tablets must not be crushed and some capsules must not be opened, so ask before you do either.
Check the tube again if it may have moved
Check the tube’s position again before the next feed after a coughing fit, vomiting, retching, difficulty breathing or reflux, because any of these can move the tube.
Daily NG tube care at home
- Keep the mouth clean and moist with regular mouth care, even though the patient is not eating by mouth.
- Keep the tube taped securely, replace tape that has come loose, and check the skin of the nose for soreness.
- If the tube blocks, do not force water through it and do not push anything down it. Contact the nurse.
When to stop and get help
Stop the feed straight away if the patient coughs, chokes, struggles to breathe or vomits during a feed, because feed may be going into the lungs. If breathing problems continue, call Rescue 1122.
If the tube comes out, partly or completely, do not push it back or put it in again yourself unless you have been trained and assessed to do so. If it came out during a feed, get medical advice. Otherwise contact the nurse or doctor to have it replaced.
How a nurse can help
On a feeding tube care visit, a Registered Nurse checks the tube, the skin around it and the feeding plan, gives the prescribed feed, water or medicine when it is safe, watches how the patient tolerates it and records any concern. The visit needs a doctor’s order, and the family provides the prescribed feed and medicines. Nurse at Home is preparing to launch and is not taking bookings yet.