What is the recommended feeding frequency for a patient with a Nasogastric (NG) tube who experiences occasional vomiting?

Feeding Frequency for Patients with NG Tube Who Experience Vomiting

For patients with a nasogastric tube who experience occasional vomiting, careful spacing of feeds with smaller volumes given more frequently (every 3-4 hours) is recommended rather than continuous or bolus feeding to reduce the risk of aspiration and improve tolerance. 1

Assessment of Vomiting Patients with NG Tubes

When managing patients with NG tubes who experience vomiting, consider:

• Positioning: Ensure patient is positioned at 30° or higher during and for 30 minutes after feeding 1
• Tube placement: Confirm proper NG tube position before each feeding using pH testing 1
• Gastric residual volume: Check before each feeding; high volumes may indicate intolerance

Recommended Feeding Schedule

For Adults:

1. Initial approach for vomiting patients:
   • Small volume feeds (100-150ml) every 3-4 hours rather than larger boluses
   • Monitor gastric residual volumes before each feeding
   • If residual volume exceeds 150ml, consider delaying the next feed 2

For Infants:

1. Careful spacing of oral feeds and fluid:
   • Normal-for-age milk intake instead of water to guarantee adequate caloric intake
   • Careful spacing of feeds can reduce "greedy" drinking followed by vomiting 1

Monitoring Parameters

During each feeding session:

• Check for signs of intolerance (abdominal distension, discomfort)
• Monitor fluid balance and biochemistry in patients who cannot self-regulate fluid intake 1
• Assess for signs of aspiration

Special Considerations

For Critically Ill Patients:

• Daily evaluation of the need for NG tube; remove as early as possible 1
• Early tube feeding (within 24 hours) should be initiated when oral nutrition is inadequate 1

For Stroke Patients:

• Small diameter nasogastric feeding tubes (8 French) should be used to reduce risk of internal pressure sores 1
• Consider early PEG placement (within 1 week) for mechanically ventilated stroke patients requiring prolonged feeding 1

Complications to Monitor

Common complications with NG tube feeding include:

• Aspiration pneumonia (preventable with proper positioning and feeding techniques) 3
• Tube displacement or blockage
• Gastroesophageal reflux
• Sinusitis with prolonged NG tube use 4

Practical Implementation

1. Start with small, frequent feedings:

   • Begin with 100-150ml every 3-4 hours
   • Gradually increase volume as tolerated
   • Avoid continuous overnight feeding to reduce aspiration risk 1

2. If vomiting persists:

   • Consider post-pyloric feeding (nasojejunal) if gastric emptying is delayed 1
   • Evaluate for underlying causes (medication side effects, ileus, obstruction)
   • Consider gastrostomy placement if feeding issues persist beyond 4-6 weeks 1

By implementing a structured feeding schedule with smaller, more frequent feedings, proper patient positioning, and regular monitoring of gastric residual volumes, the risk of vomiting and aspiration can be significantly reduced while ensuring adequate nutritional intake.