Administering Feedings Through Gastric and Enteric Tubes

Administering Feedings Through Gastric and Enteric Tubes

Equipment
■ Prescribed feeding formula at room temperature.
■ Filtered water or prescribed diluent, if ordered.
■ Tube feeding administration set and bag.
■ 60-mL Luer-Lok or catheter-tip syringe (2 needed for syringe feeding).
■ Connector to connect administration set to the feeding tube.
■ Stethoscope.
■ IV pole.
■ Linen-saver pad.
■ Graduated container.
■ pH strip.
■ Enteral feeding infusion pump.
■ For gastrostomy and jejunostomy tubes: a small precut gauze dressing.

Assessment
■ Check patient history for food allergies.
■ Check the length of the exposed tube.
■ Compare the length from the naris to the connector recorded after x-ray confirmation of placement.
■ Observe the mark that was made on it where it entered the nostril after insertion.
■ Be Safe! If there is significant change in length, tube position must again be confirmed by radiography.
■ Assess fluid status by checking breath sounds, mucous membranes, skin turgor, edema, and I&O.
■ Obtain baseline weight and laboratory studies.
■ Monitor VS before and after feedings.
■ Auscultate for bowel sounds before each feeding or every 4 to 8 hours for continuous feedings.
■ Also check for distention, nausea, vomiting, and diarrhea.
■ For gastrostomy and jejunostomy tubes: Assess the exit site at every shift. Report redness or drainage to the primary care provider.

Post-Procedure Reassessment
■ Assess tolerance to the tube feeding (abdominal discomfort, nausea, vomiting, or diarrhea).
■ Assess bowel sounds and VS every 4 hours.
■ Check gastric residual volume every 4 hours.
■ Monitor I&O every 8 hours.
■ Weigh patient at least 3 times per week.
■ Monitor the exit site for signs of skin breakdown.
■ Assess frequency of bowel movements.
■ Check laboratory values to evaluate nutritional status.

Key Points
■ Check the medical prescription for the type of formula, rate, route, and frequency of feeding. Check the expiration date on the feeding.
■ Be Safe! Check the chart to make sure there is a radiographic confirmation of tube placement.
■ Be Safe! Confirm tube placement with a combination of bedside methods before administering the feeding. Bedside methods include:
■ Measuring pH of aspirate.
■ Changes in residual volume.
■ Observing the length of the exposed tube.
■ Injecting air into the tube and auscultating (“whoosh” test).
■ Asking the patient to speak.
■ Be Safe! Elevate the head of the bed at least 30° to 45° while administering the feedings and for an hour after administration.
■ Check residual volume before feeding for intermittent feedings.
■ For continuous feeding: Check gastric residual volume at least once every shift. If the residual is 10% greater than the formula flow rate for 1 hour (or > 150 mL), hold the feeding for 1 hour and recheck. Notify the primary provider if the residual is still not within normal limits.
■ For gastrostomy and PEG tubes and gastrostomy buttons (G-buttons): Check residual volume every 4 hours.
■ Be Smart! For jejunostomy tubes: Residual volumes are not checked.
■ Flush tubing with 30 mL of water before and after feeding (every 4 hours for continuous feedings), and before and after medication administration.
■ Label and hang the bag, prime the tubing and thread it through the pump, regulate the gravity drip rate, or elevate the syringe to feed with an open-system syringe.
■ Be Smart! Remember to unclamp the tubing!
■ Change the tube feeding administration set and other supplies a minimum of every 24 hours.
■ Be Smart! Continuous feedings should be infused by pump.

Documentation
■ Chart the type of tube feeding, rate and volume of infusion, amount of gastric residual volume (if any), and tolerance of procedure.
■ Document feeding amount on the I&O flowsheet.
■ Record all flushes as intake; subtract any liquids that you aspirate and do not reinstill (e.g., when gastric residual is too high).