ADMINISTERING ENTERAL TUBE FEEDINGSEquipment

Asepto syringe or 20- to 50-ml syringe Emesis basin Clean towel Disposable gavage bag and tubing Formula Infusion pump for feeding tube Water to follow feeding Nonsterile gloves

ACTION RATIONALE1. Review client’s medical record. 1. Verifies physician’s prescription for appropriate

formula and amount.2. Gather equipment. 2. Promotes efficiency during procedure.3. Check client’s armband. 3. Verifies correct client.4. Explain procedure to client. 4. Reduces anxiety and increases client

cooperation.5. Assemble equipment. If using a bag, fill with prescribed amount of formula.

5. Ensures efficiency when initiating feeding.

6. Place client on right side in high Fowler’s position.

6. Reduces risk of pulmonary aspiration in event client vomits or regurgitates formula.

7. Wash hands and don non-sterile gloves. 7. Reduces transmission of pathogens from gastric contents.

8. Provide for privacy. 8. Places client at ease.9. Observe for abdominal distention; auscultate for bowel sounds.

9. Assesses for delayed gastric emptying; indicates presence of peristalsis and ability of GI tract to digest nutrients.

10. Check feeding tube: Insert syringe into adapter port, aspirate stomach contents, and determine amount of gastric residual. If residual is greater than 50 to 100 ml (or in

accordance with agency protocol), hold feeding until residual diminishes.

Instill aspirated contents back into feeding tube.

10. Indicates whether gastric emptying is delayed.

Reduces risk of regurgitation and pulmonary aspiration related to gastric distention.

Prevents electrolyte imbalance.

11. Administer tube feeding: 11. Provides nutrients as prescribed.INTERMITTENT—BOLUS

Pinch the tubing. Remove plunger from barrel of syringe and

attach to adapter. Fill syringe with formula.

Allow formula to infuse slowly; continue adding formula to syringe until prescribed amount has been administered.

Flush tubing with 30 to 60 ml or prescribed amount of water.

Prevents air from entering tubing. Provides system to delivery feeding.

Allows gravity to control flow rate, reducing risk of diarrhea from bolus feeding.

Prevents air from entering stomach and reduces risk for gas accumulation.

Maintains patency of feeding tube.

INTERMITTENT—GAVAGE FEEDING Hang bag on IV pole so that it is 18 inches

above the client’s head. Remove air from bag’s tubing. Attach distal end of tubing to feeding tube

adapter and adjust drip to infuse over prescribed time.

When bag empties of formula, add 30 to 60 ml or prescribed amount of water; close clamp.

Allows gravity to promote infusion of formula.

Prevents air from entering stomach. Decreases risk of diarrhea.

Ensures that remaining formula in tubing is administered and maintains patency of tube; prevents air from entering the stomach.

Change gavage bag every 24 hours or wash reusable gavage bag with soap and hot water every 24 hours.

Decreases risk of multiplication of microorganisms in bag and tubing.

CONTINUOUS GAVAGE Check tube placement at least every 4 hours. Check residual at least every 8 hours.

If residual is above 100 ml, stop feeding.

Add prescribed amount of formula to bag for a 4-hour period; dilute with water if prescribed.

Hang gavage bag on IV pole. Prime tubing. Thread tubing through feeding pump and

attach distal end of tubing to feeding tube adapter; keep tubing straight between bag and pump.

Adjust drip rate.

Monitor infusion rate and signs of respiratory distress or diarrhea.

Flush tube with water every 4 hours as prescribed or following administration of medications.

Replace disposable feeding bag at least every 24 hours, in accord with agency’s protocol.

Turn client every 2 hours.

Provide oral hygiene every 2 to 4 hours.

Ensures that feeding tube remains in stomach. Indicates ability of GI tract to digest and

absorb nutrients. Reduces risk of regurgitation and pulmonary

aspiration related to gastric distention. Provides client with prescribed nutrients and

prevents bacterial growth (formula is easily contaminated).

Removes air from tubing. Provides for controlled flow rate; prevents

loops in tubing.

Infuses formula over prescribed time.

Prevents complications associated with continuous gavage.

Maintains patency of tube.

Decreases risks of microorganisms.

Promotes digestion and reduces skin breakdown.

Provides comfort and maintains the integrity of buccal cavity.

12. Administer water as prescribed with and between feedings.

12. Ensures adequate hydration.

13. Clamp proximal end of feeding tube after formula has been administered.

13. Prevents air from entering the tube.

14. Remove gloves and wash hands. 14. Reduces risk of transmission of microorganisms.

15. Record total amount of formula and water administered on I&O form and client’s response to feeding.

15. Documents administration of feeding and achievement of expected outcome; for example, client tolerates feeding and weight is maintained or increased.

SCORE SHEETNASOGASTRIC TUBE FEEDING

NAME: DATE:

ACTION 5 3 01. Review client’s medical record.2. Gather equipment.3. Check client’s armband.4. Explain procedure to client.5. Assemble equipment. If using a bag, fill with prescribed amount of formula.6. Place client on right side in high Fowler’s position.7. Wash hands and don non-sterile gloves.8. Provide for privacy.9. Observe for abdominal distention; auscultate for bowel sounds.10. Check feeding tube: Insert syringe into adapter port, aspirate stomach contents, and determine amount of gastric residual. If residual is greater than 50 to 100 ml (or in accordance with agency protocol), hold feeding

until residual diminishes. Instill aspirated contents back into feeding tube.11. Administer tube feeding:

INTERMITTENT—BOLUS Pinch the tubing. Remove plunger from barrel of syringe and attach to adapter. Fill syringe with formula. Allow formula to infuse slowly; continue adding formula to syringe until prescribed amount has

been administered. Flush tubing with 30 to 60 ml or prescribed amount of water.

INTERMITTENT—GAVAGE FEEDING Hang bag on IV pole so that it is 18 inches above the client’s head. Remove air from bag’s tubing. Attach distal end of tubing to feeding tube adapter and adjust drip to infuse over prescribed

time. When bag empties of formula, add 30 to 60 ml or prescribed amount of water; close clamp. Change gavage bag every 24 hours or wash reusable gavage bag with soap and hot water every

24 hours.CONTINUOUS GAVAGE

Check tube placement at least every 4 hours. Check residual at least every 8 hours. If residual is above 100 ml, stop feeding. Add prescribed amount of formula to bag for a 4-hour period; dilute with water if prescribed. Hang gavage bag on IV pole. Prime tubing. Thread tubing through feeding pump and attach distal end of tubing to feeding tube adapter;

keep tubing straight between bag and pump. Adjust drip rate. Monitor infusion rate and signs of respiratory distress or diarrhea. Flush tube with water every 4 hours as prescribed or following administration of medications. Replace disposable feeding bag at least every 24 hours, in accord with agency’s protocol. Turn client every 2 hours. Provide oral hygiene every 2 to 4 hours.12. Administer water as prescribed with and between feedings.13. Clamp proximal end of feeding tube after formula has been administered.14. Remove gloves and wash hands.15. Record total amount of formula and water administered on I&O form and client’s response to feeding.

TOTAL: ________________

5 = PERFORMED WITH MASTERY3 = PERFORMED (took some time to perform)0 = FAILED TO PERFORM