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ADMINISTERING ENTERAL TUBE FEEDINGS

Equipment
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
RATIONALE
1. Review clients medical record.
1. Verifies physicians prescription for
appropriate formula and amount.
2. Gather equipment.
2. Promotes efficiency during procedure.
3. Check clients armband.
3. Verifies correct client.
4. Explain procedure to client.
4. Reduces anxiety and increases client
cooperation.
5. Assemble equipment. If using a bag,
5. Ensures efficiency when initiating
fill with prescribed amount of formula.
feeding.
6. Place client on right side in high
Fowlers position.
7. Wash hands and don non-sterile
gloves.
8. Provide for privacy.
9. Observe for abdominal distention;
auscultate for bowel sounds.

6. Reduces risk of pulmonary aspiration


in event client vomits or regurgitates
formula.
7. Reduces transmission of pathogens
from gastric contents.
8. Places client at ease.
9. Assesses for delayed gastric
emptying; indicates presence of
peristalsis and ability of GI tract to digest
nutrients.
10. Indicates whether gastric emptying
is delayed.

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
Reduces risk of regurgitation and
ml (or in accordance with agency
pulmonary aspiration related to
protocol), hold feeding until residual
gastric distention.
diminishes.
Prevents electrolyte imbalance.
Instill aspirated contents back into
feeding tube.
11. Administer tube feeding:
11. Provides nutrients as prescribed.
INTERMITTENTBOLUS
Pinch the tubing.
Prevents air from entering tubing.
Remove plunger from barrel of
Provides system to delivery feeding.
syringe and attach to adapter.
Allows gravity to control flow rate,
Fill syringe with formula.
reducing risk of diarrhea from bolus
Allow formula to infuse slowly;
feeding.
Prevents air from entering stomach
continue adding formula to syringe
until prescribed amount has been
and reduces risk for gas
administered.
accumulation.
Flush tubing with 30 to 60 ml or
Maintains patency of feeding tube.
prescribed amount of water.
INTERMITTENTGAVAGE FEEDING
Hang bag on IV pole so that it is 18
Allows gravity to promote infusion of

inches above the clients head.


Remove air from bags 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.

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.

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.
CONTINUOUS
Check tube placement at least every

4 hours.
Check residual at least every 8 hours.

formula.

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
agencys 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
clients response to feeding.

Decreases risk of multiplication of


microorganisms in bag and tubing.
GAVAGE
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. Ensures adequate hydration.


13. Prevents air from entering the tube.
14. Reduces risk of transmission of
microorganisms.
15. Documents administration of feeding
and achievement of expected outcome;
for example, client tolerates feeding and
weight is maintained or increased.

SCORE SHEET
NASOGASTRIC TUBE FEEDING
NAME:

DATE:

ACTION
1. Review clients medical record.
2. Gather equipment.
3. Check clients 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 Fowlers 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:


INTERMITTENTBOLUS

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.

INTERMITTENTGAVAGE FEEDING

Hang bag on IV pole so that it is 18 inches above the clients head.


Remove air from bags 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
agencys 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 clients response to feeding.
TOTAL: ________________
5 = PERFORMED WITH MASTERY
3 = PERFORMED (took some time to perform)
0 = FAILED TO PERFORM