LABORATORY: WEEK 9

Gastro-Endocrine I: a) Gastric Lavage, Pre/Post colonoscopy care; b) TPN Guidelines; c) Ostomy Care;
Types of Feeding Tubes
March 22, 20201

MODULE 7a: OSTOMIES

Learning Objectives
1. Enumerate medical conditions for creating
ostomies.
2. Differentiate the major types of ostomies.
3. Know the correct use of various products for
colostomy care.
4. Outline the purposes of colostomy care.
5. Perform colostomy care correctly.
6. Provide patient education for patients with
colostomy.
Ostomies

- An ostomy is an artificial opening.

- stoma is the site of the opening
- Ostomies can be created because of trauma to
the intestines, severe inflammation, or diseases
such as cancer that involve part of the intestine.
- They can be temporary or permanent, depending
on the reason they are present, and the
characteristics of the fecal material vary
according to where the ostomy is located along
the intestine.
Urostomy
- A urostomy is the diversion of urine away from a
diseased or defective bladder through a surgically
created opening or stoma in the skin.
- This may be necessary in the presence of a
congenital anomaly or when the bladder must be
removed because of disease, trauma, or
obstruction.

- Fecal material in the ileum is liquid, and fecal

matter in the rectum is solid.

3 TYPES OF OSOTOMIES

Ileostomy
- An ileostomy is an opening in the ileum.

- An ileostomy is needed when the entire colon

needs to be removed or bypassed, as in cases of
congenital defects, cancer, inflammatory bowel
disease, or bowel trauma.

COLOSTOMY CARE

- To be able to provide optimal colostomy care, it is

important for the nurse to know the correct use of
various products used for colostomy care and to
educate the patient about appropriate care and
use of these products.
Purposes:
1. To assess and care for the peristomal skin.
2. To collect stool for assessment of the amount
and type of output.
3. To minimize odors for the client’s comfort and
self-esteem.
Colostomy
Assessment:
- A colostomy is the surgical creation of a stoma
on the abdominal wall to where the colon is 1. Assess the type of ostomy and its placement in
normally attached. the abdomen.

- The colostomy then diverts stool through the 2. The type and size of appliance and the special
stoma. barrier substance applied to the skin.

- The procedure is performed for patients with 3. Color of the stoma. It should appear reddish-pink
cancer of the colon, intestinal obstructions, and slightly moist. A dusky, blueish color
intestinal trauma, or inflammatory diseases of the indicates impaired blood circulation to the area.
colon. Notify surgeon immediately.

1
 LABORATORY: WEEK 9
Gastro-Endocrine I: a) Gastric Lavage, Pre/Post colonoscopy care; b) TPN Guidelines; c) Ostomy Care;
Types of Feeding Tubes
4. Size and shape. Most stomas protrude slightly
from the abdomen.
5. Assess for stomal bleeding. A new stoma may
have a slight bleeding, which is normal, but other
bleeding should be reported.
6. Assess amount and type of feces. Assess color,
odor, and consistency.
7. Assess for complaints of burning sensation under
the skin, which may indicate skin breakdown.
Presence of abdominal discomfort / distention
needs to be reported.
PLANNING
- Review features of the appliance to ensure that
all parts are present and are functioning correctly.
Equipment needed:
□ Clean gloves
□ Bed pan
□ Moisture-proof bags, for disposable pouches
□ Cleaning materials (warm water, mild soap,
wash cloth)
□ Tissue or gauze pad
□ Skin barrier paste / skin sealant wipes
□ Stoma measuring guide
□ Scissors
□ Tail closure clamp
COLOSTOMY CARE
- One-pouch systems have a skin barrier (wafer)
that is pre-attached to the pouch; two-piece
systems have a pouch that is separate from the
water.
- Some skin barriers are precut, whereas others
must be cut to fit the stoma.
- When skin barriers are cut to fit the stoma, the
nurse should ensure that the ostomy appliance
opening is small enough to form a proper seal.
- An ill-fitting appliance can cause a pressure sore
and can lead to gangrene.
PERFORMANCE
1. Refer to patient’s record / nursing care plan for
special interventions. Rationale: Provides basis
for care.
2. Assemble equipment. Rationale: Organizes
procedure, saves time and effort.
3. Introduce self. Rationale: Reduces patient’s
anxiety.
4. Identify patient using two identifier. Rationale:
Ensures procedure is performed with the correct
patient.
5. Explain procedure. Rationale: Ensures
cooperation from patient.
6. Perform hand hygiene. Rationale: Reduces
spread of microorganism.
7. Prepare patient for intervention. Provide privacy
and adjust bed level for safe working height.
Rationale: Promotes good body mechanics.
8. Position patient comfortably in a supine position.
9. Don gloves and carefully remove wafer seal from
skin. Adhesive solvent can be used. Rationale:
Reduces trauma, jerking irritates the skin and
sometimes cause skin tearing.
10. Place a reusable pouch in bed pan or disposable
pouch in plastic bag. Rationale: Reduces the
transmission of microorganism.
11. Cleanse skin around the stoma with warm water
and mild soap; pat dry.
12. Measure stoma opening using the measuring
guide. Rationale: To ensure proper fit.
13. Place tissue over stoma, use gauze for ileostomy.
Rationale: Prevents expelled stool from leaking
during the procedure. If skin sealant is to be
used, apply to skin and allow to dry.
14. Apply protective skin barrier about 1/16 inch from
stoma. Rationale: Decreases chance of skin
irritation.
15. Cut out the traced stoma pattern to make an
opening.
16. Remove the backing to expose the sticky,
adhesive side.
- For a one-piece pouching system, center the
one-piece skin barrier and pouch over the stoma
and gently press it on the client’s skin for 30
seconds.
- For a two-piece pouching system, center the skin
barrier over the stoma, and gently press it onto
the client’s skin for 30 seconds. Then, snap the
pouch onto the flange or skin barrier wafer.
2
 LABORATORY: WEEK 9
Gastro-Endocrine I: a) Gastric Lavage, Pre/Post colonoscopy care; b) TPN Guidelines; c) Ostomy Care;
Types of Feeding Tubes
17. For drainable pouches, drain the pouch according
to the manufacturer’s directions.
18. Document the procedure.
- Document the date and time, the type of pouch
used, amount and appearance of feces, condition
of stoma, peristomal skin, and patient teaching.
VARIATION: EMPTYING A DRAINABLE POUCH
 Empty the pouch when it is one third to one half
full of stool or gas. Rationale: Emptying before it
is overfull helps avoid breaking the seal with the
skin and prevent the skin from coming in contact
with the stool.
1. While wearing gloves, hold the pouch outlet over
the bedpan or toilet. Lift the lower edge up.
2. Unclamp or unseal the pouch.
3. Drain the pouch. Loosen feces from sides by
moving fingers down the pouch.
4. Clean the inside of the tail of the pouch with a
tissue or a premoistened towelette.
5. Apply the clamp or seal the pouch.
6. Dispose of used supplies.
7. Remove and discard gloves.
8. Perform hand hygiene.
9. Document the amount, consistency, and color of
stool.
COLOSTOMY IRRIGATION
- Colostomy irrigation is sometimes used to
maintain a regular elimination pattern.
1. For colostomy irrigation, patient needs a cone-
tipped irrigation device, an irrigation sleeve, and
irrigation solution.
2. Patient places the cone-tipped irrigation device to
the stoma from the sleeve. The sleeve is used to
contain the drainage from the stoma as it passes
into the commode.
3. Approximately 500 to 1000 mL is s lowly instilled
into the stoma and the patient must sit on the
commode while it drains out.
**Note: If patient complains of cramping, stop the flow
without removing the cone until cramps sub side.
4. After all solution is instilled, remove the cone and
close top of sleeve to prevent spillage of feces.
5. Instruct the patient to remain seated about 15 to
20 minutes while the returning solution flows into
the toilet.
6. Drain the sleeve, rinse and remove it. Some
irrigation sleeves are reusable.
7. Observe patient and results of irrigation.
8. Perform care around peri stomal site.
9. Document the following; date and time, solution
used, amount of solution, results, and
observations.
References
Cooper, Kim et. Al
Foundations of Nursing, 7th Edition, Mosby 2015
Berman, Audrey et. Al
Kozier & Erb’s Fundamentals of Nursing, Concept, Process, and Practice Volume 2 10 th Edition,
Pearson 2018
Nutrition For Nursing, 4 th edition Content Mastery Series Module
American Technical Institute for Nursing Education 2010
Learning Activ ity
1. Watch the uploaded video clips: Inserting an NG Feeding Tube, Nasogastric Tube
Feeding, Ostomy Bag Pouch Change.
2. Group case presentation based on clinical scenario.
3
 LABORATORY: WEEK 9
Gastro-Endocrine I: a) Gastric Lavage, Pre/Post colonoscopy care; b) TPN Guidelines; c) Ostomy Care;
Types of Feeding Tubes
March 23, 2021

MODULE 7b: PROVIDING NUTRIENTS TO CLIENTS

Learning Outcomes
1. Identif y risk factors for and clinical signs of malnutrition.
2. Describe nursing interv entions to promote optimal nutrition.
3. Discuss nursing interv entions to treat clients with nutritional
problems.
4. Verbalize the steps used in:
a. Inserting a nasogastric tube.
b. Remov ing a nasogastric tube.
c. Administering a tube f eeding.
d. Administering a gastronomy or jejunostomy tube
f eeding.
5. Demonstrate appropriate documentation and reporting of
nutritional therapy .
Introduction

- Nutrients are organic and inorganic substances

found in foods that are required for body
functioning. Adequate food intake consists of a
balance of nutrients: water, carbohydrates,
proteins, fats, vitamins, and minerals. Food differ
greatly in their nutritive value.

- Nutrients have three major functions: providing

energy for body process and movement,
providing structural material for body tissues,
and regulating body process.

Essential Nutrients
• The body’s most basic nutrient need is water. • Fat-soluble vitamins include A, D, E, and K. the
Because every cell requires a continuous supply body can store these vitamins, although there is a
of fuel, the most important nutritional need, after limit to the amounts of vitamins E and K the body
water, is for nutrients to provide fuel or energy. can store.
• The energy-providing nutrients are - Minerals are found in organic compounds.
carbohydrates, fats, and proteins.
- The energy liberated from the metabolism of
• Carbohydrates, fats, proteins, minerals, food has been determined to be:
vitamins, and water are referred to as  4 Calories/gram of carbohydrates
macronutrients, because they are needed in  4 Calories/gram of protein
large amounts to provide energy.  9 Calories/gram of fat
• Micronutrients are those vitamins and mineral  7 Calories/gram of alcohol
that are required in small amounts to metabolize
the energy-providing nutrients.
ENTERAL NUTRITION

• Enteral Nutrition (EN) is used when a client

Micronutrients
cannot consume adequate nutrients and calories
• A vitamin is an organic compound that cannot be orally, but maintains a partially functional
manufactured by the body and is needed in small gastrointestinal system.
quantities to catalyze metabolic process.
• EN consists of blenderized foods or a commercial
• Vitamins are generally classified as fat soluble or formula administered by a tube into the stomach
water soluble. or small intestine.
• Water-soluble vitamins • There are different types of enteral formulas…
- include C and B-Complex vitamins B1
(Thiamin), B2 (Riboflavin), B3 (Niacin or
nicotinic acid), B6 (Pyridoxine), B9 (Folic
acid), B12 (Cobalamin), pantothenic acid,
and biotin.

- The body cannot store water-soluble

vitamins; thus, people must get a daily
supply in the diet.

- Water-soluble vitamins can be degraded by

food processing, storage and preparation.

4
 LABORATORY: WEEK 9
Gastro-Endocrine I: a) Gastric Lavage, Pre/Post colonoscopy care; b) TPN Guidelines; c) Ostomy Care;
Types of Feeding Tubes
Enteral Feeding Routes
- A client’s medical status and the anticipated
length of time that a tube feeding will be required
determine the type of tube used.
1. Transnasal tubes extend from the nose to the
stomach or small intestine.
• Nasogastric (NG) tubes are passed from
the nose to the stomach.
• Nasointestinal tubes are passed from the
nose to the intestine.
• These tubes are used short term (less than 3
to 4 weeks).
2. An ostomy is a surgically created opening
(stoma) made to deliver feedings directly into the
stomach or intestines.
• Gastronomy tubes are endoscopically or
surgically inserted into the stomach. A
percutaneous endoscopic gastronomy (PEG)
tube is placed with the aid of an endoscope.
• Gastronomy tube feedings are generally well
tolerated.
• Jejunostomy tubes are surgically inserted
into the jejunal portion of the small intestine
(jejunum).
Enteral Feeding Formulas
- Commercial products are preferred over home-
blended ingredients because they provide a
known nutrient composition, controlled
consistency, and bacteriological activity.
- Standard and hydrolyzed formulas are two
primary types of enteral feeding formulas
available.
 Standard formulas, also called polymeric or
intact, are composed of whole proteins or protein
isolates.
 Most provide 1.0 to 2.0 cal/mL, but are
available in high-protein, high-calorie, and
disease-specific formulas.
- Tube feedings may be packaged in cans or in
pre-filled bags.
 Pre-filled bags should
be discarded every 24
hours or according to
facility policy, even if
they are not empty.
 Cans may be used to
add formula to a generic
bag to infuse via a
pump, or for feedings
directly from a syringe.
Enteral Feeding Delivery Methods
- The delivery method is dependent on the type
and location of the feeding tube, type of formula
administered, and the client’s tolerance.
1. Continuous drip method: formula is administered
at a continuous rate over a 16 to 24 hr period.
• Infusion pumps help ensure consistent flow
rates.
• Residual volumes should be measured every
4 to 6 hours.
• Feeding tubes should be flushed with water
every 4 hr to maintain patency.
• If the volume of the gastric residual exceeds
the volume of the formula given over the
previous 2 hr, it may be necessary to reduce
the rate of feeding.
2. Cyclic feedings: formula is administered at a
continuous rate over an 8 to 16 hr time period,
often during sleeping hours.
3. Intermittent tube feedings: formula is admnstrd
every 4 to 6 hr in equal portions of 200 to 300 mL
over a 30 to 60 min time frame, usually by gravity
drip.
4. Bolus feedings: a large volume of formula
(500mL max., usual volume is 250 to 400mL) is
administered over a short period of time, usually
less than 15 min, four to six times daily.

 Hydrolyzed formulas, or elemental, are • Bolus feedings are delivered directly to the
composed of partially digested protein peptides stomach.
and are referred to as free amino acids.
 These formulas are used for clients with a
partially functioning gastrointestinal tract, or
those who have an impaired ability to digest
and absorb foods (people with inflammatory
bowel disease, short-gut syndrome, cystic
fibrosis, pancreatic disorders).

5
 LABORATORY: WEEK 9
Gastro-Endocrine I: a) Gastric Lavage, Pre/Post colonoscopy care; b) TPN Guidelines; c) Ostomy Care;
Types of Feeding Tubes

Inserting a Nasogastric Tube  Delegation

 Purpose - Inserting a nasogastric tube is an invasive

- To administer tube feedings and medications to
clients unable to eat by mouth or swallow a
sufficient diet without aspirating food or fluids into
the lungs.
 Assessment
- Check for the history of nasal surgery or deviated
septum. Assess patency of nares.
procedure requiring application of knowledge
(e.g., anatomy and physiology, risk factors) and
problem solving.
- Delegation of this skill to unlicensed assistive
personnel (UAP) is not appropriate. The UAP,
however, can assist with oral hygiene needs of a
client with a nasogastric tube.

- Determine presence of gag reflex.  Implementation

- Assess mental status or ability to participate in
the procedure.
 Planning
- Before inserting a nasogastric tube, determine
the size of the tube to be inserted.
Preparation
- Assist the client to a high-Fowler’s position if his
or her health condition permits, and support the
head on a pillow. Rationale: it is often easier to
swallow in this position and gravity helps the
passage of the tube.

- Place a towel or disposable pad across the chest.

Performance
1. Introduce self and verify client’s identity.
Explain to the client what you are going to do,
why it is necessary, and how he or she can
participate.
2. Perform hand hygiene.
3. Provide client with privacy.
4. Assess the client’s nares.
 Put on clean gloves.
 Ask the client to hyperextend the head, and,
using a flashlight, observe the intactness of
the tissues of the nostrils.
 Equipment
 Examine the nares for any obstructions or
□ Large or small bore tube.
deformities by asking the client to breathe
□ Nonallergenic adhesive tape
through one nostril while occluding the other.
□ Clean gloves
□ Water-soluble lubricant
□ Facial tissue
□ Glass of water and drinking straw
□ 20-50mL catheter tip syringe
□ Kidney basin
□ pH test strip 5. Prepare the tube
□ Stethoscope
□ Disposable pad or towel 6. Determine how far to insert the tube.
□ Safety pin and elastic band  Use the tube to mark off the distance from
the tip of the client’s nose to the tip of the
earlobe and then to the tip of the xiphoid.
Rationale: This length approximates the
distance of the nares to the stomach. This
distance varies among individuals.
 Mark this length with adhesive tape if the
tube does not have markings.
7. Insert the tube.
 Lubricate the tip of the tube well with water-
soluble lubricant or water to ease insertion.
Rationale: A water-soluble lubricant
dissolves if the tube accidentally enters the
lungs.
 Insert the tube, with its natural curve
downward, into the selected nostril. Ask the
clint to hyperextend the neck, and gently
advance the tube toward the nasopharynx.
Rationale: Hyperextension of the neck

6
 LABORATORY: WEEK 9
Gastro-Endocrine I: a) Gastric Lavage, Pre/Post colonoscopy care; b) TPN Guidelines; c) Ostomy Care;
Types of Feeding Tubes
reduces the curvature of the nasopharyngeal  Loop the elastic band around the end of the
junction. tubing and attach the elastic band to the
gown with a safety pin or attach a piece of
 Direct the tube along the floor of the nostril
tape to the tube and pin the tape to the
and toward the midline. Rationale: directing
gown. Rationale: This will prevent it from
the tube along the floor avoids the
dangling and pulling.
projections (turbinates) along the lateral wall.
11. Remove and discard gloves, and perform
hand hygiene.
12. Document relevant information related to the
procedure.

 If the tube meets resistance, withdraw it
relubricate it, and insert it in the other nostril.
Rationale: The tube should never be forced
against resistance because of the danger of
injury.
• Gastrostomy and jejunostomy devices are used
for long term nutritional support, generally more
than 6 to 8 weeks. Tubes are placed surgically or
by laparoscopy through the abdominal wall into
the stomach.

 Once the tube reaches the oropharynx • A percutaneous endoscopic gastrostomy

(throat), the client will feel the tube in the (PEG) or percutaneous endoscopic
throat and may gag and retch. Ask the client jejunostomy (PEJ) is created by using an
to tilt the head forward. endoscope to visualize the inside of the stomach,
making a puncture through the skin and
Rationale: tilting the head forward facilitates subcutaneous tissues of the abdomen into the
passage of the tube into the posterior stomach, and inserting the PEG or PEJ catheter
pharynx and esophagus rather than into the through the puncture.
larynx; swallowing moves the epiglottis over
the opening to the larynx. • The surgical opening is sutured tightly around the
tube or catheter to prevent leakage. Care of this
 If the client gags, stop passing the tube opening before it heals requires surgical asepsis.
momentarily. Have the client take a rest, take
a few breathes, and take sips of water to • The catheter has an external bumper and an
calm the gag reflex. internal inflatable retention balloon to maintain
placement.
 Pass the tube 5 to 10 cm with each swallow,
until the indicated length is inserted. • A skin-level tube can be used that remains in
place. A feeding set is attached when needed.
8. Ascertain correct placement of the tube.
 Nasogastric tubes are radiopaque, and
position can be confirmed by x-ray. This is
the only definitive method of verifying feeding
tube tip placement. If an x-ray is not feasible,
at least two of the following methods should
be used.
 Aspirate stomach contents, and check the
pH, which should be acidic. Rationale:
Testing pH is a reliable way to determine
location of a feeding tube. Gastric contents
are commonly pH 1 to 5.
 Stethoscope over the client’s epigastrium
and injected 10 to 30mL of air into the tube Enteral Feedings
while listening to for a whooshing sound.
- The type and frequency of feedings and amounts
9. Secure the tube by taping it to the bridge of to be administered are ordered by the primary
the client’s nose. care provider. Liquid feeding mixtures are
 If the client has oily skin, wipe the nose first available commercially or may be prepared by
with alcohol to de-fat the skin. the dietary department in accordance with the
primary care provider’s orders.
 Cut 3 in of tape, and split it length wise at
one end leaving a one inch tab at the end. - A standard formula provides 1 Kcal per milliliter of
solution with protein, fat, carbohydrate, minerals,
 Place the tape over the bridge of the nose, and vitamins in specified proportions.
bring the split ends either under and around
the tubing, or under the tubing and back up
over the nose. Rationale: Taping in this
manner prevents the tube from pressing
against and irritating the edge of the nostril.
10. Secure the tube to the client’s gown.

7
 LABORATORY: WEEK 9
Gastro-Endocrine I: a) Gastric Lavage, Pre/Post colonoscopy care; b) TPN Guidelines; c) Ostomy Care;
Types of Feeding Tubes
- Enteral feedings can be given intermittently or
continuously. Intermittent feedings are the
administration of 300 to 500mL of enteral formula
several times per day.
- Initial intermittent feedings should be no more
than 120mL.
- Bolus intermittent feedings are those that use
a syringe to deliver the formula into the stomach.
- Client must be monitored closely for distention
and aspiration.
- Continuous feedings are generally administered
over a 24hr period using an infusion pump that
guarantees a constant flow rate. Initial
intermittent feedings should be no more than
60mL/hr.
Administering a Tube Feeding
 Purposes
- To restore or maintain a nutritional status.
- To administer medications.
 Assessment
- For any clinical signs of malnutrition or
dehydration.
- For allergies to any food in the feeding. If the
client is lactose intolerant, check the tube feeding
formula. Notify the primary health care provider if
anuy incompatibilities exist.
- For the presence of bowel sounds.
- For any problems that suggest lack of tolerance
of previous feedings (e.g., delayed gastric
emptying, abdominal distention, diarrhea,
cramping, or constipation).
 Planning
- Before commencing a tube feeding, determine
the type, amount, and frequency of feedings and
tolerance of previous feedings.
 Equipment
□ Correct type and amount of feeding solution
□ 60mL catheter-tip syringe
□ Emesis basin
□ Clean gloves
□ pH test strip
□ Large syringe or calibrated plastic bag
feeding bag with label and tubing that can be
attached to the feeding tube or prefilled bottle
with a drip chamber, tubing, and a flow-
regulator clamp.
□ Measuring container from which to pour the
feeding (if using open system)
□ Water (60mL) unless otherwise specified) at
room temperature
□ Feeding pump as required.
 Implementation
Preparation
- Assist the client to a Fowler’s position. Rationale:
These positions enhance the gravitational flow of
the solution and prevent aspiration of fluid into
the lungs.
Performance
1. Introduce self and verify the client’s identity.
Explain to the client what you are going to do.
2. Perform hand hygiene and observe other
appropriate infection prevention procedures.
(e.g., clean gloves)
3. Provide privacy for this procedure
4. Assess tube placement.
 Attach the syringe to the open end of the
tube and aspirate. Check the pH
5. Assess residual feeding contents.
 Measure the am ount before administering
the feeding. Rationale: This is done to
evaluate absorption of the last feeding; that
is, whether undigested formula from a
previous feeding remains.
 If 100mL (or more than half the last feeding)
is withdrawn. The precise amount is usually
determined by the primary care provider’s
order or by agency policy. Rationale: At
some agencies, a feeding is delayed when
the specified amount or more of formula
remains in the stomach.
Or
 Reinstill the gastric contents into the
stomach. Rationale: Removal of the
contents could disturb the client’s electrolyte
balance.
 If the client is on a continuous feeding, check
the gastric residual every 4 to 6 hours.
6. Administer the feeding.
 Before administering feeding:
a. Check the expiration date of the feeding.
b. Warm the feeding to room temperature.
Rationale: An excessively cold feeding may
cause abdominal cramps.
Feeding Bag (Open System)
 Apply a label that indicates the date, time of
starting the feeding, and nurse’s initials on
the feeding bag. Hang the labeled bag rom
an infusion pole about 30cm or 12in tall
above the tube’s point of insertion into the
client.
Rationale: At this height, the formula should
run at a safe rate into the stomach or
intestine.
 Clamp the tubing and add the formula to the
bag.
 Open the clamp, run the formula through the
tubing, and reclamp the tube. Rationale: The
formula will displace the air in the tubing,
thus preventing the instillation of excess air
into the client’s stomach or intestine.
 Attach the bag to the feeding tube and
regulate the drip by adjusting the clamp to
8
 LABORATORY: WEEK 9
Gastro-Endocrine I: a) Gastric Lavage, Pre/Post colonoscopy care; b) TPN Guidelines; c) Ostomy Care;
Types of Feeding Tubes
the drop factor on the bag if not placed on
the pump.

Syringe (Open System)

 Remove the plunger from the syringe and
connect the syringe to a pinched r clamped
nasogastric tube.
Rationale: Pinching or clamping the tube
prevents excess air from entering the stomach
and causing distention.
 Add the feeding to the syringe barrel.
 Permit the feeding to flow in slowly at the
prescribed rate. Rationale: Quickly administered
feedings can cause flatus, cramps, and/or
vomiting.
 Prefilled Bottle with Drip Chamber (Closed
System)
 Remove the screw-on cap from the container and
attach the administration set with the tubing.
 Close the clamp on the tubing.
 Hang the container on an intravenous (IV) pole
about 30cm above the tube’s insertion point into
the client. Rationale: At this height, the formula
should run at a safe rate into the stomach or
intestine.
 Squeeze the drip chamber to fill it to one third to
one half of its capacity.
 Open the tubing clamp, run the formula through
the tubing, and reclamp the tube. Rationale: The
formula will displace the air in the tubing, thus
preventing the instillation of excess air.
 Attach the feeding set tubing to the feeding tube
and regulate the drip rate to deliver the feeding
over the desired length of time or attach to a
feeding pump.
7. If another bottle is not to be immediately
hung, flush the feeding tube before all of the
formula has run through the tubing.
 Instill 50 to 100mL of water through the
feeding tube or medication port.
Rationale: Water flushes the lumen of the
tube, preventing future blockage by sticky
formula.
8. Clamp the feeding tube.
 Rationale: Clamping prevents air from
entering the tube.
9. Ensure client comfort and safety.
 Secure the tubing to the client’s gown.
 Ask the client to remain sitting upright
Fowler’s position or in a slightly elevated
right lateral position for at least 30 minutes.
Rationale: These positions facilitate
digestion and movement of the feeding from
the stomach along the alimentary tract, and
prevent the potential aspiration of the
feedings into the lungs.
10. Dispose of equipment appropriately.
11. Document all relevant information.
References
Cooper, Kim et. Al

9
 LABORATORY: WEEK 9
Gastro-Endocrine I: a) Gastric Lavage, Pre/Post colonoscopy care; b) TPN Guidelines; c) Ostomy Care;
Types of Feeding Tubes
Foundations of Nursing, 7th Edition, Mosby 2015
Berman, Audrey et. Al
Kozier & Erb’s Fundamentals of Nursing, Concept, Process, and Practice Volume 2 10 th Edition,
Pearson 2018
Nutrition For Nursing, 4 th edition Content Mastery Series Module
American Technical Institute for Nursing Education 2010

10