TUBE FEEDING

Definition:              Is the introduction of liquid feedings directly into the stomach.

Purposes:               Provide a means of alimentation when oral route is inaccessible.
 
Different Avenues
 

Nasogastric A tube is passed through the nose or mouth into the stomach and secured in place.

Esophagostomy A temporary or permanent opening (stoma) is constructed at one of several sites to

allow a tube to be introduced through the skin into the esophagus.  Feeding tube is
  usually removed between meals.

A temporary or permanent stoma is constructed, allowing food to be introduced

Gastrostomy
through the skin directly into the stomach.

A stoma is constructed to give direct access to the jejunum.  This method of feeding
Jejunostomy
may be used when the stomach must be by passed.

 
Materials Needed:
 Tray
 Prepared feeding
 Stethoscope
  Glass of water
 Asepto syringe and bulb
Purposes:

1. To enhance the nutritional status of clients who are unable to take food normally.
2. Some clients are fed by tube because they are in a state of coma; others may be alert but suffering from paralysis
or pathology of the mouth, pharynx, or esophagus. Others cannot or will not eat enough to   provide adequate nutrients
for body functioning.
Considerations:

1. Do not hurry or force the feeding; this can cause distention, discomfort.

2. Use clean technique when you administer a tube feeding and remember that this feeding is
actually the client’s meal.
3. The formula should be at room temperature but not warm because with prepared products with a
small amount of sugar added can be an ideal medium for the growth of bacteria.  
 
 

PROCEDURE/STEPS RATIONALE
1. Check the physician’s order.  The specific amount of formula and water
and the time of the feedings will be noted.  This information may be found  
on both the original order and the medication sheet in some facilities
2. Read any observations about previous feedings noted on the client’s - This will give you a clearer idea of the client’s tolerance for
chart. the procedure.
3. Wash your hand. - For infection control
4.  Decide whether the client is to be fed using the reservoir asepto, or pre-  
filled method.  If the reservoir or pre-filled method is to be used, see
whether a pump is available.
5. Gather any equipment you will need.  Regardless of the method, you  
will need a stethoscope for checking the position of the feeding tube and
 
the feeding formula. Add one of the following:
a.  Reservoir tube feeding set  
b.  Asepto syringe and bulb
 
c.  Pre-filled tube feeding set
   Feeding sets and tubings for continuous feedings are changed every 24 - To protect the client from bacterial growth in the equipment.
hours.
 
 
- To facilitate appropriate changing of equipment.
 Label the equipment with date and   time  
   
Implementation
 
 
6. Identify the client. - To be sure you are carrying out the procedures on a correct
  client.

   

7. Explain what you are going to do.

- To lessen anxiety, and develop cooperation
 
8. Place the client in semi-Fowler’s position - This position will help gravity to empty stomach and prevent
  aspiration

   

9. Test the placement of the tube and for residual formula. - Because the tube may have become dislodged in the interval
 between feedings, it is important that you check for position
and patency each time before feeding.  It is best to use the two
most reliable method:  listening over the epigastrium with a
stethoscope as you introduce a small amount of air, and
aspirating the gastric contents.  This last is both a positive
determination of placement and a check for digestion of the
previous feeding.  
- To ensure that the tube is patent
10. Depending on the equipment used in your facility, administer a small
- Therefore, it must be kept thoroughly cleaned between
amount of water first, then any medications ordered and formula.  Follow
feedings, so that microorganisms are not harbored in the bag.
with the remainder of the water, which rinses formula out of the tubing.
a.        Reservoir method:   In most facilities where a reservoir is used more
than once, the reservoir consists of a square-shaped plastic bag or bottle
with markings calibrated in milliliters.  Attached to the reservoir is a  
drip chamber and tubing.
1)       Hold the top of the bag open as you instill a portion of the water
ordered.
2)       Open the stopcock until the water has displaced the airlift in the
tube.
3)       Attach the tube to the client’s nasogastric tube, and allow the
water to enter.  
4)       Clamp before air enters from the bag. 4. To prevent abdominal distention and discomfort.
  5)       Pour the formula into the bag and regulate the drip using the
stopcock.  
6)       Before the formula runs completely down the tube introduce the 6. This prevents air from being instilled and rinses the filling
remainder of the water. Close the stopcock and detach the out of the tube.
reservoir tubing from the nasogastric tube.
7)       Clamp or plug the nasogastric tube.
8)       Clean the bag or bottle thoroughly with water.
 
 b.        Asepto syringe method:  When you use this method, hold the
syringe manually, and fill and refill it in the sequence used with the
reservoir method.  Again, do not  allow the water or formula
fall below the narrowing at the bottom of the syringe, This method - To prevent the entrance of air through the nasogastric
may be used for instilling medications and water when given at a time tube.
separate from feedings.
 
c.        Prefilled tube feeding set:   These sets are available commercially
and consist of premeasured formula in a plastic container or a  
minibottle a drip chamber and tubing.
 
 
       1.Remove the sealed screw cap and screw in its place the cap with the  
drip chamber and tubing.
   
 
 
       2. Hang the bottle on an intravenous pole.
 
 

       3. Introduce a small amount of water in an asepto syringe  

   
- So that the air is not introduced into the stomach
       4. Start the flow from the mini bottle to fill the tubing with formula
instead of air.  
 
 
       5. When the formula has filled the tubing, attach the set of the client’s  
nasogastric tube and begin the feeding.
  
       6. Follow with water, using the asepto syringe. -  To flush the formula out of the tubing.
Note:  All three methods use gravity flow to move the formula through the
tube.  If the flow slows down or stops, gentle pressure on the asepto bulb
or “milking” the tubing may help.  If the client gags during the feeding,  
stop the procedure.
 
- To prevent air coming into the tube to  the stomach.
11. After the feeding clamp tube tightly or plug it.       
 
12. Reposition the client in low semi-Fowler’s position.  If the client is
- To prevent aspiration into the lungs if    vomiting occurs.
comatose, the head should be turned to one side.
13. Return to the client in approximately 30 minutes. - To make sure the feeding has been retained.
14. Wash your hands. - For infection control
15. Record on the medication sheet or progress notes.  Your notes should
include the date, time, type and amount of amount of water, and client’s
response.  Most clients being fed by the tube are on intake and output, so  
an appropriate entry should be made after each feeding.  The total fluid
should be entered on the intake and output, worksheet.
 
 
 
_____________________________________________________________________________________
 
CI’S Name and Signature:  __________________________   Student’s Signature: ____________________