PROCEDURAL CHECKLIST FOR ADMINISTERING SPECIALIZED NUTRITIONAL SUPPORT VIA NGT,

GASTROSTOMY OR JEJUNOSTOMY

Name: ____________________________ Area: ___________________ Date: ___________________

PERFORMANCE POINTS REMARKS

Satisfactory

Improveme
Excellent

Needs

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1. Identify the patient.
2. Review patients chart for food allergies and
doctors order for the patient.
3. Explain procedure to patient.
4. Place patient in Fowlers position by elevating
head of bed at least 30-45 degrees. If an upright
position is contraindicated help patient to a right
side lying position with head elevated at 30
degrees.
5. Perform hand hygiene and don gloves.
6. Confirm placement of tube. Attach 60ml asepto
syringe to tube. Inject 10-20ml of air while
auscultating with the stethoscope.
7. Note for any gastric residual. Notify attending
physician if gastric residual exceeds 400ml to
500ml.
8. Prepare correct amount of feeding. It should be
room temperature.
BOLUS OR INTERMITTENT FEEDING
9. Clamp gastric tubing and attach syringe or
feeding bag. If using a feeding bag, prime tubing
and attach feeding bag and tubings to the
patient feeding tube.
10 Fill syringe or feeding bag with OF. Allow feeding
. to flow in slowly (10-15minutes). If using syringe
raise or lower syringe to adjust flowrate by
gravity. Refill syringe as needed without
disconnecting. Avoid airspaces in tubing. If a
feeding bag is used, hang bag on IV pole and
adjust flow rate with clamp on tubing.
11 Clamp tubing just as feeding is completing. Rinse
. tubing with 30-60ml warm water.
12 Clamp gastric tube and disconnect from syringe
. or feeding bag.
13 Keep patient on Fowlers position for 30-
. 60minutes after feeding.
14 Wash equipment after use with soap and water.
.
15 Perform hand hygiene.
.
CONTINOUS FEEDING
16 Connect feeding bag and tubing to patients
. feeding tube.
17 Pour desired amount of OF in feeding bag.
.
18 Hang feeding bag in IV pole. Allow to flow
. through bag.
19 Connect tubing to enteral pump and set rate as
. ordered by the attending physician
20 Patient receiving continuous feeding should
. check gastric residuals every 4 to 6 hours. After
checking residual and replacing stomach
contents, flush tubing with 30-60ml of warm
water.
22 Place patient in Fowlers position.
23 Wash any reusable equipment with soap and
. water.
24 Perform hand hygiene.
.
25 Document procedure done.
.