PAMANTASAN NG LUNGSOD NG MAYNILA

COLLEGE OF NURSING

Medical- Surgical Nursing II

SKILLS LABORATORY CHECKLIST

Name: ______________________________________ February 28, 2024

Date: ______________________________
3-8
Year Level and Block: _______________________ Clinical Instructor: ______

Rating scale:

3 Performed correctly, systematically according to standard with correct rationale.

2 Performed correctly, with correct rationale but not systematic.
1 Performed correctly, but not systematic and with inadequate rationale.
0 Performed incorrectly.

Procedure: Managing Enteral Tube Feeding

PREPARATION RATIONALE PERFORMANCE REMARKS

3 2 1 0
Purpose
• Provides nutrition supplementation To restore or maintain nutritional
to clients who cannot ingest status.
adequate amounts of nutrients
orally.

Equipment:
• Stethoscope
• Ph paper (optional)
• Irrigation set with a 60 ml piston-
type syringe.
• Washcloth and towel
• Disposable gavage feeding set (bag
and tubing appropriate for pump)
• Tube feeding product (at room
temp.) ordered by doctor.
• Administration pump
• Nonsterile gloves
• Glass or cup
• pen
Assessment should focus on the following: to ensure that the patient's
• nutritional status (skin turgor, urine nutritional needs are adequately
output, weight, caloric intake, met and to identify any potential
pertinent lab values) deficiencies or imbalances that
may affect the effectiveness of
 enteral feeding.

• Gi functioning (abdominal distention, This evaluation helps prevent

bowel sounds).
complications such as feeding
intolerance, aspiration, and
gastrointestinal discomfort.

• Elimination pattern (diarrhea, addressing these issues before

constipation, date of last bowel initiating enteral feeding, can
movement) mitigate the risk of complications
ensuring safe and effective
nutritional support.

• Response to previous enteral Understanding the patient

nutritional support.
previous feedings, including any
adverse reactions or complications,
allows healthcare providers to
adjust the feeding formula, rate, or
method as necessary to prevent
recurrence of issues and ensure
patient safety and comfort.

This proactive approach minimizes

• Medical diagnoses that may affect
complications such as feeding
tolerance to product or
intolerance, aspiration, or
administration.
exacerbation of underlying medical
conditions

• Doctors order for nutritional product verifying the doctor's order before
and route of delivery. enteral feeding helps ensure that the
patient receives the right nutrition in
the safest and most effective manner.

• Confirmation of tube location. Verifying the tube's correct

placement helps prevent
complications
• Residual feeding amounts.
to assess gastric emptying and
tolerance to previous feedings
• Condition of skin at site of enteral
tube insertion
Checking the skin integrity ensures
that the tube insertion site is
healthy and free from

Procedure
1. Perform hand hygiene and organize
equipment. Confirm orders for
formula frequency, route, and rate, of
feedings:
• Change disposable gavage
feeding sets every 24 hours as
per manufacturer’s guidelines
or agency policy.
• Select tubing that is
compatible with feeding bag
and pump (if used).
• Determine amount of free
water to be infused and pour maintain fluid balance in the
into cup.
2. Explain procedure to client; provide
for privacy.
3. Adjust bed to comfortable working
height.
4. Place or assist client into appropriate
position. The head of the bed should
be elevated in high Fowler’s position
during and for at least 30 min after
the feeding
5. Don gloves
6. Assess abdomen, noting the
presence of bowel sounds. Assess
skin at site as enteral tube enters
body (naris or abdomen). provide site
care as per doctor’s orders or agency
policy, if appropriate.
7. Verify tube placement
complications
Ensures adherence to prescribed
treatment plan and prevents
errors.
to maintain hygiene and prevent
the risk of contamination and
infection.
Compatible tubing ensures a
secure connection between the
feeding bag, pump (if used), and
the patient's enteral access device
to ensure accurate hydration and
patient.
Promotes patient understanding,
cooperation, and reduces anxiety.
to optimize ergonomics and
enhance the safety and efficiency
of the feeding procedure.
These positions enhance the
gravitational flow of the solution and
prevent aspiration of fluid into the
lungs
to reduce the risk of contamination
and infection
ensures early detection of
complications, allowing timely
intervention and providing site
care as per doctor's orders or
agency policy, maintains hygiene
and reduces the risk of infection or
discomfort for the patient.
Ensures safe and effective delivery
of feedings into the
gastrointestinal tract, preventing
complications like aspiration.
8. To administer a continuous tube
feeding:
• Prepare formula: Remove An excessively cold feeding may cause
formula from refrigerator 30 abdominal cramps.
mins. Before hanging (if
applicable)

• Rinse bag and tubing with removes any residual formula or

water. medication from previous
feedings, and to prevent
contamination and ensure the
delivery of clean nutrition

This process allows for controlled

• Close roller clamp on gavage
administration of the formula,
tubing and pour a 4 hour
minimizing the risk of overfeeding
volume of formula in bag.
or underfeeding and promoting
optimal absorption and utilization
of nutrients by the patient.

to ensure proper priming of the

• Open roller clamp and allow tubing and accurate delivery of the
formula to flow to end. Clamp enteral formula. Priming the tubing
tubing and insert into pump removes air bubbles and ensures
mechanism if used. that the formula reaches the
patient without interruption,
minimizing the risk of inaccurate
feeding or air embolism.

9. Attach feeding bag tubing to enteral to establish a secure and direct

tubing to enteral tube attached to pathway for delivering enteral
client. nutrition

10. Set pump to deliver appropriate setting the pump to deliver the
volume and check infusion every 1-2 prescribed volume will regulate the
hr. flow of enteral nutrition accurately
and Regularly checking the
infusion allows for ongoing
assessment of the patient's
tolerance to the feeding regimen,
facilitating prompt adjustments as
needed to prevent complications
such as feeding intolerance or
aspiration.
11. Every 4 hour:
• Stop infusion; slowly aspirate
gastric contents, taking care
not to pull on tube; and note
amount of residual feeding.
This is done to evaluate absorption of
the last feeding; that is, whether
undigested formula from a previous
feeding remains. If the tube is in the
small intestine, residual contents
cannot be aspirated.

At some agencies, a feeding is

• If residual is greater than
delayed when the specified amount
specified amount as per
or more of formula remains in the
orders (commonly 100ml)
stomach.
discard aspirated volume
from stomach, cease feedings
and notify doctors.

• If residual feeding is within Removal of the contents could disturb

acceptable level return to the client’s electrolyte balance.
stomach.

• Monitor bowel sounds in all to assess gastrointestinal motility

abdominal quadrants. and function, changes in bowel
sounds, such as the absence or
irregularity of sounds, may indicate
feeding intolerance.

• Perform mouth care Reduces the risk of oral

complications and maintains
patient comfort.

12. Irrigate tube every 2-3 hour and
before and after medication
administration with 30-60ml of water formula.
or as per doctor’s order or agency
policy.
13. Once each shift, while irrigating
enteral tube after completing a dose
of formula, rinse bag and gavage
tubing with water.
Water flushes the lumen of the tube,
preventing future blockage by sticky
To prevents contamination and
blockages, ensuring safe enteral
feeding. This practice maintains
cleanliness and reduces the risk of
bacterial growth, promoting
patient safety.
 14. Restore or discard all equipment To ensures hygiene and reduces
appropriately the risk of contamination for
subsequent use

15. Remove and discard gloves and reduces the risk of cross-
perform hand hygiene contamination and minimizes the
spread of infection

Managing Intermittent Feeding

1. Follow steps 1-7 above Ensures adherence to prescribed
treatment plan and prevents
errors.

2. Check for residual. To ensures adequate gastric

emptying and reduces the risk of
complications such as aspiration or
overfeeding.

3. Crimp tube and connect syringe to Pinching or clamping the tube

enteral tube and aspirate small prevents excess air from entering the
amount of contents to fill tube and stomach and causing distention
lower portion of syringe
4. Fill syringe with formula and allow to
flow slowly into enteral tube. Infuse At this height, the formula should run
formula holding syringe 6 inches at a safe rate into the stomach or
above tube insertion site (nose and intestine.
abdomen) follow with water.
5. Do not allow syringe to empty until Clamping prevents air from entering
formula and water have completely the tube.
infused.
6. Clamp enteral tube, remove syringe, These positions facilitate digestion
and remind client to stay in semi- and movement of the feeding from
fowlers or high fowler’s position for the stomach along the alimentary
at least 30 min after the feeding. tract, and prevent the potential
aspiration of the feeding into the
lungs.

7. Check enteral tube placement and This assessment helps confirm the
residual feeding before each tube correct placement of the tube in
feeding. the gastrointestinal tract, reducing
the risk of complications

8. Restore or discard all equipment If the equipment is to be reused,

appropriately. wash it thoroughly with soap and
 water so that it is ready for reuse.

Change the equipment every 24

hours or according to agency policy.
9. Remove and discard gloves and reduces the risk of cross-
perform hand hygiene contamination and minimizes the
spread of infection

10. Evaluate and documents all relevant

information.
• Assessment of tube
placement and method of
confirmation 4.5. Pt. in Fowler’s position. 1 L room-
• Assessment site of tube entry temperature ordered formula begun
• Amount of residual feeding @ 60 mL/hour on pump. No nausea
• Amount and type of product reported. –––––––––––J. BUENO, RN
given
• Amount of water given with
and between feedings
• Route and method of delivery
• Client position during and
after administration of
products.
• Client tolerance of procedure
• Teaching performed.

________________________________
Signature over Printed Name of Student

Evaluated By:

________________________________
Signature over Printed Name
Clinical Instructor