Gastrostomy Button Bolus Feeding

<< DIGESTIVE

The most significant risk with tube feedings is aspiration of feeding into the lungs, be sure the student is positioned properly with head elevated at least 30 degrees

Considerations:

  • Be sure to take steps to ensure patient privacy when performing procedure
  • The most significant risk with tube feedings is aspiration of liquid nutrition into the lungs, be sure the student is positioned properly with head elevated at least 30 degrees
  • Verify with healthcare provider if residuals are to be checked prior to feeding
  • If residual checks are not ordered, discuss with healthcare provider how tube placement should be verified prior to feeding
  • Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills
  • Make feeding like mealtime: allow the student to sit with other children during mealtime, if possible

Supplies:

  • Gastrostomy button replacement kit:
    • Replacement gastrostomy button
    • 6-ml luer slip syringe
    • Medical tape
    • Water based lubricant
  • 60-ml ENFit/Enteral syringe
  • Adapter with tubing and clamp, if applicable
  • Extension set, if applicable
  • Graduated measuring cup
  • Prescribed diet at room temperature
  • Warm tap water, if prescribed
  • Towel or wash cloth
  • Non-sterile gloves
  • Alcohol wipe
  • Student’s Individualized Health Plan (IHP) and healthcare provider’s order
  • Parent/Guardian authorization form
Procedure Download
Skill Competency Download

Procedure:

  1. Review healthcare provider’s order including:
    • the type of formula
    • amount
    • infusion type and rate
    • frequency and timing of administration
    • residual volume checks
    • amount of water used to flush the tube
  2. Review student’s allergy status
  3. Ensure proper documentation of parent/guardian authorization to administer the feeding
  4. Explain the procedure to the student at his/her level of understanding
  5. Wash hands
  6. Gather equipment and place on clean surface
  7. Confirm you have the correct forumla
  8. Check expiration date on formula
  9. Note the integrity of the formula container
  10. Position child either sitting or supine with head up at least 30 degrees
    • The most significant risk with tube feedings is aspiration of liquid nutrition into the lungs, be sure the student is positioned properly with head elevated at least 30 degrees
  11. Put a towel or washcloth under student’s button
  12. Put on gloves
  13. Observe abdomen for signs of malposition or obstruction of gastrostomy button such as abdominal distention
    • If student has abdominal distention do not administer feeding and contact parent/guardian and healthcare provider
  14. If residual check is ordered:
    • Remove plug from gastrostomy button
    • Attach the extension tubing
    • Attach 60-mL ENFit/enteral syringe with plunger to the end of the extension tubing
    • Unclamp the tubing and gently draw back on the plunger to remove any liquid or medication that may be left in the stomach (residual)
    • Note the amount withdrawn from tube feeding
    • Return residual to stomach via method ordered by healthcare provider
    • Clamp tubing and remove the ENFit/enteral syringe
  15. If residual is not ordered, verify with the healthcare provider how placement of g-tube should be verified before administering feeding
  16. If residual check is NOT ordered:
    • Prior to attaching extension/adaptor tubing to the gastrostomy button:
      • Open clamp on extension tubing
      • Flush 5-mL (or enough water to fully flush the extension tubing) through extension tubing
      • Clamp extension tubing
      • Attach extension tubing to gastrostomy button, per manufacturer’s instruction
  17. Shake feeing can/container
  18. If feeding is in a can, clean the top of the feeding (formula) can with an alcohol wipe or soapy cloth
  19. Attach 60-mL ENFit/enteral sryinge with plunger removed to the end of the extension tubing
  20. Measure prescribed amount of enteral formula to be infused into clean graduated measuring cup or a syringe
    • Observe the appearance of the formula for any abnormalities
  21. Pour feeding into ENFit/enteral syringe until about one-half full
  22. Elevate the ENFit/enteral syringe above the level of the stomach
  23. Open extension tubing clamp
  24. Allow feeding to go in slowly, over prescribed amount of time
    • The higher the syringe is held, the faster the feeding will flow
    • Lower syringe if the feeding is going too fast
  25. Refill the syringe before it empties to prevent air from entering stomach
  26. Continue to add until feeding is completed over prescribed time
  27. Monitor student during feeding for any signs of intolerance or complications
  28. Stop feeding immediately for gagging, vomiting, coughing, abdominal distension, change in skin color, or difficulty breathing, etc.
  29. Flush the button with warm water when feeding is complete, amount determined by healthcare provider’s order
  30. After flushing, lower the syringe below the stomach level to facilitate burping
  31. Vent until gassiness is relieved and allow any gastric contents to instill via gravity
  32. Remove the extension tubing and ENFit/enteral syringe
  33. Insert plug into the gastrostomy button
  34. Keep the child in a feeding (upright) position for at least 30 minutes after completing feeding
  35. Wash syringe and tubing with soap and warm water and puts in home container
  36. Syringe and feeding extension tubing can be used repeated times for up to 24 hours
  37. Remove gloves
  38. Wash hands
  39. Document assessment, interventions and outcomes in student’s health record
  40. Follow up with parents/guardian and healthcare provider, as needed

References:

Applied Medical. (2017, December 22) . How to attach a feed set to an AMT MiniONE® balloon button g-tube. Retrieved June 21, 2023, from https://www.youtube.com/watch?v=rqEy_HOuw_I  

Avanos Medical, Inc. (2020). Mic-Key* g feeding tube. Enteral feeding as easy as 1 2 3. Retrieved June 21, 2023, from https://tubefed.com.au/wp-content/uploads/2021/01/MIC-KEY-G-Quick-Start-Guide-ANZ.pdf  

Avanos Medical Sales, LLC. (2019, January 23). Mic-Key* g feeding tube. Extension sets with ENFit® connectors. Your guide to proper care. Retrieved June 21, 2023, from https://tubefed.com.au/wp-content/uploads/2021/01/AVANOS-MIC-KEY-G-Guide-to-Proper-Care.pdf  

Boullata, J. I., Carrera, A. L., Harvey, L., Escuro, A. A., Hudson, L., Mays, A., McGinnis, C., Wessel, J. J., Bajpai, S., Beebe, M. L., Kinn, T. J., Klang, M. G., Lord, L., Martin, K., Pompeii-Wolfe, C., Sullivan, J., Wood, A., Malone, A., Guenter, P., & ASPEN Safe Practices for Enteral Nutrition Therapy Task Force, American Society for Parenteral and Enteral Nutrition. (2017). ASPEN safe practices for enteral nutrition therapy [Formula: see text]. JPEN. Journal of parenteral and enteral nutrition, 41(1), 15–103. https://doi.org/10.1177/0148607116673053 

Children’s Mercy Kansas City. (2022, December 2). Gastronomy tube (g-tubes): Training for school nurses.. Retrieved June 21, 2023, from https://www.youtube.com/watch?v=_Gif-699CmM 

Cleveland Clinic. (2019, November 1). Home tube feeding – Checking residuals. . Retrieved August 22, 2023, from https://www.youtube.com/watch?v=59tusCo2wAI  

Lynn, P. (2019). Administering a tube feeding. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (pp. 253-255). 

Pediatric Home Services. (2017). Bolus feeding by syringe- Gravity method (Alimentación en bolo por jeringa—Método de gravedad). . Retrieved June 21, 2023, from https://www.pediatrichomeservice.com/tips-how-tos/bolus-feeding-syringe-gravity-method/?play=1  

Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Skill 32.4 administering enteral nutrition: Nasogastric, nasointestinal, gastrostomy, or jejunostomy tube. In Clinical nursing skills and techniques. (10th ed.). (pp. 965-972). St. Louis, MO: Elsevier. 

Potter, P. A., Griffin Perry, A. G., Stockert, P. A., & Hall, A. (2023). Chapter 45 Nutrition. Skill 45.3 Administering enteral feedings via nasoenteric, gastrostomy, or jejunostomy tubes. In Fundamentals of Nursing. (11th ed.). (pp.1214-1219). St. Louis, MO: Elsevier.  

Porter, S. M., Page, D., Engholm. H., & Somppi, C. (2019). Students supported by medical technology. In J. Selekman, Shannon, R.A., Yonkaitis, C.F. (Eds.). School nursing, a comprehensive text (3rd ed., pp. 721-740). Philadelphia PA.: F. A. Davis Co. 

Spratling, R., Chambers, R., Lawrence, P., & Faulkner, M.S. (2021). Best practices with use of feeding tubes for children at home. Pediatric Nursing, 47(1), 7-10. 

Toothaker, R., & Cook, P. (2018). A Review of Four Health Procedures That School Nurses May Encounter. NASN school nurse (Print), 33(1), 19–22. https://doi.org/10.1177/1942602X17725885 

Page last reviewed: February 13, 2025
Page last updated: February 13, 2025

The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same.  The information is not intended to substitute for, supplement or replace clinical judgment.  If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider.  The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.