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
  • Encourage the student to assist in the procedure as much as he/she is able to help student learn self-care skills

Supplies:

  • 60ml feeding syringe
  • Adapter with tubing and clamp, if applicable
  • Extension set
  • Graduated measuring cup
  • Prescribed diet at room temperature
  • Warm tap water, if prescribed
  • Towel or wash cloth
  • Non-sterile gloves
  • Student’s Individualized Health Plan (IHP) and/or healthcare provider’s order
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. Explain the procedure to the student at his/her level of understanding
  3. Wash hands
  4. Gather equipment and place on clean surface
  5. 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
  6. Put a towel or washcloth under student’s button
  7. Put on gloves
  8. 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
  9. If residual check is ordered:
    • Attach the extension tubing
    • Attach 60 mL 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    • Note the amount withdrawn from tube feeding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 passively (gravity)
    • Clamp tubing and remove syringe
  10. Attach 60 mL syringe, with plunger removed, to the end of extension tubing
  11. Measure prescribed amount of enteral formula to be infused into clean graduated measuring cup or a syringe
  12. Pour feeding into syringe until about one-half full
  13. Elevate the feeding above the level of the stomach
  14. Open extension tubing clamp
  15. 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
  16. Refill the syringe before it empties to prevent air from entering stomach
  17. Monitor student during feeding for any signs of intolerance or complications
  18. Stop feeding immediately for gagging, vomiting, coughing, abdominal distension, change in skin color, or difficulty breathing, etc.
  19. Make feeding like mealtime:  allow child to sit with other children during mealtime
  20. Flush the button with warm water when feeding is complete, amount determined by healthcare provider’s order
  21. After flushing, lower the syringe below the stomach level to facilitate burping
  22. Vent until gassiness is relieved and allow any gastric contents to instill via gravity
  23. Remove the extension tubing and syringe
  24. Plug the gastrostomy button
  25. Keep the child in a feeding (upright) position for at least 30 minutes after completing feeding
  26. Wash syringe and tubing with soap and warm water and puts in home container
    • Syringe and feeding extension tubing can be used repeated times for up to 24 hours
  27. Remove gloves
  28. Wash hands
  29. Document assessment, interventions and outcomes in student’s health record
  30. Follow up with parents/guardian and healthcare provider, as needed

References:

Bowden, V. R., & Greenberg, C. S. (2016). Pediatric nursing procedures (eBook) (4th Edition). Philadelphia: Wolters Kluwer Health.

Connecticut State Department of Education. (2012). Clinical Procedure Guidelines for Connecticut School Nurses. Available at:
http://www.sde.ct.gov/sde/lib/sde/pdf/publications/clinical_guidelines/clinical_guidelines.pdf

Kimberly Clark. (2010). MIC-KEY care and usage guide.  Available at: http://www.mic-key.com/resources/mic-keystar-care-usage-guide.aspx

Pavia, M.  (2012).  National Institute for Health and Clinical Excellence (NICE). Infection. Prevention and control of healthcare-associated infections in primary and community care. London (UK): National Institute for Health and Clinical Excellence (NICE), 47 p.

Acknowledgment of Update Reviewer:

Marcy Weidkamp, APNP
Pediatric Gastroenterology
American Family Children’s Hospital

Acknowledgment of Initial Reviewers:

Lori A. Duesing, MSN, RN, CPNP-AC
Advanced Practice Nurse
Department of Gastroenterology
Children’s Hospital of Wisconsin

Kathy Leack, MS, RN, CNS
Advanced Practice Nurse
Children’s Hospital of Wisconsin

Page last reviewed: September 20, 2021
Page last updated: September 20, 2021

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.