Gastrostomy Button Continuous Feeding/Slow Drip

<< 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 feeding 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
  • 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
  • Adaptor with tubing and clamp
  • Feeding solution in can/container at room temperature
  • Feeding bag
  • 60 ml syringe
  • Pump
  • Warm tap water, if prescribed
  • Pole to hold feeding container
  • Student’s Individualized Health Plan (IHP) and healthcare provider’s orders
  • 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 feeding
  4. Explain the procedure to child at his/her level of understanding
  5. Wash hands
  6. Assemble equipment and place on a clean surface
  7. Confirm you have the correct formula
  8. Check expiration date on formula container
  9. Note 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 on gloves
  12. 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
  13. Remove cap or plug from gastrostomy button
  14. If residual check is ordered:
    • Attach extension/adaptor tubing per manufacturer’s instructions
    • Attach 60 mL syringe with plunger to the end of the enteral tube
    • 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 per method ordered by healthcare provider
    • Clamp the tubing and disconnect the syringe
  15. If residual is NOT ordered:
  16. Prior to attaching extension/adaptor tubing to gastrostomy button:
    • Open clamp on extension tubing
    • Flush 5mL or water (or enough water to fully flush the extension tubing) through extension tubing
    • Clamp extension tubing
    • Attach extension tubing to gastrostomy button per manufacturer’s instructions
  17. Shake the feeding container/can
  18. If feeding is in a can, clean the top of the feeding (formula) can with an alcohol wipe or soapy cloth
  19. Measure prescribed amount of enteral formula to be infused into clean graduated measuring cup
    • Observe the appearance of the formula for any abnormalities
    • Prepare the enteral formula per healthcare provider’s order
  20. Pour feeding/fluids into feeding container/bag
  21. Run feeding through tubing to the tip and clamp tubing
  22. Hang container on pole (or place in student’s backpack, if applicable)
  23. Turn on enteral pump
  24. Place tubing into pump and sets flow rate
  25. Zero the volume delivery amount on the enteral pump
  26. Open safety plug and insert tubing into the gastrostomy button
  27. Open clamp completely
  28. Start the enteral pump at the prescribed rate
  29. Make feeding like mealtime:
    • offer and/or provide oral care to older students
    • provide feeding while child is around other children
  30. Monitor student during feeding for any signs of intolerance or complications
  31. Stop feeding immediately for gagging, vomiting, coughing, abdominal distension, change in skin color, or difficulty breathing, etc.
  32. When single feeding is completed (bag empty), clamp feeding bag tubing and remove
    • Sometimes a larger volume water flush may be prescribed and will run via the pump and flush the remainder of the formula through the tubing
  33. Check the volume delivered on the pump to ensure the proper amount of formula was infused
  34. If larger volume water flush is not ordered:
    • Remove plunger from the syringe
    • Attach 60-mL ENFit/enteral syringe and
    • Flush adaptor tubing and button with 5 mL or prescribed water volume
  35. After flushing, lower the ENFit/enteral syringe below stomach level to facilitate burping, as needed
  36. Clamp the extension tubing
  37. Disconnect the ENFit/enteral syringe and extension tubing
  38. Insert plug into gastrostomy button
  39. Keep the child in a feeding position (upright) for at least 30 minutes after completing feeding, if required
  40. Wash ENFit/enteral syringe, feeding bag and tubing with soap and warm water and put in home container
    • ENFit/enteral syringe and feeding extension tubing can be used repeated times for up to 24 hours
  41. Remove gloves
  42. Wash hands
  43. Document assessment, interventions, and outcomes in student’s healthcare record
  44. Follow up with parents/guardian and healthcare provider, as needed

References:

Bankhead, R., Boullata, J., Brantley, S., Corkins, M., Guenter, P., Krenitsky, J., Lyman, B., Metheny, N.A., Mueller, C., Robbins, S., Wessel, J.  (2009).  Monitoring enteral nutrition administration. In: A.S.P.E.N. enteral nutrition practice recommendations.   Journal of Parenteral and  Enteral Nutrition, 33(2), 162-6.

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

Porter, S., Haynie M.D., Bierle, T., Caldwell, T. & Palfrey, J.  (1997).  Children and Youth Assisted by Medical Technology in Educational Settings.  Guidelines for Care.  Second Edition.  Paul H. Brookes Publishing Co., P.O. Box 10624, Baltimore, MD 21285-0624.

Page last reviewed: February 14, 2025
Page last updated: February 14, 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.