Gastrostomy Button Continuous Feeding/Slow Drip

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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

Supplies:

  • Gastrostomy button replacement
  • Adaptor with tubing and clamp
  • Feeding solution in container (bag) at room temperature
  • 60 ml catheter-tipped syringe
  • Pump
  • Warm tap water, if prescribed
  • Pole to hold feeding container
  • Student’s Individualized Health Plan (IHP) and/or healthcare provider’s orders

procedure download skill competency
gtube-button
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  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 child at his/her level of understanding
  3. Wash hands
  4. Assemble equipment and place on a 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 on gloves
  7. 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
  8. Remove cap or plug from Gastrostomy button
  9. If residual check is ordered:
    • Attach 60 mL catheter tip 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 (residuals)
    • Note the amount withdrawn from tube feeding
    • Return residuals to stomach passively (gravity)
    • Clamp the tubing and disconnect the syringe
  10. Pour feeding/fluids into feeding container/bag, run feeding through tubing to the tip and clamp tubing
  11. Hang container on pole
  12. Place tubing into pump and sets flow rate
  13. Open safety plug and insert tubing into the gastrostomy button
  14. Open clamp completely
  15. Program pump to prescribed feeding rate
  16. When single feeding is completed (bag empty), clamp feeding bag tubing and remove
  17. Attach catheter-tipped syringe and flushes adaptor tubing and button with 5ml or prescribed water volume
  18. After flushing, lower syringe below stomach level to facilitate burping, as needed
  19. Disconnect syringe
  20. Connect plug to gastrostomy button
  21. Keep the child in a feeding position for at least 30 minutes after completing feeding, if required
  22. Wash syringe, feeding bag and tubing with soap and warm water and put in home container
    • Catheter tip syringe and feeding extension tubing can be used repeated times for up to 24 hours
  23. Remove glove
  24. Wash hands
  25. Document assessment, interventions, and outcomes in student’s healthcare record
  26. Follow up with parents/guardian and healthcare provider, as needed

Resources:

MIC—KEY LOW–PROFIILE GASTROSTOMY FEEDING TUBE: YOUR GUIDE TO PROPER CARE
http://www.mic-key.com/media/40679/r8201b_mic-key_care_guide_english.pdf

MIC Enteral Feeding Tubes and Accessories
http://www.mic-key.com/resources/mic-keystar-care-usage-guide.aspx

Guidance and support to help you manage your gastrostomy tube (g-tube) Capsule Non-Balloon Mini ONE® Buttons
http://www.amtinnovation.com/pdf/AMT_NonBalloonPatientCare.pdf


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. (2012). Pediatric nursing procedures (Third Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

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.


Acknowledgment of 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 updated: April 2, 2015