Gastrostomy Button Gravity 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 health care provider if residuals are to be checked prior to feeding
    • If residuals are ordered, verify with the healthcare provider how residuals should be returned to the stomach (i.e. via gravity, continuous infusion, or ENFit/enteral syringe
    • If residuals are not ordered, discuss with the 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
  • EnFit adaptor with tubing and clamp
  • Feeding solution in can/container at room temperature
  • Feeding bag
  • 60-mL ENFit/enteral syringe
  • Warm tap water, if prescribed
  • Pole to hold feeding bag
  • 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 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 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
  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 cap or plug from gastrostomy button
    • Attach extension/adaptor tubing per manufacturer’s instructions
    • Attach 60-mL ENFit/enteral syringe with plunger to the end of the adaptor 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 per method ordered by healthcare provider
    • Clamp the tubing and disconnect the syringe
  15. If residual is NOT ordered:
    • Prior to attaching extension/adaptor tubing to the gastrostomy button:
      • Open clamp on extension tubing
      • Flush with 5 mL of 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
  16. Shake the feeding can/container
  17. If feeding is in a can, clean the top of the feeding (formula) can with an alcohol wipe or soapy cloth
  18. Measure prescribed amount of enteral formula to be infused into clean graduated measuring cup or ENFit/enteral syringe
    • Observe the appearance of the formula for any abnormalities
    • Prepare the enteral formula per healthcare provider’s order
  19. Pour feeding/fluids into feeding bag
  20. Run feeding through tubing to the tip and clamp tubing
  21. Hang container on pole at height required to deliver prescribed flow
  22. Remove feeding port cover
  23. Connect the feeding bag tubing to the extension tubing
  24. Open clamp on tubing and adjust flow to prescribed rate
  25. Check rate and flow periodically and adjust if needed
  26. Monitor student during feeding for any signs of intolerance or complications
  27. Stop feeding immediately for gagging, vomiting, coughing, abdominal distension, change in skin color, or difficulty breathing, etc.
  28. When single feeding is completed (bag empty), clamp feeding bag tubing and remove
    • Sometimes a larger volume water flush may be prescribed and will be administered using feeding container and will flush the remainder of the formula through the tubing
  29. Attach 60-mL ENFit/enteral syringe, with the plunger removed, and flush adaptor tubing and button with 5ml or prescribed water volume
  30. After flushing, lower syringe below stomach level to facilitate burping
  31. Vent until gassiness is relieved and allow any gastric contents to instill via gravity
  32. Disconnect ENFit/enteral syringe and extension/adaptor tubing
  33. Plug gastrostomy button
  34. Keep the child in a feeding position (upright) for at least 30 minutes after completing feeding
  35. 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
  36. Remove glove
  37. Wash hands
  38. Document assessment, interventions, and outcomes in student’s healthcare record
  39. 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

Pediatric Home Services. (2017). Using a gravity feeding bag. Retrieved June 20, 2023, from https://www.pediatrichomeservice.com/tips-how-tos/using-gravity-feeding-bag/?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 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.