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:
- 60ml feeding syringe
- Extension set, if applicable
- 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:
- 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
- Explain the procedure to the student at his/her level of understanding
- Wash hands
- Gather equipment and place on clean surface
- 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
- Put a towel or washcloth under student’s gastrostomy tube
- Put on gloves
- Observe abdomen for signs of malposition or obstruction of gastrostomy tube such as difference in external tube length compared to baseline measurements or abdominal distention
- Compare external tube length to tube length measurements obtained after initial placement of the tube, contact parents/guardian and healthcare provider if discrepancy in measurements
- If student has abdominal distention do not administer feeding and contact parent/guardian and healthcare provider
- If residual check is ordered:
- 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- Note the amount withdrawn from tube feeding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 passively (gravity)
- Clamp tubing and remove syringe
- Attach 60 mL syringe, with plunger removed, onto the end of the enteral tube
- Measure prescribed amount of enteral formula to be infused into clean graduated measuring cup or syringe
- Pour feeding into syringe until about one-half full
- Elevate the feeding above the level of the stomach
- Open G-tube clamp
- 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
- Refill the syringe before it empties to prevent air from entering stomach
- Monitor student during feeding for any signs of intolerance or complications
- Stop feeding immediately for gagging, vomiting, coughing, abdominal distension, change in skin color, or difficulty breathing, etc.
- Make feeding like mealtime: allow child to sit with other children during mealtime
- Flush the gastrostomy tube with warm water when feeding is complete, amount determined by healthcare provider’s order
- After flushing, lower the syringe below the stomach level to facilitate burping
- Vent until gassiness is relieved and allow any gastric contents to instill via gravity
- Remove the syringe and plug the gastrostomy device
- Keep the child in a feeding (upright) position for at least 30 minutes after completing feeding
- Wash syringe with soap and warm water and puts in home container
- Syringe can be used repeated times for up to 24 hours
- Remove gloves
- Wash hands
- Document assessment, interventions and outcomes in student’s health record
- 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.