Gastrostomy Tube 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 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 catheter-tip 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 download skill competency

  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 gastrostomy tube
  7. Put on gloves
  8. 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
  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    • Note the amount withdrawn from tube feeding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 tubing and remove syringe
  10. Attach 60 mL catheter tip syringe with plunger removed in to the end of the enteral tube
  11. Measure prescribed amount of enteral formula to be infused into clean graduated measuring cup or catheter tip syringe
  12. Pour feeding into syringe until about one-half full
  13. Elevate the feeding above the level of the stomach
  14. Open G-tube 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 gastrostomy tube 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. Remove the syringe and snap safety plug in place
  23. Keep the child in a feeding position for at least 30 minutes after completing feeding
  24. Wash syringe with soap and warm water and puts in home container
    • Catheter tip syringe can be used repeated times for up to 24 hours
  25. Remove gloves
  26. Wash hands
  27. Document assessment, interventions and outcomes in student’s health record
  28. 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.kchealthcare.com/media/2886710/u4850_mic_enteral_tubes.pdf

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:

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

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 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 1, 2015