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
- 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 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- Note the amount withdrawn from tube feeding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
- Attach 60 mL catheter tip syringe with plunger removed in to the end of the enteral tube
- Measure prescribed amount of enteral formula to be infused into clean graduated measuring cup or catheter tip 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
- Remove the syringe and snap safety plug in place
- Keep the child in a feeding position for at least 30 minutes after completing feeding
- 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
- Remove gloves
- Wash hands
- Document assessment, interventions and outcomes in student’s health record
- 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