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
  • Verify with healthcare provider if residuals are to be checked prior to feeding
  • If residual checks are ordered, verify with healthcare provider how residuals should be returned to the abdomen (i.e. gravity, continuous infusion ,or ENFit/enteral syringe
  • If residual checks are not ordered, discuss with 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 feedings feel like mealtime: allow the student to sit with other children during mealtime, if possible

Supplies:

  • G-tube replacement “kit” 
    • Replacement gastrostomy tube 
    • 6-mL luer slip syringe 
    • Medical tape 
    • Water-soluble lubricant 
  • 60ml ENFit/enteral syringe 
  • Extension set, if applicable  
  • Graduated measuring cup 
  • Prescribed diet at room temperature 
  • Warm tap water, if prescribed 
  • Towel or washcloth 
  • Non-sterile gloves 
  • Student’s Individualized Health Care Plan (IHCP) and health care provider’s order 
  • 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 and timing 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 the student at his/her level of understanding
  5. Wash hands
  6. Assemble equipment and place on clean surface
  7. Confirm you have the correct formula
  8. Note the integrity of the formula container
  9. Check expiration date of the formula
  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 gastrostomy tube
  12. Put on gloves
  13. 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
  14. If residual check is ordered:
    • Remove plug from gastrostomy tube
    • Attach 60 mL ENFit/enteral syringe with plunger to the end of the gastrostomy 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 via the route that is ordered
    • Clamp tubing and remove ENFit/enteral syringe
  15. If residual is not ordered, verify with healthcare provider how placement of g-tube should be verified before administering feeding
  16. If feeding is in a can, clean the top of the feeding (formula) can with an alcohol wipe or soapy cloth
  17. Attach 60 mL ENFit/enteral syringe, with plunger removed, onto the end of the enteral tube
  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 into ENFit/enteral syringe until about one-half full
  20. Elevate the ENFit/enteral syringe above the level of the stomach
  21. Open G-tube clamp
  22. Allow feeding to go in slowly, over prescribed amount of time
    • The higher the ENFit/enteral syringe is held, the faster the feeding will flow
    • Lower ENFit/enteral syringe if the feeding is going too fast
  23. Refill the ENFit/enteral syringe before it empties to prevent air from entering stomach
  24. Monitor student during feeding for any signs of intolerance or complications
  25. Stop feeding immediately for gagging, vomiting, coughing, abdominal distension, change in skin color, or difficulty breathing, etc.
  26. Flush the gastrostomy tube with warm water when feeding is complete, amount determined by healthcare provider’s order
  27. After flushing, lower the ENFit/enteral syringe below the stomach level to facilitate burping
  28. Vent until gassiness is relieved and allow any gastric contents to instill via gravity
  29. Remove the extension tubing, if used, and the ENFit/enteral syringe and plug the gastrostomy device
  30. Keep the child in a feeding (upright) position for at least 30 minutes after completing feeding
  31. Wash ENFit/enteral syringe with soap and warm water and puts in home container
    • The ENFit/enteral syringe can be used repeated times for up to 24 hours
  32. Remove gloves
  33. Wash hands
  34. Document assessment, interventions and outcomes in student’s health record
  35. Follow up with parents/guardian and healthcare provider, as needed

References:

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 Hospital St. Louis. (2015, May). Gastrostomy tubes home care manual (corpak, foley catheter, genie, malecot, mic-G). Retrieved June 22, from https://www.stlouischildrens.org/sites/legacy/files/Gastrostomy%20Tubes%20Home%20Care%20Manual.pdf  

Cleveland Clinic. (2019, November 1). Home tube feeding – Checking residuals. Retrieved August 22, 2023, from https://www.youtube.com/watch?v=59tusCo2wAI  

Lynn, P. (2019). Administering a tube feeding. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (pp. 253-255). 

Pediatric Home Services. (2017). Bolus feeding by syringe- Gravity method (Alimentación en bolo por jeringa—Método de gravedad). . Retrieved June 21, 2023, from https://www.pediatrichomeservice.com/tips-how-tos/bolus-feeding-syringe-gravity-method/?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 12, 2025
Page last updated: February 12, 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.