Gastrostomy Tube Continuous Feeding/Slow Drip

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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:

  • G-tube replacement
  • Feeding container (bag)
  • Adaptor with tubing and clamp
  • Feeding solution at room temperature
  • 60 ml catheter-tipped syringe
  • Pump
  • Warm tap water, if prescribed
  • Pole to hold feeding container
  • Student’s Individualized Health Plan (IHP) and/or healthcare provider’s orders

 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 child at his/her level of understanding
  3. Wash hands
  4. Assemble equipment and place on a 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 on gloves
  7. 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, instead contact parent/guardian and healthcare provider
  8. Remove cap or plug from G-tube
  9. If residual check is ordered, attach 60 mL catheter tip syringe with plunger to the end of the enteral tube
  10. Unclamp the tubing and gently draw back on the plunger to remove any liquid or medication that may be left in the stomach (residuals)
  11. Note the amount withdrawn from tube feeding
  12. Return residuals to stomach passively (gravity)
  13. Clamp the tubing and disconnect the syringe
  14. Pour feeding/fluids into feeding container/bag, run feeding through tubing to the tip and clamp tubing
  15. Hang container on pole
  16. Place tubing into pump and set flow rate
  17. Open safety plug and insert tubing into the G-tube
  18. Open clamp completely
  19. Program pump to prescribed feeding rate
  20. When single feeding is completed (bag empty), clamp feeding bag tubing and remove
  21. Attach catheter-tipped syringe and flush adaptor tubing and button with 5ml or prescribed water volume
  22. After flushing, lower syringe below stomach level to facilitate burping, as needed
  23. Disconnect syringe
  24. Connect cap or plug to G-tube
  25. Ensure that the clamp is not resting on the student’s skin
  26. Keep the child in a feeding position for at least 30 minutes after completing feeding, if required
  27. Wash syringe, feeding bag and tubing with soap and warm water and put in home container
    • Catheter tip syringe and feeding extension tubing can be used repeated times for up to 24 hours
  28. Remove gloves
  29. Wash hands
  30. Document assessment, interventions, and outcomes in student’s healthcare record
  31. 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.halyardhealth.com/media/128695/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:

Bankhead, R., Boullata, J., Brantley, S., Corkins, M., Guenter, P., Krenitsky, J., Lyman, B., Metheny, N.A., Mueller, C., Robbins, S., Wessel, J.  (2009).  Monitoring enteral nutrition administration. In: A.S.P.E.N. enteral nutrition practice recommendations.   Journal of Parenteral and  Enteral Nutrition, 33(2), 162-6.

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

Porter, S., Haynie M.D., Bierle, T., Caldwell, T. & Palfrey, J.  (1997).  Children and Youth Assisted by Medical Technology in Educational Settings.  Guidelines for Care.  Second Edition.  Paul H. Brookes Publishing Co., P.O. Box 10624, Baltimore, MD 21285-0624.


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