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 cc ENFit/enteral syringe
  • Pump
  • Warm tap water, if prescribed
  • Pole to hold feeding container
  • Student’s Individualized Health Plan (IHP) and healthcare provider’s orders
  • 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 child at his/her level of understanding
  5. Wash hands
  6. Assemble equipment and place on a clean surface
  7. Confirm you have the correct formula
  8. Check the expiration date on the formula
  9. Note the integrity of the formula container
  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 g-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, instead contact parent/guardian and healthcare provider
  14. Remove cap or plug from G-tube
  15. If residual check is ordered:
    • Attach 60 mL ENFit/enteral 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 as ordered by healthcare provider
    • Clamp the tubing and disconnect the syringe
  16. If residual check is not ordered, verify with healthcare provider how placement of g-tube should be verified before administering feeding.
  17. Shake the feeding container/can
  18. If feeding is in can, clean the top of the feeding (formula) can with alcohol wipe or soapy cloth
  19. 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
  20. Pour feeding/fluids into feeding container/bag
  21. Run feeding through tubing to the tip and clamp tubing
  22. Hang container on pole (or place in student’s backpack, if applicable)
  23. Turn on enteral pump
  24. Place tubing into pump and set prescribed flow rate
  25. Zero the volume delivery amount on the enteral pump
  26. Open safety plug and insert tubing into the G-tube
  27. Open clamp completely
  28. Review the programed feeding rate to ensure it has been entered into the pump correctly
  29. Start the enteral pump at the prescribed rate
  30. Monitor student during feeding for any signs of intolerance or complications
  31. Stop feeding immediately for gagging, vomiting, coughing, abdominal distension, change in skin color, or difficulty breathing, etc.
  32. Make feeding like mealtime: allow child to sit with other children during mealtime
  33. When single feeding is completed (bag empty), clamp feeding bag tubing and remove
    • Sometimes a larger volume water flush may be prescribed and will run via the pump and flush the remainder of the formula through the tubing
  34. Check the volume delivered on the pump to ensure the proper amount was infused
  35. If larger volume water flush is not ordered:
    • Remove plunger from the 60-ml ENFit/enteral syringe
    • Attach 60 cc ENFit/enteral syringe
    • Flush g-tube with 5ml or prescribed water volume
  36. After flushing, lower syringe below stomach level to facilitate burping, as needed
    • Vent until gassiness is relieved and allow any gastric contents to instill via gravity
  37. Clamp extension tubing
  38. Disconnect extension tubing and syringe
  39. Insert cap or plug to G-tube
  40. Ensure that the clamp is not resting on the student’s skin
  41. Keep the child in a feeding position (upright) for at least 30 minutes after completing feeding, if required
  42. Wash syringe, feeding bag and tubing with soap and warm water and put in home container
    • Syringe and feeding extension tubing can be used repeated times for up to 24 hours
  43. Remove gloves
  44. Wash hands
  45. Document assessment, interventions, and outcomes in student’s healthcare record
  46. 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

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).

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.

Porter, S.M., Page, D., Engholm. H., Somppi, C. (2019). Students supported by medical technology. In J. Selekman (Ed.), 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.