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 liquid nutrition 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 catheter-tipped syringe
- Warm tap water, if prescribed
- Pole to hold feeding container
- Student’s Individualized Health Plan (IHP) and/or healthcare provider’s orders
- Review healthcare provider’s order including:
- the type of formula
- amount
- infusion type and rate
- frequency of administration
- residual volume checks
- amount of water used to flush the tube
- Explain the procedure to child at his/her level of understanding
- Wash hands
- Assemble equipment and place on a 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 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 the feeding, instead contact parent/guardian and healthcare provider
- If residual check is ordered
- Remove cap or plug from G-tube
- 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- Note the amount withdrawn from tube feeding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 the tubing and disconnect the syringe
- Pour feeding/fluids into feeding container, run feeding through tubing to the tip and clamp tubing
- Hang container on pole at height required to deliver prescribed flow
- Open safety plug and insert tubing into the G-tube
- Open clamp on tubing and adjust flow to prescribed rate
- Check rate and flow periodically and adjust if needed
- When single feeding is completed (bag empty), clamp feeding bag tubing and remove
- Attach catheter-tipped syringe and flush adaptor tubing and button with 5ml or prescribed water volume
- After flushing, lower syringe below stomach level to facilitate burping
- Disconnect syringe
- Connect cap or plug to G-tube
- Keep the child in a feeding position for at least 30 minutes after completing feeding
- Wash syringe 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
- Remove gloves
- Wash hands
- Document assessment, interventions, and outcomes in student’s healthcare 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:
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
Updated: April 6, 2015