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 syringe
- Warm tap water, if prescribed
- Pole to hold feeding container
- Student’s Individualized Health Plan (IHP) and/or healthcare provider’s orders
Procedure:
- 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 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- Note the amount withdrawn from tube feeding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 passively (gravity)
- Clamp the tubing and disconnect the syringe
- Measure prescribed amount of enteral formula to be infused into clean graduated measuring cup or 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
- Monitor student during feeding for any signs of intolerance or complications
- Check rate and flow periodically and adjust if needed
- 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
- When single feeding is completed (bag empty), clamp feeding bag tubing and remove
- Sometimes a larger volume water flush may be prescribed and will be administered using feeding container and will flush the remainder of the formula through the tubing
- Attach 60 cc syringe and flush adaptor tubing and button with 5ml or prescribed water volume
- After flushing, lower syringe below stomach level to facilitate burping
- Vent until gassiness is relieved and allow any gastric contents to instill via gravity
- Disconnect syringe
- Connect cap or plug to G-tube
- Keep the child in a feeding position (upright) for at least 30 minutes after completing feeding
- Wash syringe 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
- Remove gloves
- Wash hands
- Document assessment, interventions, and outcomes in student’s healthcare record
- Follow up with parents/guardian and healthcare provider, as needed
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. (2016). Pediatric nursing procedures (eBook) (4th Edition). Philadelphia: Wolters Kluwer Health.
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 Update Reviewer:
Marcy Weidkamp, APNP
Pediatric Gastroenterology
American Family Children’s Hospital
Acknowledgment of Initial 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 reviewed: October 4, 2021
Page last updated: October 4, 2021
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.