Enteral Feeding

y used for the delivery of nutrients via a tube

y Purposes: y To restore or maintain nutritional status y To administer medication

Purpose
y To restore or maintain nutritional status

y To administer medication

Standards
y Enteral feeding is ordered by medical officers y Trained registered nurses and medical officers may

insert salem pump/fine bore gastric tubes y A salem sump tube is essential to allow monitoring of absorption of feeds when first commenced y Radiological verification of tube position is essential before enteral feeding

y Only eight hours enteral feed in the bottle at any one

time y Patients must be on a fluid balance chart whilst receiving enteral feeding y The tube must be securely anchored to the patients nose y The tube should be flushed with 10-20ml of sterile H20 before and after administration of medication y Enteral feed giving set to be changed at 2000hrs daily

Outcomes
y Store enteral feed in refrigerator and do not use feed

more than 24 hours old

y The tube will not become malpositioned y The patient will attain optimum nutrition from enteral

feeding by correct choice of feed type and volume

Materials
y y y y y

y y y y

Correct amount of feeding solution 20 50 ml syringe with an adapter Emesis basin Clean gloves Large syringe with plunger or calibrated plastic feeding bag with tubing that can be attached to the feeding tube or prefilled bottle with a drip chamber, tubing and a flow regulator pH test strip or meter measuring container from which to pour the feeding (if using open system) water (60 ml unless otherwise specified) at room temperature feeding pump as required

Types:
y Nasogastric tube (NG-tube) y An NG-tube is a small thin tube inserted through a persons nose, throat and down into the stomach.

*Nasojejunal tube or NJ-tube: y Gastrostomy Feeding (G-tube or peg tube)

y G-Tubes are surgically inserted and removed with an

endoscope.

y Gastrostomy-Jejunostomy or GJ-tube (Transgastric-Jejunal or TJ tube): y This is again like the G-tube and is surgically inserted, and like the NJ-tube it is guided though the stomach down into the jejunum.

y Balloon device (tube or button) y Buttons are used again for more long term in patients, and tend to be more widely acceptable due to there low profile design. y Jejunostomy or J-tube: y This is the same as both the NJ-tube and the GJ-tube, they make a surgical incision in the abdomen wall, the difference is they bypass the stomach and go directly into the jejunum. y Total parenteral nutrition (TPN): y is the practice of feeding a person intravenously, it passes the usual process of eating and digestion.

Procedure
y Assist the client to a Fowler s position in bed or sitting

position in a chair, the normal position for eating. If a sitting position is contraindicated, a slightly elevated right side lying position is acceptable.

y Explain to the client what you are going to do, why it is

necessary, and how he or she can cooperate. Inform the client that the feeding should not cause any discomfort but may cause feeling of fullness. For an adult, the usual intermittent feeding will take about 30 min. the exact length of time depends largely on the volume of the feeding.

y wash hands and observe appropriate infection control

procedure.
y Provide privacy for this procedure if the client desires

it.

y assess tube placement. y a. attach the syringe to the open end of the tube and aspirate alimentary secretion. Check pH. y b. Allow one hour to elapse before testing the pH if the client has received a medication y c. Use pH meter rather than pH paper if the client is receiving a continuous feeding or if food coloring has been added to formula.

y Assess residual feeding contents.

y aspirate all stomach contents and measure the amount

before administering the feeding y if 100 ml (or more than half the last feeding) is withdrawn, check with the nurse in charge or refer to agency policy before proceeding the precise amount is usually determined by the physician s order or by agency policy.

y Administer the feeding. y before administering the feeding:

y

Check the expiration date of the feeding Warm the feeding to room temperature

y when an open system is used, clean the top of the

feeding container with alcohol before opening it

FEEDING BAG (OPEN SYSTEM)

y hang the bag from an infusion pole about 30 cm. (12

in.) above the tube s point of insertion into the client.

y clamp the tubing and add the formula bag y open the clamp, run the formula through the tubing,

and reclamp the tube. The formula will displace the air in the tubing, thus preventing the installation of excess air into the client s stomach or intestine.

y attach the bag to the nasogastric/nasoenteric tube and

regulate the drip by adjusting the clamp to the drop factor on the bag.

SYRINGE (OPEN SYTEM)

y remove the plunger from the syringe and connect the

syringe to a pinched or clamped nasogastric tube.

y add the feeding to the syringe barrel. y insert the feeding to flow in slowly at the prescribed

rate. Raise or lower the syringe to adjust the flow as needed. Pinch or clamp the tubing to stop the flow for a minute if the clients feel discomfort.

PREFILLED BOTTLE WITH DRIP CHAMBER(CLOSED SYSTEM)

y remove the screw on cap from the container and attach

the administration set with the drip chamber and tubing y close the clamp on the tubing y hang the container on an intravenous pole about 30 cm (12 in) above the tube insertion point into the client.

y squeeze the drip chamber to fill it to one half of its

capacity y open the tubing clamp, run the formula through the tubing, and reclamp the tube y attach the feeding set tubing to the feeding tube and regulate the drip rate to deliver the feeding over the desired length of time. Prefilled tube feeding sets can be attached to a feeding pump to regulate the flow.

y Rinse the feeding tube immediately before all of the

formula has run through the tubing

y instill 50 to 100 ml of water through the feeding tube.

Water flushes the lumen of the tub, preventing future blockage by sticky formula.
y be sure to add the water before the feeding solution has

drained from the neck of a syringe or from the tubing of an administration set. Before adding water to a feeding bag or prefilled tubing set, first clamp and disconnect both feeding and administration tubes.

y Clamp and cover the feeding y clamp the feeding tube before all of the wter instilled y cover the end of the feeding tube with gauze held by an elastic band y Ensure client comfort and safety y Dispose the equipment appropriately y Document all relevant information y Monitor client for possible problems