Safety

• Maintaining and monitoring the tube location during feeding and keeping the head-of-bed elevation at a minimum of 30 degrees—and preferably 45 degrees—reduces aspiration incidents and subsequent pneumonia.
• Do not adjust the feeding rate; infuse the feeding as ordered.
• A sudden gain of more than 2 pounds in 24 hours usually indicates fluid retention.
• If the patient aspirates formula, do the following:
  • Report the change in patient condition to the health care provider; if there has not been a recent chest x-ray film, suggest ordering one.
  • Prepare for possible initiation of antibiotics.
• If the patient develops nausea and vomiting, which may indicate paralytic ileus:
  • Withhold the tube feeding, and notify the health care provider.
  • Be sure that the tube is patent; aspirate for residual volume.

Equipment

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Disposable feeding bag, tubing or ready-to-hang system

Disposable feeding bag, tubing or ready-to-hang system

30 mL or larger catheter-tip syringe

Stethoscope

Enteral infusion pump for continuous feedings

Prescribed enteral formula

Clean gloves

Alcohol swabs

Permanent marker

500 mL of water

Tissue

Delegation

The skill of administering a nasoenteric tube feeding can be delegated to NAP, according to your agency’s policy. However, a registered nurse (RN) or licensed practical nurse (LPN/LVN) must first verify tube placement and patency. Be sure to inform NAP of the following:

• Elevate the head of the bed at least 30 degrees, and preferably 45 degrees, or help the patient sit up in the bed or a chair.
• Infuse the continuous feeding on the pump as ordered.
• Report any difficulties infusing the feeding or any discomfort voiced by the patient.
• Report any gagging, paroxysms of coughing, or choking.
• Provide frequent oral hygiene.

Preparation

• Assess the patient for food allergies.
• Perform a physical assessment of the abdomen, including auscultation for bowel sounds, before feeding.
• Obtain a baseline weight, and review serum electrolytes and blood glucose measurement. Assess the patient for fluid volume excess or deficit, electrolyte abnormalities, and metabolic abnormalities such as hyperglycemia.
• Verify the health care provider’s orders for the type of formula, rate, route, and frequency.
• Explain the procedure to the patient.

Follow-up

• Measure gastric residual volume (GRV) according to your agency’s policy, usually every 4 to 6 hours. Ask the patient if he or she has had any nausea or abdominal cramping.
• Monitor the patient’s intake and output at least every 8 hours, and calculate daily totals every 24 hours.
• Weigh the patient daily until the maximum administration rate is reached and maintained for 24 hours, and then weigh the patient three times per week.
• Monitor laboratory values.
• Observe the patient’s respiratory status.
• Auscultate bowel sounds.
• For tubes placed through the abdominal wall, inspect the site for signs of impaired skin integrity.
• If the nasogastric tube is unable to be flushed with normal saline, obtain a product designed specifically to unclog a nasogastric tube.

Documentation

• Record and report the amount and type of feeding, method of infusion, patient’s response to tube feeding, gastric residual volume (GRV), cramping, patency of tube, and condition of the skin at the tube site.
• Record the volume of formula and any additional water on the patient’s intake and output form.
• Report the type of feeding, the status of the feeding tube, the patient’s tolerance, and any adverse outcomes.