POLICIES AND PROCEDURES MANUAL

TUBE FEEDING
DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** 1 of 4
*** REVIEW DUE
***
***

SUBJECT: TUBE FEEDING (GASTOSTOMY, ENTEROSTOMY)

1. GENERAL:

Following a physician's written order a Registered Nurse who has been

trained may administer gastrostomy/enterostomys/jejunostomy tube feeding.
This procedure is indicated for patients who are unable to take foods orally
or by nasogastric tube due to dysphagia, oral or esophageal obstruction, or
trauma, or patients who have undergone gastrointestinal surgery that
prohibits normal ingestion of food, or if patients have a chronic condition
where nutrition needs cannot be met orally.
Specific formulas are prepared commercially and are obtained from the
pharmacy. The physician prescribes the caloric value, the volume, and the
frequency of fluids to be given in a 24 hour period or at prescribed intervals.
Recommendation from the Clinical Dietitian is essential in assessing
the patient's nutritional status and developing the nutrition therapy plan.

2. PURPOSE:

To provide a means of nutritional support when the oral route is inaccessible.

3. EQUIPMENT:
A. Formula ordered by physician
B. Tube feeding bag with tubing and flow regulator clamp
C. I.V. standard
D. Disposable Gloves
E. Towel or disposable chuxs
F. Water as ordered
H. Emesis basin
I. Bulb or asepto syringe
J. Graduated container as needed
K. Catheter plug and drainage tube protector

4. PREPARATION OF FEEDING FORMULA:

A. After obtaining from the pharmacy , the unopened cans of formula may be
stored and are to be administered at room temperature. Hot formulas may
coagulate formula proteins and clog tubing. Heat may change the chemical
composition of the formula. It may burn or irritate gastric mucosa. Chilling
the formula is avoided because it increases viscosity of the liquid which may
clog the tube. Cold formula may also cause vasoconstriction which reduces
the flow of gastric digestive secretions which may cause cramping, nausea,
vomiting and distention.
B. WASH hands, to avoid cross contamination.
 POLICIES AND PROCEDURES MANUAL
TUBE FEEDING
DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** 2 of 4
*** REVIEW DUE
***
***

C. Pour the appropriate amount of formula into the feeding bag with the flow
regulator clamp closed. Squeeze the drip chamber and fill half way.
Remove the cap from the distal end of the tubing. Open the flow regulator
clamp and run the formula through the length of the tubing. Then clamp the
tubing and replace the cap on the distal end of the tubing. All air in tubing is
removed so that it does not enter the patient and cause distention and
discomfort. Hook feeding bag on I.V. standard
5. PROCEDURE:

6. SPECIAL CONSIDERATIONS:
NURSING ACTION
A. When ready to administer, shake the
can well immediately before opening.
Once opened, dispense the prescribed
volume and discard any unused formula.
B. During continuous feeding, assess the
patient often for abdominal distention.
C. If diarrhea occurs, notify the physician
so that the underlying cause can be
determined and corrected, e.g., altering
the prescribed medications, changing the
formula and/or administration
rate/volume, switching to a fiber
containing formula, administering anti-
diarrheal medication, or correcting a low
serum albumin. Also ensure that proper
infection control and equipment practices
are being followed.
D. If constipation occurs, notify the
physician so that the underlying cause
can be determined and corrected, e.g.,
altering the formula, adding fluids,
ordering a bulk forming laxative,
increasing patient activity, or changing a
medication.
E. Assess hydration and increase fluid
intake as necessary if fluids are not
contraindicated.
F. Drugs may be administered through
the feeding tube, except for enteric
coated tablets. Crush tablets or open
and dilute capsules in water prior to
administering. Flush the tubing with
water after administering medication.
(obtain liquid medication when possible).
G. Monitor blood glucose to assess
glucose tolerance. Monitor serum
electrolytes and other blood studies as
ordered by the physician.
7. DOCUMENTATION:
RATIONALE-PRECAUTIONS
A. Agitation corrects separation which
could alter the content of the planned
feeding and potentially clog to tube.
Immediate use and discard ensures the
formula is not a vehicle for microbial
contamination/growth.
B. Distention may cause nausea and
vomiting.
C. Diarrhea is the most common
complication. Common causes are: too
high infusion rate or volume, lack of fiber,
altered gastrointestinal flora (e.g., due to
medications or contamination),
hypoalbuminemia, or hyperosmolar
solutions (Isotonic formulas are best
tolerated.)
D. Irregular bowel movements can result
from the low fiber content of the formula,
inadequate fluids, medication, or lack of
activity. The feeding should be stopped
and evaluated if an obstruction is
suspected.
E. Dehydration may cause constipation.
F. Avoid need for discomfort of I.M.
injections.
G. To determine response nutritional
support.
 POLICIES AND PROCEDURES MANUAL
TUBE FEEDING
DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** 3 of 4
*** REVIEW DUE
***
***

A. On the treatment record, record the time, amount and type of formula given
and the amount of water given.
B. On the IDN's record the patient's reactions and tolerance to the procedure.
C. Total the amount of feeding and fluid given on the Daily Care Flow sheet
for the 8 hour shift.

8. REFERENCE:

Nutrition Care Manual Section 302, tube feeding and Liquid Supplements.

NURSING ACTION RATIONALE-PRECAUTIONS

A. Check the physician's order against
the treatment card.
B. Wash hands and prepare equipment.
C. Approach and identify the patient,
explain the procedure and provide
privacy.
D. Place the patient in high Fowler's or
sitting position unless contraindicated.
E. Place a towel or chux on the patient's
lap.
F. Put on disposable gloves.
G. Pinch off the patient's
gastrostomy/enterostomy/jejunostomy
tube below clamp or plug. Remove
clamp or plug.
H. Remove cap from the distal end of the
tubing to the feeding bag. Connect the
feeding tube to the patient's "ostomy"
tube. Recheck for secure fit.
I. Adjust flow regulator clamp to the
desired rate. Administer feeding slowly.
J. After administering the correct amount
of feeding flush the tubing by adding 100
cc’s of water to the feeding bag or by
asepto/bulb syringe directly into the
"ostomy" tube.
K. Shut off the flow regulator clamp and
disconnect tubing while pinching off the
"ostomy" tube. Recap and clamp
tubings.
L. Leave the patient in semi or high
Fowler's position or sitting position for at
least 30 minutes.
M. Rinse all re-usable equipment with
warm water.
N. Discard disposable equipment per
A. For accuracy in administering the correct
type, route, and amount of feeding to the
right patient, at the right time.
B. To avoid cross contamination.
C. To gain patient confidence and lesson
anxiety and embarrassment.
D. To make the patient comfortable and aid
digestion.
E. To protect patient's gown or clothing from
becoming soiled.
F. To protect staff from accidental gastric
fluid contact.
G. To Avoid leakage from tube.
H. To avoid accidental separation of tubes
during feeding.
I. To prevent sudden distention which can
cause nausea, vomiting, cramps or
diarrhea.
J. To prevent the tube from clogging and to
lessen the chance of bacterial formation.
K. To prevent leakage from the "ostomy"
tube.
L. To aid in digestion, prevent aspiration.
M. To prevent bacterial formation.
N. To prevent the spread of infections.
 POLICIES AND PROCEDURES MANUAL
TUBE FEEDING
DOCUMENT CONTOL REVISION NO. EFFECTIVITY DATE PAGE
NO. *** 4 of 4
*** REVIEW DUE
***
***

ICM III-C

O. Discard gloves and wash hands. O. To prevent nosocomial infections.

P. Change feeding equipment every 72 P. To prevent bacterial formation.
hours. (Label feeding equipment with
date and time issued, and date and time
to be replace.)