Gastrostomy Button Bolus Feeding

Digestive

Considerations:

Be sure to take steps to ensure student 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 the head elevated at least 30 degrees.
Verify with the health care provider if residuals are to be checked prior to feeding.
If residual checks are not ordered, discuss with the health care provider how tube placement should be verified prior to feeding.

Encourage the student to assist in the procedure as much as they are able to help student learn self-care skills.
Make feeding like mealtime: allow the student to sit with other children during mealtime, if possible.
If sitting with other children is not possible, brainstorm alternatives such as having the student bring a lunch buddy to the nurse office, or train a Unlicensed Assistive Personnel (UAP) to accompany students to the cafeteria to assist with feeding.

Supplies:

Gastrostomy button replacement “kit”: 
Replacement gastrostomy button
6-mL luer slip syringe
Medical tape
Water-based lubricant
60-mL ENFit/enteral syringe
Adapter with tubing and clamp
Extension set, if applicable
Graduated measuring cup
Prescribed diet at room temperature
Warm tap water, if prescribed
Towel or washcloth
Non-sterile gloves
Alcohol wipe
Student’s Individualized Health Care Plan (IHCP) and health care provider’s order
Parent/Guardian authorization

Procedure:

Review health care provider’s order including: the type of formula, amount, infusion type and rate, frequency and timing of administration, residual volume checks, amount of water used to flush the tube

Review student’s allergy status

Ensure proper documentation of parent/guardian authorization to administer the feeding

Explain the procedure to the student at their level of understanding

Wash hands

Assemble equipment and place on clean surface

Confirm you have the correct formula

Check expiration date on formula

Note the integrity of the formula container

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 the head elevated at least 30 degrees.

Put a towel or washcloth under student’s button

Put on gloves

Observe abdomen for signs of malposition or obstruction of gastrostomy button such as abdominal distention

If student has abdominal distention do not administer feeding and contact parent/guardian and health care provider

If residual check is ordered:

Remove plug from gastrostomy button

Attach the extension tubing

Attach 60-mL ENFit/enteral syringe with plunger to the end of the extension tubing

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

Clamp tubing and remove the ENFit/enteral syringe.

If residual check is not ordered, verify with health care provider how placement of g-tube should be verified before administering feeding

If residual check is NOT ordered:

Prior to attaching extension/adaptor tubing to the gastrostomy button:

Open clamp on extension tubing

Flush 5 mL water (or enough water to fully flush the extension tubing) through extension tubing

Clamp extension tubing

Attach extension tubing to gastrostomy button, per manufacturer’s instructions

Shake the feeding can/container

If feeding is in a can, clean the top of the feeding (formula) can with an alcohol wipe or soapy cloth

Attach 60-mL ENFit/enteral syringe with plunger removed to the end of the extension tubing

Measure prescribed amount of enteral formula to be infused into clean graduated measuring cup or an ENFit/enteral syringe.

Observe the appearance of the formula for any abnormalities.

Pour feeding into the ENFit/enteral syringe until about one-half full

Elevate the ENFit/enteral syringe above the level of the stomach

Open extension tubing clamp

Allow feeding to go in slowly, over prescribed amount of time

The higher the ENFit/enteral syringe is held, the faster the feeding will flow

Lower the ENFit/enteral syringe if the feeding is going too fast

Refill the ENFit/enteral syringe before it empties to prevent air from entering stomach

Continue to add until feeding is completed over prescribed time

Monitor student during feeding for any signs of intolerance or complications

Stop feeding immediately for gagging, vomiting, coughing, abdominal distension, change in skin color, or difficulty breathing, etc.

Flush the button with warm water when feeding is complete, amount determined by health care provider’s order

After flushing, lower the ENFit/enteral syringe below the stomach level to facilitate burping

Vent until gassiness is relieved and allow any gastric contents to instill via gravity

Remove the extension tubing and the ENFit/enteral syringe

Insert the plug into the gastrostomy button

Keep the student in a feeding (upright) position for at least 30 minutes after completing feeding

Remove gloves

Wash hands

Wash the ENFit/enteral syringe and tubing with soap and warm water and place in home container

The ENFit/enteral syringe and extension tubing can be used repeated times for up to 24 hours

Document assessment, interventions and outcomes in student’s health record

Follow up with parents/guardian and health care provider, as needed

References:

Applied Medical. (2017, December 22) . How to attach a feed set to an AMT MiniONE® balloon button g-tube. Retrieved June 21, 2023, from https://www.youtube.com/watch?v=rqEy_HOuw_I

Avanos Medical, Inc. (2020). Mic-Key* g feeding tube. Enteral feeding as easy as 1 2 3. Retrieved June 21, 2023, from https://tubefed.com.au/wp-content/uploads/2021/01/MIC-KEY-G-Quick-Start-Guide-ANZ.pdf

Avanos Medical Sales, LLC. (2019, January 23). Mic-Key* g feeding tube. Extension sets with ENFit® connectors. Your guide to proper care. Retrieved June 21, 2023, from https://tubefed.com.au/wp-content/uploads/2021/01/AVANOS-MIC-KEY-G-Guide-to-Proper-Care.pdf

Boullata, J. I., Carrera, A. L., Harvey, L., Escuro, A. A., Hudson, L., Mays, A., McGinnis, C., Wessel, J. J., Bajpai, S., Beebe, M. L., Kinn, T. J., Klang, M. G., Lord, L., Martin, K., Pompeii-Wolfe, C., Sullivan, J., Wood, A., Malone, A., Guenter, P., & ASPEN Safe Practices for Enteral Nutrition Therapy Task Force, American Society for Parenteral and Enteral Nutrition. (2017). ASPEN safe practices for enteral nutrition therapy [Formula: see text]. JPEN. Journal of parenteral and enteral nutrition, 41(1), 15–103. https://doi.org/10.1177/0148607116673053

Children’s Mercy Kansas City. (2022, December 2). Gastronomy tube (g-tubes): Training for school nurses.. Retrieved June 21, 2023, from https://www.youtube.com/watch?v=_Gif-699CmM

Cleveland Clinic. (2019, November 1). Home tube feeding – Checking residuals. . Retrieved August 22, 2023, from https://www.youtube.com/watch?v=59tusCo2wAI

Lynn, P. (2019). Administering a tube feeding. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (pp. 253-255). Pediatric Home Services. (2017). Bolus feeding by syringe- Gravity method (Alimentación en bolo por jeringa—Método de gravedad). . Retrieved June 21, 2023, from https://www.pediatrichomeservice.com/tips-how-tos/bolus-feeding-syringe-gravity-method/?play=1

Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Skill 32.4 administering enteral nutrition: Nasogastric, nasointestinal, gastrostomy, or jejunostomy tube. In Clinical nursing skills and techniques. (10th ed.). (pp. 965-972). St. Louis, MO: Elsevier.

Potter, P. A., Griffin Perry, A. G., Stockert, P. A., & Hall, A. (2023). Chapter 45 Nutrition. Skill 45.3 Administering enteral feedings via nasoenteric, gastrostomy, or jejunostomy tubes. In Fundamentals of Nursing. (11th ed.). (pp.1214-1219). St. Louis, MO: Elsevier.

Porter, S. M., Page, D., Engholm. H., & Somppi, C. (2019). Students supported by medical technology. In J. Selekman, Shannon, R.A., Yonkaitis, C.F. (Eds.). School nursing, a comprehensive text (3rd ed., pp. 721-740). Philadelphia PA.: F. A. Davis Co.

Spratling, R., Chambers, R., Lawrence, P., & Faulkner, M.S. (2021). Best practices with use of feeding tubes for children at home. Pediatric Nursing, 47(1), 7-10.

Toothaker, R., & Cook, P. (2018). A Review of Four Health Procedures That School Nurses May Encounter. NASN school nurse (Print), 33(1), 19–22. https://doi.org/10.1177/1942602X17725885

________________________________________

Acknowledgment of Reviewers

Angie Bulmahn, MSN, RN, NCSN
School Nurse Specialist
Missouri Department of Health and Senior Services

Marjorie Cole, MSN, RN, FASHA
State School Nurse Consultant
Missouri Department of Health and Senior Services

Renee Falkner, BSN, RN
School Nurse Supervision Specialist | Therapylog

Katherine Park, DNP, RN, NCSN
Nationally Certified School Nurse, Pierremont Elementary
Adjunct Professor, Maryville University School of Nursing

________________________________________

Page last reviewed: September 20, 2021
Page last updated: September 20, 2021, video December 20, 2023; February 15, 2024
________________________________________

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.

Skill Competency Download