Digestive
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 feeding 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:
• Gastrostomy button replacement
• Adaptor with tubing and clamp
• Feeding solution in container (bag) at room temperature
• 60 ml syringe
• Pump
• Warm tap water, if prescribed
• Pole to hold feeding container
• Student’s Individualized Health Plan (IHP) and/or healthcare provider’s orders
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Procedure:
1. Review healthcare 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
2. Explain the procedure to child at his/her level of understanding
3. Wash hands
4. Assemble equipment and place on a clean surface
5. 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
6. Put on gloves
7. 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 healthcare provider
8. Remove cap or plug from gastrostomy button
9. If residual check is ordered:
• 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• Note the amount withdrawn from tube feeding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
10. Measure prescribed amount of enteral formula to be infused into clean graduated measuring cup or syringe
11. Pour feeding/fluids into feeding container/bag, run feeding through tubing to the tip and clamp tubing
12. Hang container on pole
13. Place tubing into pump and sets flow rate
14. Open safety plug and insert tubing into the gastrostomy button
15. Open clamp completely
16. Program pump to prescribed feeding rate and start the feeding
17. Make feeding like mealtime:
• offer and/or provide oral care to older students
• provide feeding while child is around other children
18. Monitor student during feeding for any signs of intolerance or complications
19. Stop feeding immediately for gagging, vomiting, coughing, abdominal distension, change in skin color, or difficulty breathing, etc.
20. When single feeding is completed (bag empty), clamp feeding bag tubing and remove
• Sometimes a larger volume water flush may be prescribed and will run via the pump and flush the remainder of the formula through the tubing
21. Remove plunger from the syringe
22. Attach 60 ml syringe and flush adaptor tubing and button with 5 ml or prescribed water volume
23. After flushing, lower the syringe below stomach level to facilitate burping, as needed
24. Vent until gassiness is relieved and allow any gastric contents to instill via gravity
25. Disconnect syringe
26. Plug the gastrostomy button
27. Keep the child in a feeding position (upright) for at least 30 minutes after completing feeding, if required
28. Wash syringe, feeding bag 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
29. Remove glove
30. Wash hands
31. Document assessment, interventions, and outcomes in student’s healthcare record
32. Follow up with parents/guardian and healthcare provider, as needed
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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.
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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
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Page last reviewed: October 4, 2021
Page last updated: October 4, 2021; video December 22, 2023; February 15, 2024
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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.
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