Gastrostomy Button Feeding – Gravity Feeding

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 health care provider if residuals are to be checked prior to feeding.
  
  • If residual checks are ordered, verify with health care provider how residuals should be returned to the abdomen (i.e. via gravity, continuous infusion, or ENFit/enteral syringe). 
  • 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 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
    

• ENFit adaptor with tubing and clamp  
• Feeding solution in can/container at room temperature 

• Feeding bag 
• 60-mL ENFit/enteral syringe 
• Warm tap water, if prescribed 
• Pole to hold feeding container 
• Student’s Individualized Health Care Plan (IHCP) and health care provider’s orders 
• Parent/Guardian authorization form 

Procedure:

1. Review health care provider’s order including: 
   • the type of formula
   • amount 
   • infusion type and rate 
   • frequency of administration 
   • residual volume checks 
   • amount of water used to flush the tube
2. Review student’s allergy status 
3. Ensure proper documentation of parent/guardian authorization to administer the feeding 
4. Explain the procedure to student at their level of understanding  
5. Wash hands 
6. Assemble equipment and place on a clean surface 
7. Confirm you have the correct formula 
8. Check expiration date on formula 
9. Note the integrity of the formula container 
10. Position student 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 
11. Put a towel or washcloth under student’s button 
12. Put on gloves 
13. 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 
14. If residual check is ordered 
    • Remove cap or plug from gastrostomy button  
    • Attach extension/adaptor tubing per manufacturer’s instructions 
    • Attach 60-mL ENFit/enteral syringe with plunger to the end of the adaptor 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 the tubing and disconnect the ENFit/enteral syringe 
15. If residual check is not ordered, verify with health care provider how placement of g-tube should be verified before administering feeding 
16. If residual check is NOT ordered: 
    • Prior to attaching extension/adaptor tubing to the gastrostomy button: 
      • Open clamp on extension tubing 
      • Flush 5 mL of 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 
17. Shake the feeding can/container  
18. If feeding is in a can, clean the top of the feeding (formula) can with an alcohol wipe or soapy cloth 
19. Measure prescribed amount of feeding to be infused into clean graduated measuring cup or an ENFit/enteral syringe 
    • Observe the appearance of the formula for any abnormalities 
    • Prepare the enteral formula per health care provider’s order 
20. Pour feeding/fluids into feeding bag 
21. Run feeding through tubing to the tip and clamp tubing 
22. Hang container on pole at height required to deliver prescribed flow  
23. Remove the feeding port cover 
24. Connect the feeding bag tubing to the extension tubing  
25. Open clamp on tubing and adjust flow to prescribed rate 
26. Check rate and flow periodically and adjust if needed 
    • You will need to adjust the flow rate if the student’s position changes or the position of the feeding bag changes 
27. Monitor student during feeding for any signs of intolerance or complications 
28. Stop feeding immediately for gagging, vomiting, coughing, abdominal distension, change in skin color, or difficulty breathing, etc. 
29. When single feeding is completed (bag empty), clamp feeding bag tubing and remove 
    • Sometimes a larger volume water flush may be prescribed and will be administered using feeding bag and will flush the remainder of the formula through the tubing 
30. Attach 60-mL ENFit/enteral syringe, with the plunger removed, and flush tubing and button with 5 mL or prescribed water volume 
31. After flushing, lower the ENFit/enteral syringe below stomach level to facilitate burping 
32. Vent until gassiness is relieved and allow any gastric contents to instill via gravity 
33. Disconnect the ENFit/enteral syringe and extension/adaptor tubing 
34. Plug gastrostomy button   
35. Keep the student in a feeding (upright) position for at least 30 minutes after completing feeding 
36. Wash the ENFit/enteral syringe and tubing with soap and warm water and place in home container 
    • The ENFit/enteral syringe and feeding extension tubing can be used repeated times for up to 24 hours 
37. Remove gloves 
38. Wash hands 
39. Document assessment, interventions, and outcomes in student’s health care record   
40. Follow up with parents/guardian and health care provider, as needed 

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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

Pediatric Home Services. (2017). Using a gravity feeding bag. Retrieved June 20, 2023, from https://www.pediatrichomeservice.com/tips-how-tos/using-gravity-feeding-bag/?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

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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; February 15, 2024; no video
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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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