Jejunostomy Tube Feeding – Continuous Drip

Consider:

• Be sure to take steps to ensure student privacy when performing procedure.
• The unlikely risk with jejunostomy tube feedings is aspiration of formula into the lungs, be sure the student is positioned properly with the head elevated at least 30 degrees.
• Discuss with the student’s health care provider:
  • What the procedure should be if the Jejunostomy tube were to be dislodged while the student was at school.
  • How tube placement should be verified prior to feeding.
  • If the student should have decompression before/during feeding.
• Encourage the student to assist in the procedure as much as they are able to help student learn self-care skills.

Supplies:

• Adaptor/extension with tubing and clamp
• Feeding solution in container at room temperature
• 60-mL ENFit/enteral syringe
• Enteral pump
• Warm tap water, if prescribed
• Pole to hold feeding container, if applicable
  • For ease of portability, student may use a backpack to carry pump and feeding bag
• 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:
   1. the type of formula
   2. amount of formula
   3. infusion type and rate
   4. frequency and timing of administration
   5. 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. Put on gloves
11. Position student either sitting or supine with head up at least 30 degrees
12. Observe abdomen for signs of tube malposition or obstruction/clogging of jejunostomy tube such as difference in external tube length compared to baseline measurements or abdominal distention
    1. If student has abdominal distention do not administer feeding and contact parent/guardian and health care provider
13. Shake the feeding can/container
14. If feeding is in a can, clean the top of the feeding (formula) can with an alcohol wipe or soapy cloth
15. Measure prescribed amount of enteral formula to be infused into clean graduated measuring cup
    1. Observe the appearance of the formula for abnormalities
16. Prepare the enteral formula per health care provider’s order

16. Pour feeding/fluids into feeding container
17. Run feeding through tubing to the tip and the extension tubing and clamp tubing
18. Hang container on pole (or place in student’s backpack, if applicable)
19. Turn on enteral pump
20. Place tubing into pump and set prescribed flow rate
21. Zero the volume delivery amount on the enteral pump
22. Open safety plug and insert tubing into the J-tube
23. Open clamp on tubing
24. Start the feeding pump at the prescribed rate
25. When prescribed volume of feeding is completed, clamp feeding bag tubing and remove
26. Check the volume delivered on the pump to ensure the proper amount of formula was infused
27. Remove plunger from 60-mL the ENFit/enteral syringe
28. Attach 60-mL ENFit/enteral syringe to extension tubing
29. Flush extension tubing and J-Tube with 5 mL of water or prescribed amount
30. Disconnect extension tubing and the ENFit/enteral syringe
31. Cap J-tube 
32. Keep the student in a feeding (upright) position for at least 30 minutes after completing feeding, if required
33. Remove gloves
34. Wash hands
35. Document assessment, interventions, and outcomes in student’s health care record 
36. Follow up with parents/guardian and health care provider, as needed
37. Wash the ENFit/enteral syringe and tubing with soap and warm water and put in home container
    1. The ENFit/enteral syringes and feeding extension tubing can be used repeated times for up to 24 hours

References:

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

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.

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 updated: 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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