Enteral Feeding

Materials:

  • Stethoscope
  • Feeding solution
  • Sterile Water
  • Towel
  • Tray
  • Calibrated glass (for flushing solution)
  • Toomey syringe (See image) / Asepto syringe

What to do:

  1. Charge nurse/ Bedside nurse/ Ward Clerk encodes the doctor’s ordered tube feeding solution via Diet Data Entry (include the type of feeding solution, caloric requirement per day, volume per day and concentration)
  2. Charge nurse verifies the feeding bottle/ solution’s label delivered by formula man against doctor’s order sheet, tube feeding card and Kardex and shall check for the following: Type of feeding solution, caloric requirement/ day, concentration (calories/cc)
Nota Bene:
Computation for volume per day and per feeding:
(Caloric requirement per day – 2000 kcal/day)
(Concentration – 2 cal: 1 cc in 6 equal feeding per day. Compute for the volume to be given per feeding)
Formula:
Total caloric requirement per day/ Concentration (calorie/cc)/ # of feeding per day.

Example:
Volume per feeding = 2000kcal/ 2 cal x 1cc
  1. Gather and prepare the necessary equipment and the enteral feeding formula.
  2. Do hand hygiene.
  3. Assess the patient to determine the risk of aspiration and for presence of abdominal distention.
  4. Position the patient to prevent regurgitation/ aspiration of feeding solution according to the following:
Position:
Conscious: Semi Fowler’s (30-45 degree) as tolerated by patient or upright position.
Asleep : Gently wake up the patient and assist in Semi – Fowler’s position
Unconscious: Semi- Fowler’s position
  1. Assess for feeding tube placement before administering the tube feeding and at 4-hour intervals.
Steps for checking tube placement:
* Kink and remove cover of NGT
* Attach the syringe (Toomey) to the NGT
* Place diaphragm of stethoscope at the epigastric area
* Inject 5 ml of air into the NGT
* Listen with your stethoscope for presence of “whooshing” sound
* Aspirate the equivalent amount of air introduced
  1. Place towel over the patient’s neck and chest area
  2. Check for residuals by attaching a Toomey syringe into the port, gently pull back the plunger to aspirate for stomach content. Stop if resistance is felt. Do not use too much force or the tube may collapse.
  3. Re-check for correct NGT placement
Nota Bene:
* If residual formula is > 50 ml. Place in kidney basin, withhold due feeding and refer immediately to the MD.
* If <50 ml., measure gastric content and allow to flow back by gravity. Deduct the volume of the residual from the volume of the feeding solution to be given.
  1. If coffee ground aspirate is noted, hold feeding and refer to the doctor immediately
  2. Document in the I & O under drain column and nurse’s progress notes for quality/ quantity and characteristics (volume) and management done if any.
  3. If no residual is noted, proceed with feeding.
  4. Remove and discard your gloves. Do hand hygiene. Put on new gloves.
  5. Flush the feeding tube with ordered fluid, volume and frequency.
  6. Kink NGT and detach the syringe (Toomey)
  7. Connect the feeding tube bag containing the feeding solution to NGT securely.
  8. Make sure that the feeding bag is installed properly into its enteral pump, with proper data entered. (Volume to be infused and flow rate)
  9. In the absence of an enteral pump, use a feeding bag with a regulator and compute for the desired rate accordingly (drops per minute). Regulate the flow of feeding solution according to doctor’s order.
Formula:
Volume to be infused (volume per feeding) x drop factor/ # of hours x 60 minutes
  1. Hang the feeding bottle to IV stand at the height of not less than 12 -18 inches above the tube’s point of insertion.
  2. Assess for GI intolerance to tube feedings at 4-hour interval. Monitor patient for any signs of aspiration.
  3. After feeding solution has been infuse, remove cover of feeding bottle and flush it with the ordered fluid and volume. Kink and cover the NGT (for intermittent feeding)
  4. For continuous feeding, monitor the patient as often as every hour for complications of feeding.
  5. Instruct the patient/ relative to maintain semi-flower’s position/ upright position for 1 hour to prevent regurgitation.
  6. Wash with soap and water and dry (Toomey Syringe and rinsing glass). Put in a kidney basin/ wrap in ziplock plastic and place inside the bedside table.
  7. Re -assess patient for signs of aspiration/ feeding complications.
  8. Remove your gloves and do hand washing.
  9. Document.
Document:
* Feeding (Nurse’s notes and I/O sheet
* Type of feeding solution
* Caloric requirement/ day
* Residual feeding
* Assessment of patient (Nurse’s Notes)
* Condition of patient before, during and after procedure
* Signs of aspiration and other feeding complications (if any).
* Others (Nurse’s Notes)
* Doctor’s name, time, and response to the referral.
* Feeding time, dose, volume of feeding given.