Procedure Guideline for Providing Enternal Feeding

Procedure Guideline for Providing Enteral Feeding

1. Verify the health care provider’s orders. Check the patient’s baseline weight. Review lab results, such as blood glucose and electrolyte values.
2. Gather the necessary equipment and supplies.
3. Perform hand hygiene, and provide for the patient’s privacy.
4. Introduce yourself to the patient and family, if present.
5. Identify the patient using two identifiers, such as name and date of birth or name and account number, according to agency policy. Compare these identifiers with the information on the patient’s identification bracelet.
6. Ask the patient for any food allergies, and explain the procedure to the patient.
7. Apply clean gloves.
8. Auscultate for bowel sounds, and assess abdomen. Place the patient in the high- Fowler’s position, or elevate the head of the bed to at least 30 degree, preferably 45 degrees. If the patient must remain supine, place him or her in the reverse  Trendelenburg position.
9. Obtain the prescribed formula to administer to the patient:
10. Verify the correct formula, and check the expiration date. Note the condition of the container.

Providing Enternal Feeding, Watch Nursing Lesson.

1. Administer the formula at room temperature.
2. Prepare the formula for administration:
3. Use aseptic technique when manipulating the components of the feeding system, including the formula, admini stration set, and connections.
4. Shake the formula container well. Clean the top of any canned formula with an alcohol swab before opening it.
5. If you are using an open system, pour the formula from the can into the administration bag. Hang the bag and prime the tubing. For closed systems,  connect the administration  tubing to the container.
6. Verify tube placement, referring to the video skill “Managing a Nasogastric Tube.” Check the gastric residual volume (GRV) before each bolus for intermittent feeding, or every 4 to 6 hours for continuous feeding.
7. Draw 10 mL to 30 mL of air into a syringe, and connect the syringe to the end of the feeding tube.
8. Inject the air into the feeding tube. Pull back slowly on the plunger, and aspirate the entire gastric contents. Observe the appearance of the aspirate, and note its pH.
9. Note the volume of aspirate, and return the aspirated contents to the stomach unless the volume exceeds 250 mL, or proceed according to your agency’s policy.
10. Do not administer a feeding when a single gastric residual volume (GRV) measurement exceeds 500 mL, or when two measurements taken 1 hour apart each exceed 250 mL.
11. Flush the tubing with 30 mL of water.
12. Before attaching a feeding administration set to the feeding tube, trace the tube to its point of origin. Label the admini stration set “Tube Feeding Only.”
13. Label the bag with the tube-feeding type, strength, and amount. Include the date, time, and your initials. Change the bag every 24 hours.
14. Continuous or intermittent feeding with feeding bag using a pump:
15. Pinch the proximal end of the feeding tube, remove the cap, and attach it to the tubing.
16. Set the infusion rate by adjusting the roller clamp on the tubing, or attach the tubing to the feeding pump. Allow the bag to empty gradually over 30 to 45  minutes.
17. Gradually advance the rate of tube feedings, as ordered.
18. Cap or clamp the end of the feeding tube used for intermittent feeding when not in use.
19. Flush the tubing with 30 mL of water before and after each intermittent feeding, every 4 hours during a continuous feeding, or as often as your agency’s policy specifies. The head of the bed should remain raised until at least 1 hour after the infusion is complete.
20. Rinse the bag and tubing with warm water whenever feedings are interrupted. Use a new administration set every 24 hours.
21. Help the patient into a comfortable positi on, and make sure the head of the bed remains elevated at least 30 degrees (pre ferably 45 degrees to high Fowler’s).
22. Place the call light within easy reach, and ma ke sure the patient knows how to use it to summon assistance.
23. To ensure the patient’s safety, raise the a ppropriate number of side rails and lower the bed to the lowest position.
24. Dispose of used supplies and equipment. Leave the patient’s room tidy.
25. Remove and dispose of gloves, if used. Perform hand hygiene.
26. Document and report the patient’s response and expected or unexpected outcomes.