From the Guidelines
The proper procedure for feeding a patient through a feeding tube involves starting with a low flow rate and gradually increasing it, using either bolus or continuous infusion, and prioritizing patient safety and comfort. When initiating tube feeding, it is essential to verify the patient's identity and check the medical order for the correct formula and rate 1. Position the patient in a semi-recumbent position (30-45 degrees) to reduce aspiration risk. Before administering any feed, check tube placement by aspirating gastric contents and measuring pH (should be 1-5.5), or follow your facility's protocol which may include X-ray verification for newly placed tubes.
Some key considerations for tube feeding include:
- Starting with a low flow rate (e.g., 10 ml/h, max 20 ml/h) and increasing the feeding rate carefully and individually due to limited intestinal tolerance 1
- Using bolus or continuous infusion, depending on clinical need, safety, and level of precision required 1
- Administering bolus feeds with a syringe over 15-60 minutes, or using a feeding pump for continuous infusions 1
- Flushing the tube with 30ml of water before and after feeding, and when administering medications to prevent clogging
- Monitoring the patient for complications such as nausea, vomiting, diarrhea, or abdominal distention
It is also crucial to maintain proper tube care by cleaning the insertion site daily and securing the tube to prevent dislodgement. The choice of feeding method, whether bolus or continuous, should be based on the patient's clinical needs, safety, and level of precision required, with a strong consensus (92%) supporting the use of either method 1. By following these guidelines and prioritizing patient safety and comfort, healthcare providers can ensure safe and effective enteral nutrition delivery while minimizing complications.
From the Research
Proper Procedure for Feeding a Patient through a Feeding Tube
To ensure safe and effective feeding, the following steps should be taken:
- Confirm correct tube placement before feeding, as misplacement is a common problem 2
- Use a protocol that provides guidelines for handling and selecting formulas, administering formulas, and monitoring patients 3
- Add food coloring to all feedings to help detect aspiration or tube displacement 3
- Flush feeding tubes with water every 4 hours during continuous feedings, after giving intermittent feedings, after giving medications, and after checking for gastric residuals 3
- Use a controller pump to administer continuous feedings at a constant rate or to administer formulas that are viscous 3
- Select feedings that contain appropriate nutrient sources, caloric density, and osmolality, and handle feedings in a way that minimizes bacterial contamination 3
Monitoring and Assessment
Regular monitoring and assessment are crucial to prevent complications and ensure the patient is receiving adequate nutrition:
- Check urine sugar and acetone levels every 6 hours (until stable) 3
- Determine vital signs and fluid intake and output every 8 hours, and measure weight on a daily basis 3
- Determine serum electrolytes, blood urea nitrogen, and glucose levels daily, until serum levels stabilize 3
- Make weekly measurements of trace elements to ensure adequate mineral replacement 3
- Assess for potential complications, such as refeed syndrome, buried bumper syndrome, and contaminated tube feeding 2
Administration Methods
There are different methods for administering enteral feedings, including:
- Pump feeding: using a volumetric enteral feeding pump to administer feed at a constant rate 4
- Bolus feeding: administering feed via an enteral syringe 4
- Constant drip method: a method of administration that has been shown to be efficient and time-saving 5
Tube Care and Maintenance
Proper care and maintenance of the feeding tube are essential to prevent complications: