G-Tube Feeding Management After Continuous Infusion
Yes, G-tube feeding should be turned off after continuous infusion is complete, and the tube must be flushed with at least 30 mL of water before and after feeding, or every 4 hours during continuous feeding to prevent tube obstruction. 1
Tube Flushing Requirements
The most critical aspect of G-tube management after continuous infusion is proper flushing:
- Flush with at least 30 mL of water of drinking quality before starting and after completion of feeds 1
- During continuous feeding, flush every 4 hours to prevent tube blockage 1, 2
- This practice prevents tube obstruction caused by protein-rich solutions, viscosity of fluids, and the small diameter of the tube lumen 1
Feeding Delivery Methods
The decision to turn off continuous feeding depends on your chosen delivery method:
Continuous Infusion
- Typically delivered via pump over extended periods 1
- Should be changed to intermittent infusion as soon as clinically possible 1
- Continuous feed should NOT be given overnight in patients at risk of aspiration 1
- Results in higher intragastric pH levels that can promote bacterial growth 1
Intermittent Infusion (Preferred when tolerated)
- Provides moderate rates of feed via gravity or pump 1
- Allows breaks in feeding of 6 hours or more 1
- More physiological and reduces infection risk 1
Bolus Feeding (Alternative for gastric tubes)
- 200-400 mL administered over 15-60 minutes, 4-6 times daily 1
- Considered more physiological for gastric feeding 1
- Should NOT be used for jejunal tubes as it causes dumping syndrome 1
Clinical Considerations
Overnight continuous feeding is acceptable for specific situations:
- Allows patients to be active during the day for work/study 1
- Provides uninterrupted sleep without flow rate adjustments 1
- However, must be avoided in aspiration-risk patients 1
Combination approaches can be used:
- Overnight continuous feeding plus daytime bolus feeding provides autonomy while meeting nutritional needs 1
Common Pitfalls to Avoid
- Never skip flushing: Inadequate flushing is the primary cause of tube obstruction, especially when medications are also administered through the tube 1
- Don't continue continuous feeding indefinitely: Transition to intermittent feeding when medically stable to reduce bacterial overgrowth risk 1
- Monitor aspiration risk: Patients should be positioned at 30° or more during feeding and for 30 minutes after 1
- If tube obstruction occurs despite proper flushing, attempt irrigation with water or cola 2