1. Practical Nursing Diploma Program - Semester II Labs
N/G tube/J tube/G tube Feeding

3. Indications for enteral feedings [1305]
oral surgery
swallowing difficulties ( dysphagia) from dementias, CVAs, Parkinson’s,..
Respiratory failure with prolonged intubation
GI disorders such as IBD, pancreatitis,…

4. delays wound healing, immune system deteriorates, lengthens hospital stays
enteral feedings provide more nutrition per volume, cause fewer infections and complications and costs less than parenteral feedings
one study showed that up to 1/2 of hospitalized patients may be malnourished

5. Types of tubes……. may be short term or long term situation
short term feedings may be given through nasogastric tube or nasointestinal tube
long term given through gastrostomy or jejunostomy tube
G and J tubes may require surgical procedures and general anesthetic

7. percutaneous endoscopic gastrostomy tubes are becoming more popular as can be inserted at the bedside using local anesthetic and an endoscope
another option is the LPGD or low profile gastrostomy device - better for long term, continuous feedings in active adults, children

10. French size refers to the outer diameter of the tube with larger tubes having higher French size (same as foley catheters, suction tubes etc.)
most made of silicone and/or polyurethane
use of gastrostomy tube requires a functioning GI tract
J tubes are an alternative if there are problems with the GI tract

11. these tubes are relatively stable and difficult to dislodge but require special care to avoid skin breakdown etc.
tape tube to abdomen to prevent movement

12. Feeding Schedule
based on pt’s physical, medical and nutritional condition
continuous feedings - gradual introduction of formula into GI tract allowing for maximal absorption
- requires use of feeding pump which limits movement

13. continuous feeding into intestine (J tube) used to avoid dumping syndrome
continuous feeding into stomach (G tube) is controversial due to risk of reflux and aspiration

14. Intermittent or Cyclic Feedings
intermittent feedings are given over specific period of time at regular intervals ie. q6h and run over 3 hours
cyclic feeding involves giving continuous feeding over a specific time frame (usually hours overnight) in a 24 hour period which allows the patient to eat normally during the day and allows for more mobility

15. Feeding Formulas
component of feed depends on the route, the patient’s ability to digest and absorb nutrients and his/her nutrient and fluid requirements
also have to consider medical conditions that require special diets, food intolerances, and allergies

16. typical formula contains : 16% protein, 54% carbohydrate and 30% fat
most contain 1 calorie per mL but some contain more so check it out
dietician is generally involved in this process to ensure patient gets proper formulation depending on individual need

17. Potter & Perry [ ]
may be prefilled bottles that you simply spike and hang or bags/containers that you have to fill
lots of different products on the market so know what your patient’s needs are and question if order inappropriate
Given via feeding pump or gravity

18. Use of feeding pumps……..
Usually have specialized tubing specific to the individual pump
regulates rate of feeding delivered to patient
allows increased control and accuracy
most have built in safe guards (alarms) to prevent free flow, attachment to IV tubing (different sized tip), automatic tube flush
audible and visual alarms
most operate up to 8 hours on battery but should be plugged in whenever possible

19. Confirming placement of tube….
J and G tubes require regular assessment to determine that they have not become dislodged
this involves measuring the length of the tube outside of the body and comparing to length at time of insertion
NG tubes increase risk of aspiration and must be checked prior to each use to ensure correct placement ie. Not in lungs!!!

20. GI Aspirate [1319]
another method used primarily with NG tubes is to check the pH of the aspirate
wait about 1 hour post medication or feeding or stop continuous feeding for one hour
insert 30 mL of air into tube and aspirate 5-10 mL of gastric secretions

21. place drop of secretion on pH paper and compare colour with chart from manufacturer
stomach pH = 0-4, or 4-6 if taking acid inhibiting agent
Intestinal pH = 7 or higher
respiratory tract pH = 6 or higher

22. colour of aspirate is also a clue as to its origin
stomach - green, tan, off white, bloody or brown
intestine - medium to deep golden yellow - may be greenish brown if stained with bile
resp tract - off white and tinged with mucous

23. Safety Checks for any Delivery Method
always check tube from beginning to end to ensure intact and attached to right machine and container
check tube for placement prior to each feed
check residual, according to policy, before each feeding or every 4-6 hours if continuous and report excess of over 100 mL
assess bowel sounds at least once per shift

24. Prevent contamination during feeding by:
washing hands prior to handling any part of system
using closed system when possible
checking expiry date of formula
follow policy for the type of fluid for flushing tube
cap disconnected tubes properly

25. replace setup every 24 hours or wash reusable setup with soap and hot water every 24 hours (check organization’s policy for these activities)
label container with pt’s name, date and time feeding hung

26. Administering an enteral feeding
explain procedure
check bowel sounds
gather equipment
check amount, concentration, type, expiry date and frequency of tube feeding with chart
wash hands, put on gloves

27. position patient with HOB elevated about 30 degrees
examine tube for proper placement
check pH and residual if indicated [1319]
prepare formula and clear tubing of air
For gravity feed, hang feeding on IV pole about 12 inches above stomach

28. attach tube to patient tubing and regulate rate manually or with pump
flush tubing post feed with mL of fluid type according to agency policy
observe patient response during and after
have patient remain upright for mins after intermittent feed
wash and clean equipment or discard depending on equipment used

29. document type and amount of feeding and patient’s response
monitor blood glucose if required

30. Complications
extubation - measure tube at regular intervals, anchor tube securely, check patency at least q shift
stoma complications - clean site q shift with soap and water and dry thoroughly, assess for signs of infection
provide exceptional mouth care to prevent drying and relieve thirst

31. clogged tube - flush q4h during continuous feed and at start and end of intermittent and after withdrawing aspirate - use 30 mL of water with a 50 mL syringe
diarrhea - start feed slowly, prevent contamination, assess for fecal impaction
N & V - check residual q4h if continuous and at start of intermittent feed

32. if your patient complains of abdominal pain, bloating or N&V, stop the feeding, reassess the patient and resume at a slower rate

33. Administering medication through a feeding tube…….
safety measures – 3 checks and 6 rights
use liquid form or meds that can be crushed and combined with liquid
have med at room temperature
ensure proper tube placement prior to administering medication

34. flush tube with 15 – 30 ml of water before and after giving med to check patency and prevent plugging of tube
give each med separately and flush after each one
don’t forget to count “flush” in I & O
many meds can’t be given together due to interactions so check first

35. if tube connected to suction, disconnect and allow 20 – 30 minutes for absorption of med before reconnecting
disconnect continuous feeding prior to giving meds and leave off according to agency policy
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