Patients who have the inability to ingest, swallow or chew foods but are able to digest and absorb nutrients require feeding via tubes. Tube feedings deliver liquid feeding formula directly to the stomach, duodenum or jejunum.
For a patient who cannot normally eat due to dysphagia, oral or esophageal obstruction or injury, gastric gavage (tube) feeding is typically indicated. In addition, it is indicated to patients who are unconscious, intubated or those recovering from GI tract surgery and cannot ingest food orally.
- Feeding formula
- Bulb syringe
- 120 ml water
- Gavage bag with tubing and flow regulator clamp
- Towel or linen-saver pad
- 60 ml syringe
- pH test strip
Preparation of Equipment
- Check the feed formula containers for expiry dates. Discard expired formulas.
- Powdered formulas should be used within 24 hours of mixing.
- Shake the container well to mix the solution thoroughly.
- The formula should be warmed to room temperature before feeding. Administering cold formulas can increase the chance of diarrhea. Do not warm the formula in direct heat or microwave as it may cause the solution to curdle and the chemical composition. Also, a hot formula can injure the patient.
Gastric Gavage(Tube) Feeding Procedure
- Confirm patient’s identity using two patient identifiers according to your facility’s policy.
- Verify physician’s order. Tube feedings MUST be ordered by a physician. The order will indicate the type of formula to be used, route, amount to be administered and frequency of feeding.
- Provide privacy and explain the procedure to the patient.
- Place a towel or linen-saver pad on the client’s chest to protect him from spills.
- Position the patient in a high-Fowler’s position (30 to 45 degrees). Inform the patient to remain in this position during and 1 hour after feeding to limit the risk of aspiration and reflux.
- Wash hands and don gloves.
- Assemble equipment.
- Check the placement of the feeding tube to verify the correct placement of the tube in the stomach. NEVER administer a tube feeding until you are sure the tube is properly positioned in the stomach. Administering feeding through a misplaced tube can cause the formula to enter the lungs.
- To check tube patency and position, remove the cap or plug from the tube feeding and use a syringe to aspirate stomach contents. Examine the aspirate and place a small amount on the pH test strip. The tube is patent if the aspirate has a pH of 5.0 or less. If pH is higher, do not proceed to feed, inform the physician as the tube may be displaced. Another way to check the placement of the tube is by obtaining an x-ray film for tube placement.
- NOTE: In the past, insufflation of air into the tube was followed by auscultation of abdominal sound. This technique is no longer considered reliable in determining the placement of the tube.
- Assess gastric emptying by aspirating and measuring residual gastric contents. If the residual volume is greater than 150ml or the predetermined amount specified in the physician’s order, hold feedings. Reinstill any aspirate obtained.
- Observe the abdomen for distention to assist in recognizing delayed gastric emptying and decreases the risk of regurgitation and pulmonary aspiration due to gastric distention.
- Auscultate abdomen for bowel sounds to check the presence of peristalsis and ability of GI tract to digest nutrients.
- Administer tube feeding.
- Bolus or intermittent feeding: (a) Pinch the proximal end of the feeding tube to prevent excess air from entering the patient’s stomach, causing distention. (b) Attach the syringe to the end of the tube and elevate it 18 inches above the head of the patient. (c) Pour the formula into the syringe. Allow the syringe to gradually empty. Refill syringe until the ordered amount has been consumed.
- Continuous-drip method: (a) Hang gavage bag to an IV pole. The patient should be checked every 6-8 hours. (b) Connect the end of the bag to the proximal end of the feeding tube. (c) Connect the infusion pump and set the rate.
- Flush the tubing by adding 60 ml of water to the gavage bag or bulb syringe, after administering the prescribed amount. This maintains tube patency by removing excess formula which could occlude the tube.
- Cover the end of the feeding tube with its plug or cap or clamp the proximal end of the feeding tube to prevent leakage and contamination of the tube.
- Remove and dispose of gloves in a proper receptacle.
- Document time, amount and type of feeding.
The body requires food to provide energy for organ function, replace and repair cells and speed up recovery from illness. Hence, for patients who have trouble swallowing or chewing food, gastric gavage feeding is one important procedure nurses have to implement and master.
- Fundamentals of Nursing, Potter and Perry
- Best Practices, Lippincott Williams & Wilkins