Enteric Tubes/Feedings 

Purpose: 

To provide enteral nutrition to residents with gastrostomy tubes. 

Policy: 

The Physician’s Order shall include: 

• Type of enteric tube, size of tube 

• Type of feeding formula 

• Rate at which formula is to be administered and over what period of time (e.g., 12 hours – start at 7:00 p.m. and end at 7:00 a.m.) 

• Frequency and amount of water flushes 

• Instructions for evaluating residual volumes 

• If bolus feeding is desired – frequency and amount of formula to be administered 

• Replace PRN if indicated (only if this is a long-standing G-tube and not a PEG tube) 

• Change dressing on the tube site daily 

Enteral tubes shall be placed by the Physician. 

Verification of Tube Placement: 

• Enteral tube feedings shall be initiated only after tube placement is confirmed by x-ray, CT scan, or ultrasound (if placed by that method). The Physician or designee is responsible for notifying the nursing staff of proper tube placement. 

• Prior to initiation of feeding and/or medication administration, placement can be checked by either: 

• Withdrawing gastric contents (if there is residual volume of twice the amount per hour, notify the Physician before proceeding). 

• Injecting 5-10cc of air into the tube and auscultating the abdomen with a stethoscope for the characteristic gurgling sound. 

Initiation of Feeding: 

• For new PEG/G tubes, the tube feedings will begin at a slower rate, and residuals will likely need to be checked more frequently. Orders to hold the feeding if residuals are usually greater than 60cc. 

• The head of the bed should remain elevated at >30 degrees during feeding. 

Care of the Tube Site: 

• The site is generally cleansed and then covered with a split sponge or folded 4x4 (no fraying) and is dated and changed daily or per physician order. 

• All tube feeding supplies are resident-specific and are delivered and billed as such. 

• Most formulas are packaged in a unit dose self-contained system. Tubings, the formula itself, and piston syringes are dated and changed daily. Syringes are rinsed with water after each use. 

Compliance and Documentation: 

• Adhere to CMS guidelines and Requirements of Participation for Long-Term Care Facilities. 

• Document the enteral feeding procedure, including the resident’s response and any observations, in their medical record. 

• Note any abnormalities or difficulties encountered during the procedure. 

• Regularly review and update techniques for enteral feeding according to the latest clinical best practices and regulatory standards. 

• Provide training to staff on proper enteral feeding procedures to ensure resident safety and comfort. 

• Conduct regular audits to ensure compliance with this policy and address any gaps in practice or documentation. 

References: 

• Centers for Medicare & Medicaid Services (CMS). State Operations Manual (SOM), Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. 

• CMS Requirements of Participation for Nursing Homes.