Gastroenterostomy Tube Feeding

Gastroenterostomy Tube Feeding 

Purpose: 

To provide enteral nutrition to residents with gastrostomy or nasogastric tubes via a feeding pump set at a specific flow rate. 

Policy: 

Enteral tube feeding will be administered as per the Physician’s Order, which shall include the type of enteric tube, size of tube, type of feeding formula, rate and volume of infusion, frequency and amount of water flushes, and instructions for evaluating residual volumes. 

Procedure: 

Continuous Feeding: 

1. Prime Enteral Feeding Tube: 

• Ensure the tube is free of air bubbles. 

• Prime the feeding tube with the prescribed formula. 

2. Set Rate and Volume: 

• Set the feeding pump to the rate and volume as prescribed by the physician. 

3. Label Container: 

• Label the feeding container with the resident’s name, date, and time. 

4. Check Tube Placement: 

• Verify tube placement by checking for gastric residuals or auscultating for air bubbles. 

• Confirm the tube placement by aspirating a small amount of gastric content and checking pH. 

5. Attach Enteral Tubing: 

• Connect the primed enteral tubing to the resident’s feeding tube securely. 

6. Infuse Feeding: 

• Start the feeding pump according to the physician’s order. 

• Monitor the resident for any signs of discomfort or adverse reactions. 

7. Flush Tube: 

• After the feeding is complete, flush the feeding tube with water as per the physician’s order to ensure patency. 

Bolus Feedings: 

1. Check Tube Placement: 

• Verify tube placement as per the continuous feeding procedure. 

2. Prepare Syringe: 

• Using a piston syringe without the plunger, administer the prescribed amount of water to flush the tube. 

3. Administer Formula: 

• Pour the prescribed formula into the syringe and allow it to flow into the stomach via gravity. 

• DO NOT force fluids through by using the syringe plunger. 

4. Flush After Feeding: 

• After each bolus feeding, flush the tube with the amount of water prescribed by the physician. 

Documentation: 

• Record the type of formula, rate and volume infused, and the amount of water used for flushing in the resident's medical record. 

• Document the verification of tube placement before each feeding. 

• Note any observations of discomfort, complications, or adverse reactions during the feeding process. 

• Maintain accurate records of the feeding schedule, including start and stop times. 

Compliance and Review: 

• Ensure compliance with CMS guidelines and the State Operations Manual. 

• Regularly review and update procedures based on the latest clinical best practices and regulatory standards. 

• Conduct periodic training for staff on the proper administration of enteral feedings and monitoring of residents. 

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.