Clinical Skills - Enteral Tube Feeding
by Ellis Parker February 21, 2022 Updated: December 07, 2022 4 min read
Hi. I'm Ellis with Level Up RN. In this video, I'll be demonstrating and discussing how to perform an enteral tube feeding. I just wanted to note that I do refer to the syringe that I'm using as a piston syringe, but you might have heard it be called a 60 cc syringe or even a Toomey syringe. I'll be following the steps that are included in our clinical nursing skills deck. If you have the deck, that's great. Grab it. Follow along with me. If you don't have the deck and you're interested in looking at them, head on over to leveluprn.com. One more quick note that I just wanted to share from personal experience, any time you're working with a PEG tube or G-tube or anything like that, do make sure that once you're done that you have thoroughly clamped the tube off. I vividly remember providing a G-tube feeding in my very early days as a nursing student, forgetting to clamp the G-tube off, and it leaking all over the bed. So not only did my patient, unfortunately, lose his feeding, but there was much cleaning and linen changing that had to occur. So just make sure your lines are closed.
Before starting or resetting a continuous feed, I want to make sure that my patient is sitting at at least a 30 to 45 degree angle because of that risk for aspiration. So even though they're not orally consuming, they're still getting contents in their stomach, and there's still a potential risk for that aspiration. So I want to make sure the head of the bed is at least 30 degrees. And then I, depending on what type of tube I'm working with, need to check that the tube is placed correctly, right?
So if it's an NG tube, I might want to aspirate some of that contents and test the pH. If I'm working with something like a G-tube, PEG tube, I'm not really worried about where it's placed. What I might be worried about, though, is the gastric residual volume or the GRV, and what that means is what is in their stomach at that point in time, because if their GRV is really elevated, should we be pumping more food on top of that? Right? So what I can do is get my piston syringe. I'm going to simply pinch this a bit while I unplug it so that it doesn't just shoot out on me. I'm going to insert my piston syringe, and I'm going to withdraw on the plunger until nothing happens. So my patient today has no GRV. In that case, I would move forward with what I'm doing. Otherwise, you do need to follow your facilities policy. In some facilities, I would want to remove it, put it in another cup, and then waste it. And in other facilities, I would actually re-insert it into my patient's stomach. And a lot of that depends on how much GRV your patient has. There's a general feeling that if it's over 500, we need to reconsider continuing this feed or maybe the rate or the type. Whatever the case may be, our practitioner probably needs to be involved. So if I need to check GRV according to my facility policy, that's how I would do that. And then I would go ahead and set up my feedbag.
So for today, I've got this graduated cylinder of tube feeding. This can come in cans, bottles, bags. They come in all different types of things. Sometimes I would need to pour it out. Sometimes I actually can just flip the cap off of a bottle and put tubing directly into that bottle. But otherwise, I'm going to make sure my tubing is clamped, open the top of my tube feeding bag, and pour the desired amount in. Looks delicious. All right. I'm going to put the cap on. There's even a little tab to pull that cap down just so it doesn't accidentally pop off and become exposed, and I'm going to hang it up. And I've already checked to make sure this is the correct product. I'm doing the correct method of insertion. I'm going to set it at the correct rate. And all of that information could be labeled on this bag as to what this is, when it was hung, who hung it, all of those different things so that anyone that's coming into this room after me knows exactly what's going on with this patient and their tube feeding. Once I do that, I can either prime it with the pump, or I can prime it without the pump. It just depends on what pump I'm using. I'm going to go ahead and prime without it. I'm just going to go ahead and use this graduated cylinder. So I'm going to remove this cap, put it over my graduated cylinder, and unclamp my tubing.
It's going slow because I've got the end of it so high. All right. I've got it primed. And now with these pumps, I've already turned it on. I'm going to place the drip chamber in there. I'm going to loop this stretchy tube around and drop that black piece into that hole. And then I can put this tubing here, and that actually just helps make sure that this part doesn't kink off or bend over. So it just helps make sure there's no kinks. Then I'm going to put the end of this tube into their port. So I'm going to remove their cap and make sure it's nice and secure in there. And then there's actually a dial on the side of this one to decide the rate. So we're going to go with 20. That means it's going to go at 20 milliliters an hour. And then there's a VTBD button, and that's volume to be delivered. So I'm going to click on that button, and I'm going to say - and it will end up going faster and faster - that we have-- we have actually 600 in our bag today. And once that's done, I can go ahead and hit start. And my volume will begin being delivered. And that's how you set up a tube feeding.
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