R epubl i c of the Phi l i ppi nes

CE B U TEC HNOLOG IC AL U NIVE R SITY

Mai n Campu s
i n consort i um wi t h
C EB U C ITY ME D IC AL CE NTER - C OLLEG E OF NU R SING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: ctuccmc_cn@ymail.com

SKILL LABORATORY
Second Semester, Academic Year 2019-2020

ADMINISTERING A TUBE FEEDING

NAME: _______________________________ YEAR & SEC.:_____________________

PROCEDURE
A. ASSESSMENT
1. Assess for any clinical signs of
dehydration or malnutrition.
2. Assess for allergies to any food in
the feeding.
3. Assess for the presence of bowel
sounds.
4. Assess for any problems that
suggest lack of tolerance of
previous feedings.
B. PLANNING
1. Determine the type of feeding
2. Determine the amount of feeding
3. Determine the frequency of
feedings and tolerance of previous
feedings.
C. IMPLEMENTATION
1. Introduce self and verify the
client’s identity using the agency
protocol.
2. Explain to the patient the procedure
and describe each item.
3. Wash hand and observe other
infection control procedures
4. Provide privacy
5. Assist the client to a Fowler’s
position (at least 30 degrees
elevation) in bed or a sitting
position in a chair.
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RATIONALE
identify any deficiencies, excesses or
problems with delivery
Assess if the patient is lactose intolerant,
check the feeding formula. Notify the
doctor if any incompatibilities exist.
Reduced (hypoactive) bowel sounds
include a reduction in the loudness, tone, or
regularity of the sounds. They are a sign
that intestinal activity has slowed which
indicate risk of vomiting.
To notify the doctor if there is any
incompatibilities that exist. So that there
would be a changes for the next feeding.
To ensure that you are using the most
appropriate type of feeding that is
prescribed by the physician.
To ensure that the patient is receiving the
desired amount of enteral nutrition.
To prevent feed intolerance.
Explain the person what you are going to
do, why it is necessary and how he or she
can cooperate.
To ensure that the patient understands all
of the ramifications of what is happening
To prevent spread of microorganism or any
contamination
To promote client comfort.
-It is often easier to swallow in this
position and gravity helps the passage of
the tube.
-These positions enhance the gravitational
 R epubl i c of the Phi l i ppi nes
CE B U TEC HNOLOG IC AL U NIVE R SITY
Mai n Campu s
i n consort i um wi t h
C EB U C ITY ME D IC AL CE NTER - C OLLEG E OF NU R SING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: ctuccmc_cn@ymail.com

flow of the solution and prevent aspiration

6. Assess for the tube placement.
 Apply clean gloves
 Attach the syringe to the
open end of the tube and
aspirate.
7. Assess for residual feeding
contents.
 If tube is placed in the stomach,
aspirate all contents and measure
the amount before administering
the feeding.
8. Reinstill the gastric contents into
the stomach (if this is the agency’s
policy or primary care provider’s
order)
9. Administer the feeding.
 Check the expiration date of
the feeding prior
 Warm the feeding to room
temperature.
 When an open system is
used, clean the top of the
feeding container with
alcohol before opening it.
10. Syringe (Open System)
A. Remove the plunger from the
syringe and connect the syringed to
a pinched or clamped nasogastric
tube.
B. Add the feeding to the syringe
barrel.
C. Permit the feeding to flow
slowly at the prescribed rate.
D. Raise or lower the syringe to
adjust the flow as needed.
E. Pinch of clamp the tubing to stop
the flow for a minute if the client
experiences discomfort.
of fluid into the lungs.
-To prevent spread of microorganism or
any contamination
- To minimize the risk of aspiration
- To evaluate absorption of the last feeding
This is done to evaluate absorption of the
last feeding; whether undigested formula
from a previous feedings remains, if the
tube is in the small intestine, residual
contents cannot be aspirated.
Removal of the contents could disturb the
client’s electrolyte balance.
-An excessively cold feeding may cause
the top of the feeding
-this minimizes the risk of contaminants
entering the feeding syringe or feeding bag.
-Pinching or clamping the tube prevents
excess air from entering the stomach and
avoids causing distention.
-Quickly administered feedings can cause
flatus, cramps and/or vomiting.
-Pinching or clamping the tube prevents
excess air from entering the stomach and
avoids causing distention.

11. Instill 50 to 100 ml of water -Water flushes the lumen of the tube,
through the feeding tube or preventing future blockage by sticky
___________________________________________________________________________
“ A premier multi-disciplinary technological university “
 R epubl i c of the Phi l i ppi nes
CE B U TEC HNOLOG IC AL U NIVE R SITY
Mai n Campu s
i n consort i um wi t h
C EB U C ITY ME D IC AL CE NTER - C OLLEG E OF NU R SING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: ctuccmc_cn@ymail.com

medication port. formula.

12. Be sure to add he water before the
feeding solution has drained from
the neck of a syringe or from the
tubing of an administration set.
13. Clamp the feeding tube.
14. Ensure client comfort and safety
15. Ask the cline to remain sitting
upright in Fowler’s position or in a
slightly elevated right lateral
position for at least 30 minutes.
16. Document all relevant information.
 Document feeding,
including amount and kinds
of fluids administered.
 Record the volume of
feeding and water
administered on the client’s
intake and output record.
17. Monitor the client for possible
problems.
-Adding the water before the syringe or
tubing is empty prevents the instillation of
air into the stomach or intestine and thus
prevents unecessary distention.
-Clamping prevents leakage and air from
entering the tube.
-This minimizes pulling of the tube, thus
preventing discomfort and distention.
-These positions facilitate digestion and
movement of the feeding from the stomach
along the alimentary tract and prevent the
potential aspiration of the feeding into the
lungs.
-This determines adequate absorption and
the client’s tolerance of feeding.
-Carefully assesses person’s receiving tube
feedings for problems. To prevent
dehydration, give the client supplemental
water in addition to prescribed tube feeding
as ordered.

References:
Berman,A. Snyder,S. J. Kozier, B. Erb,G. L. (2014). Kozier & Erb's Fundamentals of
Nursing Australian Edition 3. (1378-1381).

The different types of system used in administering a tube feeding (enumerate and describe
in 500 words)

Your feed can be delivered using one of the following types of tubes:

Nasogastric feeding tube (NG) - A nasogastric tube is inserted through one of the nostrils,
down the nasopharynx, and into the alimentary tract. Traditional firm, large-bore
nasogastric tubes (i.e., those larger than 12 Fr indiameter) are placed into the stomach
Nasogastric tubes are used for feeding clients who have adequate gastric emptying, and
who require short-term feedings. They are not advised for feeding clients without intact gag

___________________________________________________________________________
“ A premier multi-disciplinary technological university “
 R epubl i c of the Phi l i ppi nes
CE B U TEC HNOLOG IC AL U NIVE R SITY
Mai n Campu s
i n consort i um wi t h
C EB U C ITY ME D IC AL CE NTER - C OLLEG E OF NU R SING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: ctuccmc_cn@ymail.com

and cough reflexes since the risk of accidental placement of the tube into the lungs is much
higher in those clients.

A nasoenteric (nasointestinal) tube, a longer tube than the nasogastric tube (at least 40
cm [15.75 in.] for an adult), is inserted through one nostril down into the upper small
intestine. Some agencies require specially trained nurses or primary care providers to
perform this procedure. Nasoenteric tubes are used for clients who are at risk for aspiration.

Nasojejunal feeding tube (NJ) – the feeding passes through the nose, throat and
esophagus, continues through the stomach and ends in the first section of the small
intestine.

Gastrostomy tubes, e.g. percutaneous endoscopic gastrostomy (PEG) - Gastrostomy

and jejunostomy devices are used for long-term nutritional support, generally more than 6
to 8 weeks. Tubes are placed surgically or by laparoscopy through the abdominal wall into
the stomach (gastrostomy) or into the jejunum (jejunostomy).

A percutaneous endoscopic gastrostomy (PEG) or percutaneous endoscopic jejunostomy

(PEJ) is created by using an endoscope to visualize the inside of the stomach, making a
puncture through the skin and subcutaneous tissues of the abdomen into the stomach, and
inserting the PEG or PEJ catheter through the puncture.

Tube Feeding delivery systems are categorized as either open or closed:

Open feeding system – involves pouring a volume of formula from a can or mixing bowl
(or container) into an empty tube feeding bag, syringe, or infusion container. The infusion
bag or container is reopened and refilled periodically with more formula. Clean technique
is required when decanting the tube feeding formula into the bag and when handling the
tubing connections. Formula hang time is limited to 8 hours or less. Hang time is further
reduced if additives such as protein powder are placed into the formula. The tube feeding
infusion bag should be rinsed with sterile water before initial filling and subsequent
refilling with formula. The tube feeding administration set, tubing and infusion bag should
be changed every 24 hours. The primary benefit of the open system is the ability to
modulate the tube feeding formula.

Closed feeding system – is composed of a sterile vessel that is purchased prefilled with
tube feeding formula. The container is spiked and connected to an infusion pump. Hang
time is expanded to 24 to 48 hours. Benefits of the close system are reduction of time,
labor, and contamination risk. Caveats of the closed system are its increased cost and
inability to modulate the formula. Regardless of the system used, good hand washing is
essential for the reduction of bacterial contamination.

___________________________________________________________________________
“ A premier multi-disciplinary technological university “
 R epubl i c of the Phi l i ppi nes
CE B U TEC HNOLOG IC AL U NIVE R SITY
Mai n Campu s
i n consort i um wi t h
C EB U C ITY ME D IC AL CE NTER - C OLLEG E OF NU R SING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: ctuccmc_cn@ymail.com

COMMENTS:

SCORE: _______

Prepared by:

Miss Dafhne C. Gallendo

Clinical Instructor- Level II

Noted by:

Mr. Richard O. Lam

Level Chairman- Level II

Instruction for Skills Laboratory:

1. Provide the rationale of each procedure using the same format.

At the end of the procedure, in 500 words, enumerate and describe the different of types of
system used in administering a tube feeding.

2. Include the reference (book, website except Wikipedia)

3. Send the output to the same e-mail address along with your case analysis, IL (GI
dysfunction and Skills laboratory) to rlam4917@gmail.com.
4. If you have questions or concerns feel free to send it via this mobile no, 09284570296

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