Enteral Nutrition Administration

Summary

This instructional video outlines the process of administering enteral feeding to a patient with a nasogastric (NG) tube. It emphasizes the importance of verifying the tube's correct placement in the stomach through pH testing or X-ray, and measuring the tube's length to ensure it hasn't moved. The video also covers gastrointestinal assessment, checking for allergies, and using a 60cc syringe for feeding. It demonstrates how to flush the tube with sterile water for patency, administer the feeding solution by gravity, and clamp the tube after to prevent backflow. Post-feeding, it advises waiting before suction to avoid losing the feeding, and the necessity of documenting the procedure and patient's response.

Takeaways

• 🔍 Ensure the NG tube is correctly placed in the stomach before feeding by verifying with methods such as pH testing or X-ray.
• 📏 Measure the NG tube from the nose to the insertion point and document this to ensure consistent placement.
• 👂 Perform a gastrointestinal assessment, including listening for bowel sounds and checking for patient discomfort or allergies.
• 📋 Double-check the provider's orders and verify the correct tube feeding formula against the MAR.
• 🧼 Practice good hygiene by washing hands and wearing gloves before handling the NG tube.
• 💧 Use a 60 CC syringe to flush the tube with sterile water to check for patency and to prevent clogging.
• 🚫 Avoid using small syringes due to pressure gradients; a 60 CC syringe is recommended.
• 🍼 Administer the tube feeding formula by gravity, ensuring the tube is unclamped during the process.
• 🔄 Always flush the tube before and after administering feedings to maintain patency.
• ⏱ Wait at least 30 minutes to an hour before connecting the patient to suction after feeding to prevent the feeding from being sucked back out.

Q & A

What is the primary focus of the skill being discussed in the script?

The primary focus of the skill being discussed is how to provide a patient with enteral feeding using a nasogastric (NG) tube.

Why is it important to verify the placement of an NG tube before administering feeding?

It is important to verify the placement of an NG tube before administering feeding to ensure that the tube is still in the correct spot in the stomach, preventing potential complications such as aspiration.

What are the two methods mentioned for verifying the placement of an NG tube?

The two methods mentioned for verifying the placement of an NG tube are pH testing and measuring the tube from the nose to the point of insertion after confirming placement with an X-ray.

Why is it necessary to measure the length of the NG tube after verifying its placement?

Measuring the length of the NG tube after verifying its placement helps to ensure that the tube has not moved and remains in the correct position for each feeding, which is crucial for proper administration of enteral nutrition.

What is a gastrointestinal assessment, and why is it performed before administering an NG feeding?

A gastrointestinal assessment involves listening to bowel sounds and checking for symptoms like bloating, cramping, or diarrhea. It is performed to ensure the patient's gastrointestinal system is ready to receive the feeding and to prevent complications.

Why is it important to check the patient's ID and allergies before administering a tube feeding?

Checking the patient's ID and allergies is important to ensure that the correct patient receives the feeding and to avoid administering any substances that the patient may be allergic to, which could cause adverse reactions.

What is the significance of using a 60 CC syringe for administering enteral feedings?

Using a 60 CC syringe is significant because it helps to manage pressure gradients and ensures that the feeding is administered smoothly without causing discomfort or harm to the patient.

Why is it recommended to flush the NG tube with water before and after administering a feeding?

Flushing the NG tube with water before and after administering a feeding ensures that the tube remains patent and clear of any obstructions, preventing complications and ensuring the proper delivery of nutrients.

How does the process of administering a tube feeding by gravity differ from using a pump?

Administering a tube feeding by gravity involves pouring the feeding solution into the tube and allowing it to flow naturally, while using a pump involves a mechanical device that controls the rate and volume of the feeding.

Why is it advised to wait before attaching the patient to suction after a tube feeding?

It is advised to wait at least 30 minutes to an hour before attaching the patient to suction after a tube feeding to allow the nutrients to be absorbed and to prevent the feeding from being suctioned out, which would negate the purpose of the feeding.

What steps should be taken after administering a tube feeding to ensure the patient's comfort and safety?

After administering a tube feeding, the nurse should ask the patient about any discomfort, document the feeding, ensure the bed is lowered and alarms are set, and provide the call light and tray table within reach to ensure the patient's comfort and safety.

Outlines

00:00

🩺 Enteral Feeding with NG Tube

This paragraph introduces the process of providing enteral feeding to a patient with a nasogastric (NG) tube. It emphasizes the importance of verifying the correct placement of the NG tube in the stomach using methods such as pH testing or measuring the tube length after X-ray confirmation. The nurse must document the tube's position to ensure it hasn't moved. A gastrointestinal assessment is necessary, including listening for bowel sounds and checking for patient discomfort. The paragraph also covers the preparation for feeding, which includes checking provider orders, verifying the patient's identity and allergies, and setting up the feeding equipment. The use of a 60 CC syringe for feeding and the importance of using sterile water are highlighted, along with the steps for flushing the tube before and after feeding to maintain patency.

05:00

💧 Verifying Tube Patency and Administering Feeding

The second paragraph details the steps for ensuring the NG tube is patent by flushing it with 30 CCs of sterile water before administering the tube feeding. It explains the importance of using a 60 CC syringe for the feeding and the method of administering the feeding by gravity, which involves unclamping the tube and allowing the formula to flow into the stomach. The paragraph also discusses the post-feeding procedure, which includes clamping the tube after use and flushing it again to prevent clogging. The nurse is advised to wait at least 30 minutes to an hour before connecting the patient to suction to avoid drawing out the feeding. The importance of documenting the feeding, assessing the patient for any adverse reactions, and ensuring the patient's comfort and safety by adjusting the bed and setting up the call light is also covered.

10:02

🛏️ Completing the Tube Feeding Process

The final paragraph summarizes the completion of the tube feeding process. It includes the steps of setting alarms, placing the call light and tray table within reach, and ensuring the patient's comfort and safety. The paragraph concludes by emphasizing the importance of these final steps in providing a comprehensive and patient-centered approach to tube feeding.

Keywords

💡Enteral feeding

Enteral feeding refers to the process of providing nutrition directly into the gastrointestinal tract, typically through a tube. In the video, this is the primary focus, as it demonstrates how to administer tube feedings to a patient with a nasogastric (NG) tube. The method is crucial for patients who cannot eat by mouth and need nutritional support.

💡NG tube

NG stands for 'nasogastric,' which is a tube that passes through the nose, down the esophagus, and into the stomach. The NG tube is mentioned as the type of tube used for the patient in the video. It's essential for the demonstration because it's the conduit through which the enteral feeding is administered.

💡Salem pump tube

A Salem pump tube is a type of enteral feeding tube that can be used for both medication administration and tube feedings. In the script, it's noted that while the demonstration uses a Salem pump tube, the techniques shown can be applied to other types of tubes as well, emphasizing the versatility of the procedure.

💡Verification of placement

Verification of placement is a critical step before administering enteral feedings to ensure the NG tube is correctly positioned in the stomach. The video mentions pH testing and measuring the tube as methods to verify its placement. This step is essential to prevent complications such as aspiration or incorrect delivery of nutrients.

💡Gastrointestinal assessment

Gastrointestinal assessment involves checking the patient's bowel sounds, lung sounds, and any signs of discomfort like bloating or cramping. This assessment is highlighted in the video as a necessary precursor to tube feeding to ensure the patient's gastrointestinal system is ready to receive the feeding.

💡MAR

MAR stands for Medication Administration Record, which is a document used in healthcare settings to record medication and treatment administration. In the script, it's mentioned as part of the process to double-check the tube feeding formula and orders, ensuring accuracy and patient safety.

💡Sterile water

Sterile water is water that has been treated to remove or kill microorganisms, making it safe for medical use. The video script specifies the use of sterile water for flushing the NG tube to maintain its patency. This is important to prevent infection and ensure the tube is clear for feeding.

💡Gravity feeding

Gravity feeding is a method of administering enteral nutrition where the feeding bag is hung above the patient, and the formula flows by gravity into the tube. The video demonstrates this technique, emphasizing its simplicity and effectiveness for short-term tube feedings.

💡Patency

Patency in the context of the video refers to the open and unobstructed state of the NG tube. The script describes flushing the tube with water to ensure it remains patent before and after feeding. Maintaining patency is crucial to prevent blockages and ensure the tube is ready for use.

💡Documentation

Documentation is the process of recording patient care activities, including the administration of tube feedings. The video script mentions documenting the type and amount of feeding, as well as the patient's response. This is a critical aspect of nursing practice to ensure continuity of care and legal accountability.

💡Suction

Suction is a medical procedure that involves the removal of fluids or gases from a body cavity, such as the stomach. The video script advises waiting before connecting the NG tube to suction after feeding to prevent the newly administered nutrients from being removed. This advice is crucial for ensuring the effectiveness of the feeding.

Highlights

Focus on providing enteral feeding to patients with a nasogastric (NG) tube.

Verification of NG tube placement is crucial before feeding.

Use of pH testing or measuring the tube for placement verification.

Marking the tube's position on the patient to ensure consistent placement.

Gastrointestinal assessment before feeding includes listening for bowel sounds and checking for patient discomfort.

Checking the patient's medical orders and verifying the tube feeding formula.

Importance of verifying patient identity and allergies before administering feeding.

Use of a 60 CC syringe for administering feeding to prevent pressure issues.

Preference for sterile water over tap water for tube feeding.

Procedure for flushing the NG tube with 30 CCs of sterile water to ensure patency.

Administering the tube feeding formula by gravity instead of using a pump.

Clamp the tube after administering to prevent backflow.

Post-feeding, flush the tube again with 30 CCs of sterile water to maintain patency.

Wait at least 30 minutes to an hour before connecting the patient to suction after feeding.

Documenting the tube feeding process, including amount, type, and patient's response.

Ensuring patient comfort and safety by adjusting the bed, setting alarms, and providing a call light.

Transcripts

- All right.

So this skill is going to be focusing on how to provide a

patient with enteral feeding.

This particular patient has a NG tube in,

and this, as you can see, is a Salem Salem pump tube,

but it can be utilized for tube feedings as well,

especially when the tube feeding is short term.

So just a few,

few pieces of information regarding a NG tube.

First of all, when a patient has an NG tube,

before you are going to put anything into that tube,

you have to make sure that it is still in the correct spot.

So NG means that it goes through the narrows into the

stomach.

So you want to make sure that it's staying in the stomach.

There's a couple of ways that you can verify placement,

and that would be per your facility's policy.

That would either be by doing pH testing.

And that that's one way of doing it.

The other way that you can do it is by measuring the tube.

So once it's been verified that it's in the stomach using a

X-ray,

then you would go ahead and mark at the tube

where right up to the nearest, where it's inserted

and measure that.

So you would go ahead and measure how long the tube is

coming out of the nose to the end.

And then you would document that in the patient's chart.

So that each time a nurse goes in to put something

in the tube, they can measure it to make sure that

measurement stays consistent so that we know that the

tube hasn't moved.

All right. We also,

before we want to put anything in the tube is we want to do

a gastrointestinal assessment.

So that would include making sure that you listen to the

lung,

listen to the bowel sounds and make sure that those are

present.

You also want to ask the patient if they're having any

bloating or cramping or maybe diarrhea.

And then the other thing you want to do is make sure that

you're looking at their,

the nose and making sure that they're not swollen.

Everything looks patent

or if they're not having a lot of discomfort.

All right. So when we're going to give,

to feeding through an NG tube,

obviously you want to make sure that you check the

provider's orders and you want to make sure that you have

the correct tube feeding formula and that you would do the

same as you with any medication you would double check with

your MAR and make sure you do your checks.

And then if you,

when you come into the patient's room and you're ready to

give them the tube feeding,

you also want to make sure that you check their ID to make

sure that you verify their name and date of birth,

and also any allergies that they might have.

Okay.

All right. So now I think we're going to begin.

So I have all my equipment here.

It's good practice to have some type of either a towel or a,

an observable pad to put underneath

where you're going to be giving the, the feeding.

So you want to make sure that, you know,

if you're doing it this way,

that you have the pad under there for our purposes,

we're going to be doing this via kind of a simulated way,

because we don't want the mannequin to the mannequin isn't

capable of taking in tube feeding

So we're going to use this as our simulation here.

All right.

Okay. So we have all that.

And then we're going to have a 60 CC LULAC syringe,

not LULAC I'm sorry, which is regular CC 60 CC syringe.

And it should be that large.

You don't want any smaller syringes,

just stick with the 60 CC because of the pressures,

pressure gradients.

You also want to check your policy as far as using tap water

versus sterile water.

I'm using sterile water.

And also you might want to have a clamp to put into your

tube feeding if you don't have one and your measuring tape

before you come into the room. Okay.

So now I'm going to go ahead,

wash my hands again quick and put my gloves on

because I verified placement.

And so the tube is actually in the right place.

It's in the stomach.

I've already done my GI assessment and asked my patient

questions regarding that.

I'm going to be providing the tube feeding formula

via gravity.

You will also know that we have,

pumps, tube feeding pumps that we can use that are similar

IV pumps that actually pumped the fluid in

whoever I'm going to do this by gravity.

All right. So we wanna make sure that our tube is patent.

So that means that we want to

draw up 30 CCS of water and

inject that into the tube to make sure that it's open and

usable before we put the tube feeding in

and your sterile water,

you just want to make sure it's not expired.

And it shouldn't be open for more than 24 hours.

Always label when you open it,

the date and the time so that you can keep it under that

24 hours or under.

All right.

So I basically just filled up the medicine cup with 30 CCS

of water.

(paper Crinkling)

You may see that there are specific containers that you can

use to, to put your sterile water in,

instead of drawing it right out of the container,

you probably don't want to do that all.

So alright, What we're going to do, retract myself here.

We're going to take the plunger, just show you that,

make sure it's nice and flexible there.

And we're going to go ahead

and draw up our 30 CCS and there might be some air in there.

You can just push that air out.

So you don't want to give the patient too much air.

Alright?

And then I'm going to take out this little clamp thing here

so that I can go ahead and check for patency.

So basically I'm just flushing the tube with

the sterile water to make sure that it's fluent

so I can put my tube feeding in there.

And so after you put something in,

you always want to clamp it afterwards so that it doesn't

back full, back out.

So always clamp after you're done. Now,

the next thing I'm going to do is I've checked and did all

my checks on my formula.

And I noticed that when I'm going to have

to give this patient is basically this,

60 CCS of this,

per my order,

And I'm going to do this by gravity.

So I'm going to take out the plunger since I'm doing it by

gravity, keeping it clamped.

You're tubing clamped.

You're going to go ahead and put this syringe right onto the

tubing.

Okay.

And I'm not sure how this is going to work for me here real

well here, but I'm going to go ahead and

excuse me,

I'm just going to grab this here real quick and I'll measure

the amount on my syringe to be most accurate.

(water glugging)

Okay.

So basically you're just going to pour that in it's it's not

on, let's just say it's still clamped.

Okay. So then when you're ready to go in you, unclamp it.

And I put the 60 CC zen

and I'm just basically

administering it by gravity and it'll go into the stomach

that way versus being pumped through with a pump.

Okay. When that goes in, I'm going to clamp it.

So you would clamp it, take this off,

and then I'd have to flush it one more time after I'm done

giving the feeding to keep the tube patent.

Just put this over here,

and then I'm going to go ahead and flush it with 30 more

CCS.

So always flush before and after you're administering

anything.

That's I got my 30 CCS there.

Okay. And then I can also flush by gravity as well,

so I initially did it.

I did it by force by pushing it in,

but you can also flush with gravity as well.

Some of the flushes may 30 CCS

and let that go through.

Okay. So now the flush is completed.

So I'm done with that.

So you want to make sure it's clamped.

Okay.

And now the patient's just had their tube feeding.

If this patient was hooked up to suction,

cause you can also add this to suction it,

this type of NG tube,

you would want to wait at least 30 minutes to an hour before

you hook that up to suction.

'Cause otherwise it'll just suck all that food

that you just gave.

So once I'm done with that, I'm going to again,

ask the patient if they're having any cramping or feeling

bloating and document that I administered, the tube feeding,

how much was administered, what type,

make sure that that's all documented correctly.

I'm going to ask the patient if they have any questions and

I'm going to lock and lower the bed,

I'm going to put the alarms on if needed.

And I'm going to put the call light by the patient and the

tray table.

And then that concludes the tube feeding by gravity.