The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [276]
Displacement of tube
A tube can accidentally be pulled out, particularly if a patient is restless or distressed. It can also be coughed or vomited out of place. In this situation it is advised that the position of the tube should be checked. If it is not possible to confirm that the nasogastric tube remains within the stomach then it should be removed and a new tube placed (NPSA 2005).
Administration of enteral tube feed
Preprocedural considerations
Prior to using enteral feeding tubes for medication or feed administration, it is vital to know where in the gastrointestinal tract the tube tip lies. This may be difficult in patients who have tubes placed in other organs or where there is little visible difference externally between gastrostomy, gastrojejunostomy or jejunostomy tubes. Where available, the tube size, type, insertion date and method should be clearly documented. If this information is unavailable, the tube should be aspirated and the pH used to differentiate between gastric or small bowel placement. If there are sutures securing the external fixator to the patient’s abdomen, these should not be removed until it has been confirmed that they are not required to keep the tube in position.
Procedure guideline 8.12 Enteral feeding tubes: administration of feed
Essential equipment Optional equipment
50 mL enteral or catheter-tipped syringe
Commercial ready-to-hang feed
Tap water or sterile water (for jejunostomy tubes or for patients who are immunosuppressed) (NICE 2003). Water should be fresh and kept covered
Preprocedure
Action Rationale
1 Explain and discuss the procedure with the patient.
To ensure that the patient understands the procedure and gives their valid consent (NMC 2008b, C).
Procedure
2 Check the date on the feed container.
To ensure that the feed has not passed its expiry date. E
3 Shake the feed container gently.
To ensure the feed is evenly dispersed therefore reducing the risk of blocking the giving set. E
4 Take a new giving set from a sealed package and ensure that the roller clamp/tap is closed.
To avoid accidental spillage of feed from end of administration set. E
5 Screw the giving set tightly onto the feed container.
In order to pierce the seal on the container and maintain a sealed system (Matlow et al. 2006, C).
6 Hang the container upside down from the hook on a drip stand.
To avoid backflow of intestinal contents into the feed container (Matlow et al. 2006, C).
7 Open the roller clamp/tap and prime the feed to the end of the giving set. (Follow instructions for individual pump.)
This ensures that air is not fed into the stomach when feeding commences. E
8 Feed the giving set into the pump as directed by the manufacturer’s instructions.
To connect the giving set to the pump device. E
9 Set the rate of the feed as directed by the manufacturer’s instructions and according to the patient’s feeding regimen.
To ensure the correct rate of feed is administered. E
10 Set the dose of the feed as directed by the manufacturer’s instructions and according to the patient’s feeding regimen.
To ensure that the correct dose of feed is administered. E
11 Flush the feeding tube with a minimum of 30 mL of water or sterile water in an enteral syringe by attaching to the end of the feeding tube. Depress the plunger on the syringe slowly.
To ensure the patency of the feeding tube (BAPEN 2003b, C).
12 Remove the end cover from the giving set and connect to the feeding tube.
To ensure that the feed is delivered via the enteral feeding tube. E
13 Set the rate of the feeding pump and commence administration of feed.
To ensure that the feed is delivered via the enteral feeding tube. E
Postprocedure
14 Document the time that the feed commenced and the rate of administration.
To ensure accurate documentation of nutritional and fluid intake (NMC 2009, C).
15 Dispose of any equipment that is no longer required.
To reduce the chance of equipment being re-used and to reduce cross-contamination with new equipment. E
Problem-solving table 8.4 Prevention