62

ENTERAL FEEDING

SKILL 24 ADMINISTRATION OF A BOLUS

FEEDING (NG, NJ,
GASTROSTOMY)

SKILL 25 ADMINISTRATION OF NG, NJ,

AND GASTROSTOMY
CONTINUOUS FEEDING

EQUIPMENT
Formula
Water
Catheter tip syringe
Gloves, nonsterile

PROCEDURE

1. Check order for type, amount, and frequency of feed-

ing.

2. Gather equipment. Promotes organization and effi-

ciency.

3. Explain procedure to child and family. Enhances cooper-

ation and participation and reduces anxiety and fear.

4. Wash hands. Reduces transmission of microorganisms.
5. Warm formula to room temperature. Promotes comfort.
6. Position child on right side or supine with head ele-

vated. Have assistant hold/comfort child as necessary.
Reduces risk of reflux or vomiting.

7. Put on nonsterile gloves. Protects from contact with

body fluids.

8. Check placement of tube as appropriate for type of

tube. Tube could have moved since last feeding.
a. For nasogastric tube check placement as described

earlier.

b. For a nasojejunal tube check placement by measur-

ing length of tube from nose to tube hub. This dis-
tance should have been recorded in the chart at the
time of verification of placement and checked on a
regular basis after verification.

c. Placement check not needed for gastrostomy tubes.

9. Check for residual if indicated. Attach syringe and pull

back on plunger. Note amount and character of residual.

10. Return residual to child and flush tube. Prevents elec-

trolyte imbalance.

NOTE: If residual greater than

1

/

2

the amount of the

previous feeding notify the physician. For neonates
notify physician if residual exceeds 20% of previous
feeding or more than 2 cc/Kg. Prevents distention of
the stomach with possible reflux or vomiting.

11. Attach empty syringe. Keep the tubing pinched.

Prevents air from entering the stomach.

12. Flush tube. Assesses patency and flow in the tube.

a. Neonates or fluid restricted children flush with 1–2

cc water or air.

b. Other children flush with 5–10 cc of water.

13. Add feeding to syringe and administer feeding. Control

rate of feeding by raising or lowering the syringe. Too
rapid feeding may cause vomiting.

NOTE: The length of feeding should be similar to that
of oral feeding, not less than 20 minutes. May take
30–60 minutes.

NOTE: With a gastrostomy tube hold straight up from
insertion site. Puts less stress on the tube.

14. Following administration of feeding, flush tube with

water. Prevents tube from becoming clogged.
a. Neonate or fluid restricted children flush with 1–2 cc

of water or air. If flushing with air and feeding gets
sluggish consider flushing with water.

b. Other children flush with 10–15 cc of water.

15. Remove syringe and rinse after each feeding. Syringe

may be used for 12 hours before being discarded.
Reduces risk of contamination.

16. Remove gloves. Wash hands. Reduces transmission of

microorganisms.

DOCUMENTATION

1. Check for residual.
2. Amount of residual.
3. Time of feeding.
4. Type and amount of formula.
5. How procedure tolerated.

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Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.

SKILL 24

SKILL 24

Administration of a Bolus Feeding (NG, NJ,
Gastrostomy)