Definition
Feeding through a gastrostomy (G-tube) or jejunostomy (J-tube) is a vital nursing procedure used to deliver nutrition, fluids, and medications directly into the stomach or small intestine when oral intake is not possible or safe.
Purpose
To maintain nutritional status of a patient whose upper GI tract is bypassed.
Articles
- Disposable gavage bag and tubing
- 60 mL syringe
- Stethoscope
- Feed
- Intravenous stand
- Administration set
Procedure
| Nursing Actions | Rationale | |
| 1. | Before procedure Identify patient’s need. | The type and timings of feed need to be planned. |
| 2. | Assess patient for allergies. | Prevents patient from developing localized or systemic allergic responses. |
| 3. | Auscultate for bowel sounds before feeding. | Bowel sounds indicate presence of peristalsis and ability of Gl tract to digest nutrients. |
| 4. | Verify physician’s order for formula, rate, and frequency. | Reduces errors in the feeding process. |
| 5. | Assess gastrostomy site for skin breakdown, irritation or drainage. | Infection, pressure from gastrostomy tube, or drainage of gastric secretions can cause skin breakdown. |
| 6. | Obtain baseline weight and laboratory values. | |
| 7. | During procedure Wash hands. | Prevents cross infection. |
| 8. | Prepare bag and tubing to administer feed: a. Connect tubing and bag. b. Fill bag and tubing with feed. | Administering of feed through tubing prevents excess air entering Gl tract. |
| 9. | Explain procedure to patient. | Proper explanation enables patient to be informed. Informed patient is more cooperative and feels more at ease. |
| 10. | Place patient in Fowler’s position or elevate head of bed 30°. | Elevating the patient’s head helps prevent chances of aspiration. |
| 11. | Check placement of gastric tube. Aspirate gastric secretions and check gastric residual contents. | Presence of gastric contents indicates that the end of tube is in stomach Gastric residual contents determine if gastric emptying is delayed. |
| 12. | Initiate feeding: Bolus or intermittent feeding: Pinch proximal end of gastrostomy tube. Attach syringe to the end of tube and elevate to 18 inches above the patient’s abdomen. Fill syringe with formula. Allow syringe to empty gradually and refill it until prescribed amount has been delivered to the patient. If gavage bag is used, attach bag to the end of the feeding tube and raise, bag 18 inches above patient’s abdomen. Fill bag with prescribed amount of feed, allow bag to empty gradually over 30 minutes. Continuous drip method: Hang gavage bag to IV pole. Connect end of bag to the proximal end of the gastrostomy tube. Connect infusion pump and set rate. | Prevents air from entering the patient’s stomach. Gradual emptying of tube feeding by gravity from a syringe or gavage bag reduces the risk of diarrhoea induced by bolus tube feedings. Continuous feeding method is designed to deliver a prescribed hourly feeding. This method reduces the risk of diarrhea. Patients who receive continuous drip feedings should have residual gastric contents checked every 4 hours. |
| 13. | When tube feedings are not being administered, clamp the proximal end of the feeding tube. | Prevents air from entering the stomach between feedings. |
| 14. | Administer water via feeding tube as ordered, with or between feedings. | Provides patient with source of water to help maintain fluid and electrolyte balance. |
| 15. | Rinse bag and tubing with warm water after bolus feedings. | |
| 16. | Change gastrostomy exit site dressing as needed. Inspect exit site every shift. Clean ostomy site daily with warm water and mild soap. A small gauze dressing may be applied to exit site. | Leakage of gastric drainage may cause irritation and excoriation of skin around feeding tube. |
| 17. | After procedure Dispose off supplies and wash hands. | Reduces transmission of microorganisms. |
| 18. | Evaluate patient’s tolerance of tube feeding. | Tolerance of tube feeding is evaluated by checking the amount of aspirate every 4 hours. |
| 19. | Monitor blood glucose every 6 hours, if hospital policy requires it. | Alerts nurse to patient’s intolerance of glucose. |
| 20. | Monitor intake and output every shift. | Intake and output are indications of fluid balance. |
| 21. | Weigh patient daily. | Weight gain is an indicator of nutritional status. |
| 22. | Observe for changes in laboratory values to normal. | Improving laboratory values or electrolytes indicate return to normal nutritional status. |
| 23. | Observe stoma site for skin integrity. | Gastric secretion can cause injury and necrosis at stoma site. |
| 24. | Record amount and type of feeding, patency of tube, and any untoward effects. | Documents patient’s reaction to therapy and identifies presence of any adverse reactions. |
| 25. | Report to nursing staff, type of feeding, status of gastrostomy tub patient’s tolerance, and adverse effects. | Provides new nursing personnel with status of gastric feeding. Allows new nursing staff to plan for next feeding. |
Special Considerations
- In case of aspiration of feed, suction patient, notify physician, and obtain chest X-ray films. Risk of aspiration may be lessened if head of bed is elevated to 30-45° during feeding and for 1 hour after feeding.
- In case of diarrhea, decrease feeding, review medication, and notify physician.
- In case of nausea and vomiting, notify physician and withhold feeding.
- If bowel sounds are absent, notify physician before initiating feeding.
- Gastrostomy tube is appropriate for long-term use.
- Intermittent feeding is preferred in infants because of possible perforation of stomach and irritation to mucous membrane. Tube feeding should be gradually advanced to prevent diarrhea and gastric intolerance of formula.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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