tube feeding policy and procedure

This usually depends on the condition and confidence with the tube feeding process. The NG tube is placed through the nose, down the oesophagus and into the stomach, whereas the NJ tube is placed through the nose, down the oesophagus, through the stomach and into the small intestine (jejunum). %PDF-1.7 A percutaneous endoscopic gastrostomy (PEG) is a procedure for placing a feeding tube directly into the stomach through a small incision in the abdominal wall using an instrument known as an endoscope. Enteral feeding is a method of supplying nutrients directly into the gastrointestinal tract. or jejunostomy tube contact the medical team immediately.. If very small rates are required, consider using frequent syringe bolus feeding techniques as an alternative.. That you are a healthcare professional and are following the appropriate guidance in your country. note: in most situations an IV syringe pump is not recommended for administration of enteral feeds and should not be used on the ward. A feeding tube ostomy procedure may be done 3 main ways: Image-guided Surgical Endoscopic The type of procedure will depend on several factors including hospital resources, medical team expertise, patient health factors, and whether the patient is having other procedures or surgery. Taylor, S., 2013, Confirming nasogastric feeding tube position versus the need to feed, Intensive and Critical Care Nursing, 29, pg 59-69. Discuss with senior nursing staff or medical staff. Policies & Procedures: Enteral Tube Feeding -Adult I.D. %%EOF EFFECTIVE DATE : June 30, 2020 . 1. Contact the medical team and/or Gastroenterology Clinical Nurse Consultant to review. Please note: patients who have a history of Liver Failure and known/or suspected oesophageal varices should not have a gastric aspirate removed from the NGT. They may be removed from the fridge 15-20 minutes prior to administration to bring it to room temperature and should not hung for longer than 4 hours use the dose limit function on the feed pump to ensure this occurs.. The content in this section is only intended for healthcare professionals. However in shorter tubes 1.5mls would be sufficient).. SCOPE X Professional _ Facility DESCRIPTION Enteral Nutrition is commonly defined as the provision of nutritional requirements through a tube in the stomach Lippincott's Nursing Procedures Lippincott 2013-01-21 Lippincott's Nursing Procedures, 6e, is start-to-finish guide to more than 400 nursing The method selected is dependent of the nature of the feed and clinical status of the child. Remove and replace the tube. Keep the tube in place by taping it to the skin until a plan for re-insertion can be made. High acuity and intensive care patients may require management of Gastric Residual Volumes (GRV) to assist in management of gastric emptying delays, feeding intolerance, electrolyte balance and patient comfort. 775 0 obj <> endobj For children who have enteral feeding regimes at home: Speak with the family and child to establish normal feeding regimes and where possible, considering the reason for admission and clinical condition of the child, continue this regime in hospital, Ensure the medical team/dietitian have ordered the childs home feeding regime, Formula can be ordered from the Formula Room, Discuss feeding options with the family if the infant is usually breast fed, but cannot continue whilst hospitalised. Prior to, in-between and after medications, Modify flush volumes throughout as needed for infants and children with fluid restrictions these patients may require minimal volume (0.5mL) flushing and/or flushing with air to push feed or medication to the end of the tube, Tap water is suitable for most children with OGT or NGT, Boiled/sterile water may be necessary for children under 6 months of age or as clinically indicated e.g. Elevate the head of the bed to a 30 - 45 degree angle during enteral feeding and for 30-60 minutes after completion. Medication administration via enteral tubes: a survey of nurses practices, Journal of Advanced Nursing, 67(12), 2586-2592. Port. You or the person you care for may take mild pain killers to control the pain, as advised by the healthcare team. If the patient is receiving a medication which is known to alter pH readings notify medical team, pharmacy and senior nursing staff, a clear plan for confirming the tubes position should be documented in the progress notes. Radiology guided: The gastrostomy tube can be inserted using x-rays to place the feeding tube into the stomach. Note: The MIC-KEY* feeding tube does not require a dressing. hYmo9+bXK_rE!7Msb7PP$E# hBjCc28at-B]R`iTkF#$fPZiAA. You can go out to restaurants with friends, have sex, and exercise. A feeding tube can remain in place as long as you need it. Some people stay on one for life. Tubes can deliver food in different ways. Some use a pump or syringe to push the food, while others rely on gravity. Metropolitan working party: 2007,' Enteral tubes: Enteral feeding management best practice'. The site of the gastrostomy/jejunostomy may look a little red and ooze a bit, but this will settle down a few days after the operation. NO. Tube placement for feeding should optimally be performed during daytime hours when care can be escalated to more senior personnel if attempts are unsuccessful or complications Remove the protective cap from the end of the giving set and open the roller clamp, allowing the feed to run down to the end of the giving set (to prime the line), then close the roller clamp. Remove the plunger from the syringe and place the tip of the syringe into the enteral tube connector at end of the enteral tube. endstream endobj startxref POLICY AND PROCEDURE. % If reading greater than 5, cease the feed for Confirm that the enteral feeding tube is the intended route for a medication before administration. Pediatric enteric feeding techniques: insertion, maintenance, and management of problems, Cardiovascular Intervention Radiology, 33, pg 1101-1110. endstream endobj startxref Wiley-Blackwell : West Sussex, United Kingdom. gravity feeding for bolus, intermittent feeds and continuous feeds. 3 11. Enteral Feeding and Medication Administration. Using only one feeding set per RTH container helps control the introduction of microbes from touch contamination. Gastrostomy tubes should be reinserted and taped into position if the balloon has burst. Please note this guideline does not refer to the management of Jejunal tubes, for information regarding care of these please see the Stoma site = an opening from the outside of the body through the skin where the feeding tube enters into the stomach or the small intestine (jejunum). endstream endobj 776 0 obj <>/Metadata 38 0 R/Outlines 52 0 R/PageLayout/OneColumn/Pages 771 0 R/StructTreeRoot 173 0 R/Type/Catalog>> endobj 777 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 778 0 obj <>stream Description. Link to Consult your ward pharmacist or call Medicines Information (ext: 55208) for advice on how to prepare a drug for enteral administration. hb```\B ce`a054cJG;5JLM' Zj=,ELdR?o1=a)^oj 8.1|TWx@b`}xf .< + When to Call the DoctorFlush the tube with warm water.Flush the tube with 50 ml of water after each feeding to remove excess sticky formula, which can clog the tube.When possible, use liquid forms of medications. Otherwise, crush well. File Type Enteral Nutrition Policy and Procedure 57.50 (ex VAT) This policy assists the residential home in the management and delivery of care for residents with Percutaneous Endoscopic Gastronomy (PEG) tubes used for nutritional supplementation, fluid replacement, and/or medication administration. Turgay, A S., & Khorshid, L. 2010. Nurses who are preparing and administrating medication via an enteral tube must adhere to theMedication Management Procedure.. Enteral feeding pumps can be obtained via CARPS if the ward area does not have its own supply. Tube feeding is now legally regarded as medical treatment. Feeds and medications should only be administered via a TAT tube at the direction of the treating medical team.. Viscous liquid medications may require dilution to prevent clogging of the enteral tube., If a liquid formulation is not available consult a pharmacist to confirm if the tablet form can be crushed to a fine powder and then dispersed in water, or whether a capsules can be opened to disperse the contents in water., Do not crush enteric coated or sustained/controlled release medications., Interaction between gastric acid, formula and medications, Interactions between medications if tube is not flushed between medications, Inappropriately prepared medications e.g. Remove the cap from the distal end of the tubing. Observe and document the position marker on NGT/OGT compare to initial measurements. Published December 2017., 50 Flemington Road Parkville Victoria 3052 Australia, Site Map | Copyright | Terms and Conditions, A great children's hospital, leading the way, Nasogastric and Orogastric Tube Insertion policy, P&P: Standard Precautions Infection Control, Nasogastric and Orogastric Tube Insertion procedure, High Flow Nasal Prong (HFNP) therapy clinical guideline, Enteral Nutrition for Preterm Infants guideline, Breastfeeding support and promotion clinical guideline, Nasogastric and Orogastric Tube Insertion Procedure, Enteral Feeding and Medication Administration, Facial or oesophageal structural abnormalities, Administer bolus, intermittent feeds and continuous feeds, Facilitate free drainage and aspiration of the stomach contents, Facilitate venting/decompression of the stomach. Enteral feeding refers to the delivery of a nutritionally complete feed via an enteral tube directly into the stomach, duodenum or jejunum and includes nasogastric tubes (NGT), nasojejunal tubes (NJTs), percutaneous endoscopic gastrostomies (PEGs), and percutaneous endoscopic jejunostomies (PEJs). Signs the child is not tolerating feeds include: Nasogastric tube dislodgment or accidental removal consider ongoing nutritional needs and clinical status of the child and in consultation with senior nursing staff, medical team and/or dietician decide if tube should be replaced. Enteral feeding or administration of medication may proceed in this case dependent on the individual childs condition, The tube may be clamped for 30 minutes to an hour post administration to prevent loss of feed or medication, Continuous venting may be facilitated following administration by securing the distal end of the tube above the head of the child. The position of the tube needs to be checked 4 hourly with change of feeds It is recommended that the feed be ceased, withdraw aspirate and test pH. The provision of nutrition through nasogastric or gastrostomy feeding tubes is not part of basic care according to several recent court decisions. disclaimer. hbbd```b``3@$ ~&c@$60VfHF]`q~0[,"g I 6?d\Q ,Rv)XLI b&j)@  Clean the MIC-KEY* tube's feeding port after feeding. If a reading greater than 5 is obtained, placement of the tube is questionable and it should not be used until the position of the tube is confirmed. The surgeon will make an opening into the stomach or small intestine (jejunum) and place the feeding tube through the skin into the stomach or jejunum. Open and close the roller clamp until the desired drip rate is set correctly. Further guidance regarding the management and return of GRVs can be located under Use a syringe in the side tap of your feeding tube. The endoscope is inserted through the mouth and down the esophagus, which leads to %PDF-1.5 % %%EOF Blood samples may be taken to check if you're well enough before the operation. Link for insertion of Nasogastric and Orogastric Tube Insertion policy, Nutrition on PICU Guidelines and Jejunal Feeding Guideline. x\YSH~'P Tcb"a"a,v24~3IA:+++/IYiV>>iv/nUVjy|^t~}{>%I4t}`e~x_lyx{`csqFp5]Q>9a_w?euUU9_soM]4v$){n >{IyaFK{zMfiis8My/z4H ,D q[an" ,`tI;Gd_%[;dxa9.9:QU#9Gskn57_{-^gi0:=gk% u?K8D~p_^`psB\J" Ew>d9T^H+aRm/_ >C%=W=],\P'WzeCQZ.OOS\UF+-lNWWZ^iy9rT]V v7*(TLmN:OMG"MG&XW"8,I. Datford and Gravesham, ' Paediatric enteral feeding guidelines & operational policy (infants & children)', Jan 2007, NHS Trust. 2. The following needs to be checked 2 hourly during the feed: Other assessment considerations for the child receiving enteral feeds. You or the person you care for will be discharged home when feeding is established and well tolerated. This would be appropriate for all infants and older children who experience discomfort with cooler feeds. care information, essential policies and procedures, and vital regulatory and safety requirements. Clean skin around the feeding tube stoma daily. If a child belches immediately following air insufflation, the tip of the tube may be in the oesophagus. endstream endobj 226 0 obj <. This This medical policy is solely for guiding medical necessity and explaining correct procedure reporting used to assist in making coverage decisions and administering benefits. Tube feeding is As a guide, 20 drops of standard feed is approximately 1ml. To unblock enteral tubes, flush the tube in a pulsating manner (push/pull) with 10-20ml with warm water, if it is safe to do so taking into account the childs age, size and clinical status. Oral Nutrition for Adults (age >21): Intensive and Critical Care Nursing, 25, pg 258-267. This may be attached to the end of a 5 or 10mL enteral/oral syringe with the plunger removed to create a reservoir should gastric contents reflux. Gastrostomy Tube Feeding - Slow Drip/Continuous Method with Residual Check. Evidence Table - Use a cotton-tip applicator . High Flow Nasal Prong (HFNP) therapy clinical guideline. Endoscopy: The gastrostomy tube can be inserted using an endoscope. OR If a member utilizes an enteral tube and oral feedings then utilize the route that is the more prominent source of nutrition (>/= 70% of caloric need). short-term methods (<3 months) of enteral tube feedings include nasogastric, nasoduodenal or nasojejunal tubes. For information regarding the Jejunal feeding and medication administration please see the After the procedure you will be given advice by the healthcare team and they will explain how long you or the person you care for might have to stay in hospital. Use the following equation or the table below to calculate the drip rate: (ml/hour) /3 = drops/minute. Turn off enteral feeding 1 hour before the individual needs to be repositioned at less than 30 degrees. The position of the NG and NJ tube must be confirmed before tube feeding can commence. The tube must be flushed with water (air in neonates) to prevent tube from blocking (see above). It is recommended that flushing occur BEFORE, DURING and AFTER administration of enteral medications and feeds. There is limited evidence available to support one method of feeding over the other. Before tube feeding can begin, the tube has to be placed. Phillips, N M., & Endacott, R., 2011. dressing to remain in contact with the skin. Open the roller clamp and set the flow rate by counting the drops per minute. 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