How to administer enteral feeding tubes: A comprehensive guide for caregivers

According to StatPearls, enteral nutrition is the preferred route for feeding critically ill patients who cannot swallow, providing key benefits like reduced infection risk compared to parenteral feeding. This guide will explain how to administer enteral feeding tubes safely, effectively, and with confidence.

Quick Summary

This article provides a comprehensive overview for caregivers on administering enteral feeding tubes. It details the various types of tubes and feeding methods, outlines step-by-step procedures for administering formula and medication, and explains how to prevent common complications.

Key Points

• Verify Placement Before Every Use: Always check the tube's position before administering feed, medication, or water to prevent life-threatening aspiration, especially with NG tubes.

• Maintain Strict Hygiene: Wash hands and equipment thoroughly to prevent bacterial contamination, which can lead to infection and gastrointestinal issues like diarrhea.

• Position Patient Upright: Elevate the patient's head to at least 30-45 degrees during feeding and for 30-60 minutes after to reduce the risk of reflux and aspiration pneumonia.

• Flush Regularly to Prevent Clogs: Flush the feeding tube with lukewarm water before and after every feed and medication administration to maintain patency.

• Handle Medications Separately: Administer each medication individually, flushing the tube between doses to avoid interactions and blockages.

• Know Emergency Procedures: Understand how to manage tube dislodgement or severe complications and when to seek immediate medical attention.

Understanding Enteral Feeding Tubes

Enteral feeding, or tube feeding, is the delivery of nutritional support directly into the gastrointestinal tract using a specialized tube. It is necessary for individuals who are unable to consume sufficient nutrition orally due to various medical conditions, such as stroke, head and neck cancers, or neurological disorders. There are several types of feeding tubes, categorized primarily by their insertion location and intended duration of use.

Types of Feeding Tubes

• Nasogastric (NG) Tube: A flexible tube inserted through the nose, down the esophagus, and into the stomach. It is typically used for short-term feeding, generally less than four to six weeks.
• Nasojejunal (NJ) Tube: Similar to an NG tube, but it extends further past the stomach into the jejunum, a part of the small intestine. This is used for patients who cannot tolerate feedings in the stomach.
• Gastrostomy (G-Tube or PEG Tube): Surgically or endoscopically inserted directly into the stomach through the abdominal wall. These are intended for long-term feeding needs, offering more comfort and stability than nasal tubes.
• Jejunostomy (J-Tube or PEJ Tube): A tube placed directly into the jejunum through the abdominal wall, bypassing the stomach completely. It is used when the stomach is not functioning correctly.

Administering Enteral Feeding: A Step-by-Step Guide

Proper technique is crucial for preventing complications like aspiration and infection. Always follow the specific feeding regimen prescribed by a healthcare provider.

Preparation

1. Gather Supplies: Ensure you have the correct feeding formula, feeding bag and tubing, pump (if needed), a 60ml syringe, and lukewarm water for flushing.
2. Hand Hygiene: Wash your hands thoroughly with soap and water before handling any equipment or feed.
3. Patient Positioning: Position the patient upright, or with their head elevated at least 30 to 45 degrees, during the feed and for 30 to 60 minutes afterward to minimize aspiration risk.
4. Check Tube Placement: For NG tubes, verify placement before each feeding by checking the tube's external marking and testing the pH of aspirated gastric contents, which should be below 5.5. Always follow agency policy.
5. Prepare the Feed: Check the formula's expiration date. Shake the formula well before use. If using a feeding bag, fill it with no more than 8 hours' worth of formula (4 hours for powdered formula) to reduce bacterial growth.

Procedure for Feeding

1. Flush the Tube: Connect a syringe filled with the prescribed amount of lukewarm water to the feeding tube and flush it. This clears the tube and prevents blockages.
2. Administer the Feed: The method depends on the type of feeding ordered by the healthcare provider.
   • Bolus Feeding (using a syringe): Remove the plunger from the syringe and attach the barrel to the feeding tube. Pour the prescribed amount of formula into the syringe and allow it to flow by gravity. Adjust the syringe height to control the flow rate.
   • Continuous or Intermittent Feeding (using a pump): Connect the feeding bag and tubing to the pump and set the prescribed flow rate. Connect the end of the tubing to the feeding tube.
3. Post-Feed Flush: After the feeding is complete, flush the tube again with the prescribed amount of lukewarm water.
4. Clean Up: Disconnect and clean all equipment according to manufacturer and healthcare provider instructions.

Comparison of Feeding Methods

Feature	Bolus Feeding	Continuous Feeding
Administration Method	Syringe or gravity drip	Infusion pump delivering a consistent rate
Infusion Time	5-15 minutes, multiple times daily	Typically 24 hours per day
Best For	Stomach feeding, mimicking meal patterns	Small intestinal feeding, or patients with poor gastric emptying
Risk of Aspiration	Higher, especially if administered too quickly	Lower, due to slower, more controlled rate
Advantages	Offers greater patient mobility and mimics natural eating patterns	Allows for constant, gradual nutrient delivery and better tolerance
Disadvantages	Can cause bloating, nausea, and reflux if too large a volume is given	Limits patient mobility and can increase risk of bacterial contamination if not changed frequently

Administering Medications Through the Feeding Tube

Medications should never be mixed with formula. Always consult a pharmacist or doctor before altering any medication for tube administration.

Procedure for Medications

1. Prepare Medications: Whenever possible, use liquid medications. If using tablets, crush them into a fine powder and dissolve in lukewarm water. Never crush enteric-coated, sublingual, or extended-release tablets.
2. Stop the Feed: If a continuous feed is running, pause it before administering medication.
3. Flush: Flush the tube with 15-30 mL of lukewarm water.
4. Administer Separately: Give each medication separately, flushing with water between each one to prevent interactions and clogging.
5. Final Flush: Complete the process with a final flush of water.
6. Resume Feed: Restart the feed after the final flush. Some medications may require a pause in feeding for a specific duration; always follow professional advice.

Preventing and Managing Common Complications

Careful attention to detail can prevent many common problems associated with enteral feeding.

Tube Clogs

• Prevention: Flush the tube with lukewarm water before and after every feeding and medication dose. Flush unused tubes daily.
• Remedy: If a clog occurs, use a syringe to gently push and pull lukewarm water through the tube. Avoid excessive force. If unsuccessful, consult a healthcare provider for a tube declogging kit or further instructions.

Aspiration

• Prevention: Maintain proper patient positioning (elevated head) during and after feeding. Monitor for signs of feeding intolerance.
• Signs: Symptoms include coughing, gagging, or signs of respiratory distress during feeding.

Skin Irritation and Infection

• Prevention: Keep the insertion site clean and dry. Wash daily with mild soap and water, and report any redness, swelling, or unusual drainage to a healthcare provider.
• Causes: Pressure from the tube, leakage of gastric contents, or poor hygiene.

Tube Dislodgement

• Prevention: Secure the tube properly to prevent accidental pulling. Check tube marking regularly to ensure it hasn't moved.
• Action: If a tube is dislodged, especially a new gastrostomy tube (less than 6-8 weeks old), seek immediate medical attention. Never attempt to reinsert without proper training.

Conclusion

Administering enteral feeding tubes is a critical task that requires meticulous attention to detail and adherence to safe practices. By understanding the different types of tubes, following the correct administration procedures for both food and medication, and actively preventing common complications, caregivers can ensure the patient receives the necessary nutrition safely. Regular communication with healthcare professionals is key to managing any issues that arise and ensuring the patient's nutritional needs are met. For more detailed information on preventing tube complications, see this resource from the NIH: Gastroenteric tube feeding: Techniques, problems and solutions.

Frequently Asked Questions

What is the difference between continuous and bolus feeding?

Continuous feeding uses a pump to deliver a slow, consistent rate of formula over a long period (e.g., 24 hours). Bolus feeding involves administering a larger volume of formula over a shorter time (e.g., 5-15 minutes) using a syringe or gravity drip, mimicking a meal schedule.

How often should I flush the enteral feeding tube?

You should flush the feeding tube with lukewarm water before and after every feeding, before and after every medication dose, and every four to six hours if the patient is on a continuous feed.

Can I crush any pill to give it through the feeding tube?

No. You must never crush enteric-coated, sustained-release (SR), extended-release (XR), or sublingual tablets. Always consult a pharmacist or doctor to determine the appropriate preparation method for each medication.

What should I do if the feeding tube becomes clogged?

First, try to gently flush the tube with lukewarm water using a 60ml syringe with a push-pull motion. If this does not work, do not use excessive force or insert objects. Contact a healthcare provider for assistance, as special declogging kits may be necessary.

What are the signs of a tube feeding complication?

Watch for signs like coughing, gagging, or difficulty breathing during feeding (aspiration), nausea, vomiting, or bloating (intolerance), redness, swelling, or drainage at the insertion site (infection), and diarrhea or constipation.

How do I check for proper tube placement before feeding?

For NG tubes, placement is confirmed by checking the tube's external marking and, if instructed, by aspirating gastric contents and testing the pH level, which should be acidic (below 5.5). For G- and J-tubes, ensure the external bumper is secure and the tube has not moved.

How should I clean the skin around a gastrostomy (G-tube) site?

Clean the skin around the tube site daily with mild soap and warm water. Pat the area dry thoroughly to prevent bacterial growth. Monitor for any signs of infection like redness, swelling, or unusual discharge.