A Complete Guide on How to Feed a Patient With a Feeding Tube

According to the Cleveland Clinic, a feeding tube is used to provide nutrition when a patient cannot safely chew or swallow due to medical conditions. Learning how to feed a patient with a feeding tube is crucial for caregivers to ensure proper nutrition, hydration, and medication delivery while preventing complications like infection or aspiration.

Quick Summary

This guide outlines the critical procedures for managing enteral nutrition, including preparation, delivery methods, site care, and medication administration through a feeding tube.

Key Points

• Prepare Safely: Always wash hands, check formula expiration, and ensure it's at room temperature before feeding.

• Position Correctly: Elevate the patient's head to at least 30-45 degrees during and for 30-60 minutes after feeding to prevent aspiration.

• Master Bolus Feeding: Use a syringe and gravity for timed feeds, managing the flow rate to prevent discomfort.

• Execute Continuous Feeding: Use an electronic pump for a steady, controlled delivery of nutrition, especially for J-tubes.

• Flush Regularly: Flush the tube with warm water before and after every feed and medication to prevent clogging.

• Manage Medication: Give medications separately, never mixing them with formula, and ensure they are dissolved or in liquid form.

• Recognize Complications: Watch for signs of feed intolerance (nausea, bloating, diarrhea) and know how to address a clogged or dislodged tube.

Preparing for a Feeding Tube Session

Proper preparation is the cornerstone of a safe and successful tube feeding. Before starting, always wash your hands thoroughly with soap and water. Gather all necessary supplies, including the prescribed formula, a feeding syringe or bag, warm water for flushing, and any prescribed medications. Check the formula’s expiration date and confirm it is at room temperature to prevent stomach cramps. For canned formula, clean the top of the can before opening. If using a pump, ensure all connections are secure and the equipment is functioning correctly.

Positioning the Patient

Correct patient positioning is vital to prevent complications such as aspiration, where fluid enters the lungs. The patient should be in an upright or semi-upright position, with their head elevated to at least 30 to 45 degrees. This position should be maintained throughout the feeding and for at least 30 to 60 minutes afterward. If the patient is lying down, use extra pillows or raise the head of the bed. For patients who are mechanically ventilated, healthcare providers must ensure airway protection.

Administering the Feeding

There are two main methods for tube feeding: bolus feeding and continuous feeding. Your doctor or dietitian will determine the appropriate method and schedule based on the patient's nutritional needs and tube type.

Bolus Feeding

Bolus feeding involves delivering a specific amount of formula several times a day using a syringe or gravity bag, mimicking mealtime. It is typically used for G-tubes (gastrostomy tubes) placed directly into the stomach.

Steps for bolus feeding:

1. Wash your hands and gather supplies.
2. Position the patient correctly.
3. Flush the tube with the prescribed amount of warm water before starting the feed.
4. Remove the plunger from the feeding syringe and connect it to the feeding tube port.
5. Pour the formula into the syringe, filling it halfway.
6. Hold the syringe high and allow gravity to let the formula flow slowly into the tube. If it flows too fast, lower the syringe. If it's too slow, gently push the plunger, but avoid forcing the feed.
7. Continue until the prescribed amount is administered, refilling the syringe as needed.
8. Flush the tube again with warm water to clear it completely.
9. Clamp the tube, disconnect the syringe, and close the feeding port.
10. Ensure the patient remains upright for 30-60 minutes post-feed.

Continuous Feeding

Continuous feeding involves a steady, slow flow of formula over a longer period, often using an electronic pump. This method is common for jejunostomy tubes (J-tubes), which deliver nutrition directly to the small intestine.

Steps for continuous feeding:

1. Wash your hands and prepare the formula bag according to instructions.
2. Connect the bag to the feeding pump and set the prescribed rate and duration.
3. Flush the tube with water before starting the feed.
4. Connect the pump's tubing to the feeding tube and start the pump.
5. Regularly check the pump and the patient for any issues.
6. After the feeding is complete, flush the tube with water and disconnect the tubing.

Comparison of Bolus vs. Continuous Feeding

Feature	Bolus Feeding	Continuous Feeding
Delivery Method	Syringe or gravity bag	Electronic pump
Duration	Several small feeds daily	Constant, slow infusion over many hours
Best For	Stomach (G-tubes)	Small intestine (J-tubes), better for digestion issues
Advantages	Mimics natural eating patterns, more mobility	Better tolerance, reduces nausea/diarrhea
Disadvantages	Can cause bloating if administered too quickly	Requires specialized equipment, less mobility

Administering Medications Through the Tube

Medications can be given via the feeding tube but must be prepared and administered correctly to prevent clogging and ensure effectiveness.

Guidelines for medication administration:

• Do not mix medications with formula. This can cause clogs or reduce the drug's effectiveness.
• Use liquid medication when possible. If not available, crush tablets into a fine powder and dissolve them in warm water. Never crush sustained-release or enteric-coated medications.
• Administer each medication separately. Flush the tube with 15-30 mL of water between each dose.
• Pause continuous feeding when administering medication, then restart after flushing.

Troubleshooting Common Problems

Clogged Tube

Prevention: Regular flushing with warm water is the best prevention. To clear a clog: Attach a syringe with warm water and use a gentle push-pull motion. Let the warm water sit for up to 20 minutes to dissolve the clog. Never use carbonated beverages or wires to unclog the tube.

Displaced Tube

If an NG tube is dislodged, or a new gastrostomy tube (less than 6-8 weeks old) falls out, seek immediate medical attention. The insertion tract can close rapidly. For mature gastrostomy sites, a replacement tube can often be reinserted, but this should still be handled by a healthcare professional or as trained.

Gastrointestinal Symptoms

Nausea, vomiting, diarrhea, and bloating can indicate feed intolerance. Try slowing the feed rate. Ensure the formula is at room temperature. If symptoms persist, consult a doctor.

Conclusion

Feeding a patient with a feeding tube is a critical and manageable task for caregivers. By consistently following proper hygiene, positioning, and administration techniques, you can ensure the patient receives the necessary nutrition safely and comfortably. Always refer to the patient’s specific care plan provided by their healthcare team, which includes dietitians and nurses. For more details on specific tube types and care, refer to reliable medical resources like the Cleveland Clinic's detailed guide on tube feeding.

For further information on tube feeding, visit the Cleveland Clinic.

Frequently Asked Questions

How often should I flush the feeding tube?

Flush the feeding tube with warm water before and after each feeding, before and after administering medications, and at least once per shift during continuous feeding to prevent clogs. Your healthcare provider will specify the correct volume of water.

What should I do if the feeding tube becomes clogged?

First, try flushing the tube with a syringe filled with warm water, using a gentle push-pull motion. If that fails, clamp the tube and let the water sit for up to 20 minutes before trying again. Never use carbonated drinks or a wire to clear the blockage.

What is the correct patient position for feeding?

The patient should be in a semi-upright or high Fowler's position, with the head elevated to at least 30 to 45 degrees, during the feed and for 30 to 60 minutes afterward to prevent aspiration.

Can I mix medications with the formula?

No, you should never mix medications directly with the feeding formula. Administer each medication separately, flushing the tube with water before and after each dose to avoid clogs and ensure proper delivery.

What are signs of feeding intolerance?

Signs of feeding intolerance include nausea, vomiting, abdominal bloating or pain, and diarrhea. If these symptoms occur, try slowing the feeding rate and consult a healthcare provider if they persist.

How do I care for the feeding tube insertion site?

Clean the skin around the tube (stoma) daily with mild, unscented soap and warm water, and pat it dry completely. Check for signs of infection like redness, swelling, or drainage. Rotate the tube daily if it's a G-tube with a bolster to prevent it from sticking to the skin.

What should I do if the feeding tube falls out?

If a gastrostomy tube (G-tube) is new (less than 6-8 weeks old) and falls out, go to the emergency room immediately, as the tract can close quickly. For older tubes, if you have been trained, you may reinsert it and secure it, but it is best to contact a healthcare provider for instruction.