How to Prime Enteral Feeding Tubing: A Comprehensive Guide

A 2018 study reported that improper enteral feeding practices are a leading cause of preventable feeding tube-related complications. Priming enteral feeding tubing is a critical safety step to ensure all air is removed before connecting to the patient, preventing air from entering the gastrointestinal tract and causing complications.

Quick Summary

This guide provides detailed, step-by-step instructions for priming enteral feeding tubing using both manual gravity and pump-assisted methods, emphasizing proper technique and important safety protocols.

Key Points

• Preparation is Key: Gather all supplies, including formula and tubing, and wash hands thoroughly before starting any priming procedure.

• Remove All Air: Priming removes all air from the tubing to prevent gastric discomfort, bloating, and other complications for the patient.

• Use the Correct Method: Follow specific steps for either manual gravity or pump-assisted priming, as the procedures differ based on the feeding method.

• Never Prime Connected to Patient: Always disconnect the feeding set from the patient's tube before priming or re-priming to prevent air from being infused.

• Flush to Prevent Clogs: Regularly flushing the tubing with water as instructed prevents clogging and maintains the tube's patency.

• Don't Rush: Take your time to ensure all air is out of the line, as rushing can lead to bubbles and incomplete priming.

Why is Priming Essential for Enteral Feeding?

Before any liquid nutrition can be delivered through an enteral tube, the entire tubing system must be primed. This process involves filling the line with formula or water to displace all air. The presence of air in the tubing can lead to several problems for the patient, including gas, bloating, and abdominal discomfort. In more severe cases, infusing air can trigger retching, vomiting, or aspiration, which is a significant safety risk, especially for individuals with compromised swallowing reflexes or delayed gastric emptying. Following a sterile and meticulous priming procedure is non-negotiable for safe and effective enteral nutrition. The process is not just about convenience; it is a fundamental aspect of patient care that prevents complications and ensures the patient receives the correct dose of nutrition without interruption.

Preparing for the Priming Process

Before you begin to prime enteral feeding tubing, proper preparation is key to ensuring a smooth and sanitary process. Always work in a clean, uncluttered area.

Supplies Needed

• Enteral formula or liquid nutrition prescribed by a healthcare provider.
• Feeding bag and tubing set (gravity or pump, as ordered).
• Clean cloth or towel to place underneath the workspace.
• Enteral syringes, if using the manual bolus method.
• Tap water for flushing, if directed by a healthcare professional.
• IV pole or a suitable hanging surface, if using gravity or pump feeds.

Step-by-Step Preparation

1. Wash your hands: Always begin by washing your hands thoroughly with soap and water for at least 20 seconds.
2. Gather equipment: Collect all necessary supplies and place them on a clean, dry surface.
3. Inspect formula: Check the expiration date on the formula container. Gently shake the formula to mix it thoroughly. Ensure it is at room temperature before use; do not microwave to warm it.
4. Confirm the system: Ensure all clamps on the tubing are securely closed before filling the bag to prevent spills.

Method 1: How to Prime Enteral Feeding Tubing for a Pump

Pump-assisted feeding is a common method, and many modern enteral pumps have an automated priming feature. This simplifies the process, but manual intervention may still be required to ensure complete air removal.

1. Fill the feeding bag: Pour the prescribed amount of formula into the feeding bag. Close the cap tightly to prevent contamination.
2. Hang the bag: Place the bag on the IV pole, ensuring it is positioned above the pump.
3. Load the tubing: Open the pump door and carefully loop the tubing around the pump rotor according to the manufacturer's instructions. Ensure the tubing is not kinked or overstretched.
4. Initiate priming: Turn the pump on. Disconnect the feeding line from the patient. Access the priming options, which may be labeled "Prime Pump" or have a dedicated "Prime" button.
5. Choose priming mode:
   • Auto Prime: Pressing this option will automatically fill the line with formula, stopping just before the end of the tubing to avoid spills.
   • Manual Prime: Some pumps offer a "Hold to Prime" option for manual control. Press and hold this button to manually advance the formula through the line.
6. Check for air: Observe the tubing as it primes. If you see any remaining air bubbles, manually prime the line again or gently tap the tubing to encourage bubbles to move out.
7. Complete the process: Once the formula reaches the end of the tubing and all air is expelled, select "Done" on the pump. The system is now ready to be connected to the patient's feeding tube.

Method 2: How to Prime Enteral Feeding Tubing for Gravity Feeding

Gravity feeding does not use a pump and relies on the height of the feeding bag to regulate the flow. This method requires careful manual priming.

1. Fill the feeding bag: Close the roller clamp on the tubing. Pour the formula into the bag, ensuring the cap is closed securely.
2. Hang the bag: Hang the bag on a hook or pole. Hold the end of the tubing over a container or sink to collect any dripping formula.
3. Release the formula: Slowly open the roller clamp. Allow the formula to flow down the tube, pushing the air out in front of it.
4. Stop the flow: As soon as you see formula beginning to drip from the end of the tubing, close the roller clamp tightly. This indicates that the line is completely primed.
5. Confirm no air: Inspect the length of the tubing one last time to confirm no remaining air bubbles are trapped.

Priming Comparison: Pump-Assisted vs. Manual Gravity

Feature	Pump-Assisted Priming	Manual Gravity Priming
Mechanism	Automated priming function on the pump.	Uses manual control and gravity flow.
Equipment	Requires a dedicated enteral feeding pump.	Relies on the height of the feeding bag.
Speed & Control	Faster, more consistent priming. Can be topped off manually if needed.	Slower, requires manual attention to prevent spills.
Efficiency	Highly efficient for continuous feeds or when re-priming a bag.	Effective for bolus feeds, but can be prone to small air bubbles if not done slowly.
Ease of Use	Simple, especially with an auto-prime feature, but requires learning pump settings.	Straightforward process, but relies on user technique to manage flow rate.
When to Use	Continuous feeding, high-risk patients, or when precise control is necessary.	Bolus or intermittent feedings, often for patients with good gastric tolerance.

How to Re-Prime Tubing During a Feed

Sometimes, a feeding bag may run empty before the entire feed is complete, especially during a continuous feed. In this case, you must re-prime the tubing to prevent air from entering the system. The process is similar to the initial priming but with a key difference: you must disconnect the line from the patient first.

1. Disconnect: Stop the pump or close the roller clamp. Disconnect the feeding set from the patient's feeding tube port.
2. Refill: Refill the feeding bag with fresh formula.
3. Re-prime: Use the pump's prime function or the manual gravity method to push the new formula through the line, displacing any air that may have entered.
4. Reconnect: Once re-primed, reconnect the feeding set to the patient and resume the feed.

Troubleshooting Common Priming Issues

• Air bubbles persist: If you can't get rid of small bubbles, try gently flicking the tubing to dislodge them. For stubborn bubbles, hang the bag higher and allow the formula to flow for a few extra seconds.
• Formula spills: If you get too much air out and formula starts spilling, quickly close the roller clamp or press the 'stop' button on the pump. Use a towel to wipe up any spills. This is why priming over a container is recommended.
• Clogged tubing: Ensure you flush the tubing with the required amount of water before and after every feed and medication administration to prevent formula buildup. If a clog occurs, use warm water and a syringe to apply gentle pressure. Do not use fruit juices or soda, as these can worsen the clog.

Conclusion

Properly priming enteral feeding tubing is a simple yet critical skill for anyone involved in tube feeding, whether in a hospital or home care setting. It is a fundamental safety measure that ensures the patient's comfort and prevents potentially serious complications like aspiration. By understanding the distinct procedures for pump-assisted and manual gravity feeding, and adhering to strict hygiene practices, caregivers can confidently administer nutrition and fluids. Always remember that patient safety is the top priority, and taking the few minutes required to correctly prime the tubing is an investment in their health and well-being. For specific medical questions, always consult with your healthcare provider or a registered dietitian.

For more in-depth information on enteral nutrition and its safe administration, visit the National Institutes of Health (NIH) website: Enteral Feeding - StatPearls - NCBI Bookshelf.

Frequently Asked Questions

Why is it important to prime enteral feeding tubing?

Priming is important to remove all air from the tubing set, preventing air from entering the patient's gastrointestinal tract, which can cause discomfort, bloating, and potentially more serious complications.

Can I re-use a feeding tube set?

Some tubing sets are reusable for a specific period, typically 24 hours, provided they are properly cleaned and rinsed with warm water after each use. Always follow the manufacturer's and your healthcare provider's instructions for reusing or discarding equipment.

What is the difference between manual and pump priming?

Manual priming uses gravity or gentle squeezing to move formula through the line. Pump priming uses an automated feature on the enteral feeding pump to fill the line and is more precise.

What should I do if I see air bubbles after priming?

If you notice small air bubbles, gently tap the tubing to dislodge them. For larger or persistent bubbles, disconnect the tube from the patient and re-prime the set, allowing the formula to flow through again.

Can I warm the formula before feeding?

Formulas should generally be administered at room temperature. If warming is necessary, use a bottle warmer or place the container in warm water. Never use a microwave, as it can cause dangerous hot spots.

How do I prime a gravity feeding set?

To prime a gravity set, first close the roller clamp. Fill the bag with formula and hang it. Hold the end of the tubing over a container, then slowly open the roller clamp until the formula reaches the tip, expelling all air.

How often should I prime the tubing?

The tubing must be primed every time a new feeding set is used. If a feeding bag runs empty during a continuous feed, you must re-prime the tubing before refilling and reattaching it.

What if the tube gets clogged?

If the tube clogs, first try flushing it with warm water using a syringe and a gentle back-and-forth motion. Do not force the plunger. If this fails, contact your healthcare provider. Avoid using acidic juices or soda, which can worsen clogs.