62

ENTERAL FEEDING

SKILL 24 ADMINISTRATION OF A BOLUS

FEEDING (NG, NJ,
GASTROSTOMY)
SKILL 25 ADMINISTRATION OF NG, NJ,
AND GASTROSTOMY
CONTINUOUS FEEDING
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SKILL 24 Administration of a Bolus Feeding (NG, NJ,

Gastrostomy)
EQUIPMENT 13. Add feeding to syringe and administer feeding. Control
Formula rate of feeding by raising or lowering the syringe. Too
Water rapid feeding may cause vomiting.
Catheter tip syringe
NOTE: The length of feeding should be similar to that
Gloves, nonsterile
of oral feeding, not less than 20 minutes. May take
30–60 minutes.
PROCEDURE
1. Check order for type, amount, and frequency of feed- NOTE: With a gastrostomy tube hold straight up from
ing. insertion site. Puts less stress on the tube.
2. Gather equipment. Promotes organization and effi-
14. Following administration of feeding, flush tube with
ciency.
water. Prevents tube from becoming clogged.
3. Explain procedure to child and family. Enhances cooper- a. Neonate or fluid restricted children flush with 1–2 cc
ation and participation and reduces anxiety and fear. of water or air. If flushing with air and feeding gets
4. Wash hands. Reduces transmission of microorganisms. sluggish consider flushing with water.
5. Warm formula to room temperature. Promotes comfort. b. Other children flush with 10–15 cc of water.
6. Position child on right side or supine with head ele- 15. Remove syringe and rinse after each feeding. Syringe
vated. Have assistant hold/comfort child as necessary. may be used for 12 hours before being discarded.
Reduces risk of reflux or vomiting. Reduces risk of contamination.
7. Put on nonsterile gloves. Protects from contact with 16. Remove gloves. Wash hands. Reduces transmission of
body fluids. microorganisms.
8. Check placement of tube as appropriate for type of
tube. Tube could have moved since last feeding. DOCUMENTATION
a. For nasogastric tube check placement as described 1. Check for residual.
earlier. 2. Amount of residual.
b. For a nasojejunal tube check placement by measur-
3. Time of feeding.
ing length of tube from nose to tube hub. This dis-
tance should have been recorded in the chart at the 4. Type and amount of formula.
time of verification of placement and checked on a 5. How procedure tolerated.
regular basis after verification.
c. Placement check not needed for gastrostomy tubes.
9. Check for residual if indicated. Attach syringe and pull
back on plunger. Note amount and character of residual.
10. Return residual to child and flush tube. Prevents elec-
trolyte imbalance.
NOTE: If residual greater than 1/2 the amount of the
previous feeding notify the physician. For neonates
notify physician if residual exceeds 20% of previous
feeding or more than 2 cc/Kg. Prevents distention of
the stomach with possible reflux or vomiting.

11. Attach empty syringe. Keep the tubing pinched.

Prevents air from entering the stomach.
12. Flush tube. Assesses patency and flow in the tube.
a. Neonates or fluid restricted children flush with 1–2
cc water or air.
b. Other children flush with 5–10 cc of water.

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