NG Tube-Bolus Feed

Equipment:

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• Formula
• 30-60mL catheter-tip syringe
• Stethoscope
• pH strips
• Water
• Clean gloves

Steps

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1. WIIAPA:

1. 1. Wash hands
   2. Introduce self
   3. Identify patient (use 2 identifiers)
   4. Allergies – don’t forget food allergies
   5. Plan of care
   6. Assess patient  – focused abdominal assessment, auscultate bowel sounds, inspect tube insertion site noting skin integrity

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2. Verify Order with MAR. Remember 7 rights of med administration.
3. Perform hand hygiene and apply gloves.
4. Educate patient:
   1. Explain procedure
   2. Should remain upright x 1 hour after feeding
5. Prepare formula for administration:
   1. Verify correct formula, package integrity, and check expiration date
   2. Should be at room temperature
   3. Shake can well
   4. Clean top with alcohol swab prior to opening
6. Place patient in high fowlers position or elevate HOB at least 30°, 45° recommended.
7. Aspirate 5 mL of gastric content and note pH to verify placement
8. Check Gastric Residual Volume:
   1. Draw up 30 mL of air and push air through tube
   2. Pull back slowly for aspirate and measure amount
   3. Return to stomach unless content exceeds 250 mL. GRVs in the range of 200-500 mL should raise concern for the need of implementation of measures to reduce the risk of aspiration. Cessation of feeding should not occur for GRV less than 500 mL in the absence of other signs of intolerance. Simply notify provider.
9. Flush tubing with 30 mL of water. Remove plunger from syringe and reinsert syringe into tube prior to flushing prepared water and let flush by gravity.
10. Administer Bolus feed:
    1. Pour formula into syringe
    2. Move up in height above insertion site & allow to flow by gravity
11. Flush tubing with 30 mL of water (or prescribed amount of water by provider).
12. Clamp tubing, remove syringe, and replace plug/cap at end of tubing.
13. Keep HOB elevated x 1 hour.
14. Dispose of supplies and clean patient area.
15. Perform hand hygiene.
16. Monitor patient / Evaluate tube feeding tolerance.
17. Document – ex: Placement check, GRV, pH of aspirate, formula administered, response to feeding, patient teaching, etc.