PEG- Bolus Feed

Equipment:

  • 60 mL catheter-tip syringe
  • Stethoscope
  • pH strips
  • Water
  • Prescribed formula
  • Clean gloves

Steps:

  1. WIIAPA:
    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
  1. Verify Order with MAR. Remember 7 rights of med administration.
  2. Hand hygiene and apply clean gloves.
  3. Prepare formula for administration:
    1. Verify correct formula & check expiration date.
    2. Should be at room temperature.
    3. Shake formula container well.
    4. Clean top of canned formula with alcohol swab prior to opening.
  4. Educate patient:
    1. Explain procedure.
    2. Should remain upright x 1 hour after feeding.
  5. Place patient in high Fowler position or elevate HOB at least 30°, 45° recommended.
  6. Verify tube placement:
    1. Auscultate for presence of bowel sounds.
    2. Attach syringe and aspirate 5 ml gastric content and check pH (less than 5.0= good indicator tip of tube is in stomach).
  7. Check Gastric Residual Volume:
    1. Draw up 10-30 mL of air and inject air slowly into tube.
    2. Pull back slowly and aspirate total amount of gastric contents.
    3. Return to stomach unless content exceeds 250 mL.
    4. GRVs in the range of 200 – 500 mL should raise concern and lead to 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. Notify provider.
  8. Flush tubing with 30mL of water.
    1. Pinch/clamp tube and remove syringe.
    2. Draw up 30 ml of water into syringe.
    3. Reconnect syringe to tube, release clamp, and flush tubing with water.
  9. Administer Bolus feed:
    1. Pour formula into syringe.
    2. Move up in height above insertion site & allow to flow by gravity.
  10. Flush tubing with 30 mL of water (or prescribed amount of water by provider).
  11. Clamp tubing, remove syringe, and replace plug/cap at end of tubing.
  12. Keep HOB elevated 30° – 45° x 1 hour.
  13. Dispose of supplies and clean patient area.
  14. Remove and dispose of gloves. Hand Hygiene.
  15. Monitor patient / Evaluate tube feeding tolerance.
  16. Document – ex: Placement check, GRV, pH of aspirate, formula administered, response to feeding, patient teaching, etc.

Reference: Perry, A. G., Potter, P. A., Ostendorf, W. R., & Laplante, N. (2022). Clinical Nursing Skills & Techniques (10th ed., pp. 966-970). Elsevier.