1.   1. For any new order to insert a feeding tube, there must be documented evidence in the resident’s chart that the facility was no   not able to maintain or improve the resident’s nutritional status through oral intake.

a. There must be a physician’s order for insertion of a new feeding tube.

b. Registered Nurses are the only staff members authorized to insert feeding tubes.

2.    2. Physician’s orders for a feeding tube must state:

a. Type and size of tube

b. Feeding formula

c. Total calories per day

d. Amount, rate, and frequency of formula

e. Type, amount, and frequency of flushes

3.   3. Every resident with a feeding tube must be monitored by a registered Dietician.

4.   4. Licensed Nurses are the only members authorized to:

a. Administer fluids and medications into feeding tubes

b. Disconnect or reconnect feeding tubes

c. Identify and set up equipment and formula administration

d. Monitor and adjust flow rates

e. Flush feeding tubes

f. Set or change any settings on formula pumps

g. Remove feeding tubes or disconnect tubing

5.   5. Licensed Nurses will not delegate any of the above tasks to any other staff members.

6.   6.Residents receiving tube feedings must have:

a. The head of the bed elevated 30 degrees at all times unless contraindicated.

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b. Oral care every shift

c. Weekly weights

7.   7. Formulas

a. Check the manufacturer’s expiration date before use.

b. Cover and refrigerate formula after it is opened as recommended by the manufacturer.

i. Date and initial the container.

ii. Discard opened formula not used within 24 hours.

8.   8. Infusion Feeding Pumps

a. Formulas given as continuous feeding must be administered by an infusion feeding pump.

b. Refer to the pump’s manufacturer instructions in the policy and procedure manual.

c. Instruct the unit’s staff members that they must:

i. Inform the Unit Nurse whenever the pump alarms sound.

ii. Inform the Unit Nurse whenever the resident must be moved or needs a procedure that would require the tubing or pump to be disconnected.

d. Instruct the unit’s staff members that they must Not:

i. Disconnect or reconnect any tubing from the pump

ii. Change any settings on the pump

iii. Turn the pump alarm off

iv. Turn the pump on or off

9.   9. Tubing, Bags, and Syringes

a. Change bags, tubing, and syringes at least every 24 hours.

b. Label all bags, tubing, and syringes with date and initials.

10. 10. Verify tube placement:

a. Every shift

b. Before administering formula

c. Before administering medications

d. Before flushing

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11. 11. Flush the tube per physician’s orders. The tube should be flushed:

a. At least once every shift

b. Before and after bolus administration of formula

c. Before and after administration of medications

12. 12. Medications

a. Check medications and formulas to make sure they are compatible, as certain combinations will cause clotting of formulas.

b. Medications should be in liquid form whenever possible.

c. If the medication is in tablet form, check that it is permissible to crush it.

d. Dissolve crushed medications in water before administering.

e. Do not crush enteric coated tablets.

f. Administering medications:

i. Stop the feeding.

ii. Confirm tube placement by aspirating a small amount of gastric contents. Placement may also be confirmed by injecting 5-10 cc of air into the tube, and listening to air entering the stomach.

iii. Flush the tube with 30 cc of water unless the physician’s order states otherwise.

iv. Administer the medication.

v. Flush with 30 cc of water.

vi. Continue the feeding.

13. 13. Dressings

a. Change dressings at least every 24 hours unless the physician’s order states otherwise.

b. Replace dressings when they become damp, loose, or soiled.

c. Use sterile or non-sterile clean gloves during dressing changes.

d. Clean the tube insertion area with normal saline or other solution prescribed by the resident’s physician.

e. Apply ointment as prescribed by the physician.

f. Apply sterile, dressing and tape.

g. Date, time, and initial the dressing when it is applied or changed.

h. Document the dressing change in the resident’s chart.

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14. 14. Monitoring and Documentation

a. Check every shift the:

i.    Resident

ii.   Placement and patency of tube

iii.  Insertion site and dressing

iv.  Tubing

v.   Bag

vi   Pump

b. Monitor for the following, and document in the resident’s chart:

i. Tube intact and patent

ii. Gastrointestinal assessment which includes evaluation of :

Bowel sounds

Abdominal distention

Nausea or vomiting

Cramps or diarrhea

Constipation

iii. Hydration assessment

iv. Pump running correctly

v. Type of formula and medications are as ordered

vi. Flow and rate as ordered

vii. Dressing intact, free of blood or drainage

15. 15. Intake and Output

a. Keep strict intake and output for any resident receiving tube feeding.

b. A log of formula administration must be included in the resident’s Medication Administration Record (MAR).

c. At the end of the shift, record exactly how much of the formula, flushes, and medications the resident received.

d. These amounts should be added for totals at the end of night shift.

16. 16. The resident’s physician must be notified if the tube becomes clogged or displaced. 

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