Preparation to administer enteral nutrition:

• Check order - treat enteral formula the same as a medication (is it the right formula, right rate, etc. to meet the patient's need)
• How much water do you need to give the patient?
  • 1 ml/cal - usual fluid recommendations
  • Most formulas contain approximately 80% water (more concentrated TF have less water)
  • Therefore, with more concentrated TF, pt. may need more water - especially if the pt. cannot drink other fluids - water can be administered to flush the tube or concurrently with the tube feeding.
  • Please note: most enteral formulas are order specific. (Manufactures offer a variety of solutions and concentrations.)
• Prepare equipment; obtain ordered formula; 
  Ffor the 60 ml syringe, it may need to be either catheter tip or regular tip depending on the feeding tube in place
• Aspirate stomach contents to check tube placement and amount of residual
  • If residual is over prescribed amount (usually 50-100ml, but may be 300-500 ml), reinstill residual and hold feeding
  • Observe color and consistency of gastric aspirant
    • If patient is on continuous feeding, aspirant often looks like curdled formula
    • Gastric aspirants are usually cloudy and green, tan or off-white, or bloody or brown
    • Intestinal aspirants are usually clear and yellow to bile-colored
    • Respiratory fluids usually contain blood; in no blood is present, pleural fluid is usually pale yellow and bile-colored and tracheobronchial secretions are usually tan or off-white.
  • Ascertain the hospital protocol before Insertion of Small-Bore Nasogastric or Nasointestinal Feeding tubes with stylet (guide wire). Many Orange County hospitals only allow the Clinical Nurse Specialist (CNS), Enteral Therapist Nurse, interventional radiologist or physician to insert a feeding tube with stylet. Most popular small bore feeding tube is a Dobbhoff. Such tubes require a physician's order. Small bore feeding tubes can be left in place for an extended period with less irritation to the nasopharynegeal, esophageal, and gastric mucosa.
  • Most hospital's protocol does not include the use of analyzing gastric contents with litmus/pH paper. Instill 30 ml of air to clear the tube of formula and withdraw a small sample. Measure the pH of gastric aspirant
    • Usual pH of gastric contents is 1-4
    • pH of intestinal fluids generally >6
    • pH of pleural fluid is generally >6
  • Following insertion of a nasogastric feeding tube, placement MUST be verified by x-ray!
• Elevate head of bed at least 30⁰ while patient is receiving a tube feeding (prevent aspiration)

Testing pH Level

	pH 1-4 indicates gastric placement   pH >6 indicates either intestinal or respiratory placement

Bolus Feeding:

Pour in ordered amount of tube feeding formula. Hold syringe approximately 18 inches above patient. After formula has infused, administer 30-60 ml of water. If using an tube feeding bag, set drip rate to run in ordered amount of formula in 30 minutes. The usual drop factor for feeding bags is 20 gtt/ml.

Continuous Feeding

Information on enteral feeding pumps:

Flexiflo Companion Pump (this is a PDF file. If you do not have Adobe Acrobat, you can download a free copy at: Adobe.com)	Flexiflo Quantum Enteral Pump (this is a PDF file)