Editing Nutrition (section)

=== Nursing Management of Tube Feeding ===

# '''Verify placement.''' Radiographic confirmation is the gold standard after initial insertion of a blindly placed tube and before the first use. Thereafter, check the exit-site marking on the tube, measure the external tube length, and assess gastric aspirate. Auscultating an air bolus over the epigastrium is '''not''' a reliable method and is no longer recommended. Gastric aspirate pH is typically 5.5 or lower, though acid-suppressing medications raise it.
# '''Elevate the head of the bed to 30 to 45 degrees''' during feeding and for at least 30 to 60 minutes afterward. This is the single most important aspiration precaution.
# '''Check gastric residual volume''' per institutional policy, typically every 4 to 6 hours during continuous feeding. Current guidance from professional societies is not to hold feeding for a residual under 500 mL in the absence of other signs of intolerance, but many facilities still use 250 to 500 mL thresholds. Return the aspirate unless policy directs otherwise, since discarding it discards electrolytes.
# '''Flush the tube''' with 30 mL of water before and after each feeding and each medication, every 4 hours during continuous feeding, and any time the feeding is interrupted. Water is the flush of choice. Cranberry juice and cola are not effective and can worsen clogging.
# '''Give medications separately.''' Crush immediate-release tablets finely and dissolve them, or use liquid forms. '''Never''' crush enteric-coated, sustained-release, or extended-release formulations. Flush between each medication.
# '''Hang time.''' Discard open ready-to-hang formula per policy, generally within 24 to 48 hours for closed systems and within 4 to 8 hours for decanted or reconstituted formula. Change the administration set every 24 hours.
# '''Formula temperature.''' Administer at room temperature. Cold formula causes cramping and diarrhea.
# '''Monitor''' daily weight, intake and output, glucose, electrolytes, bowel pattern, and abdominal distention.