Enteral Nutrition: A Case Study
I. The procedure for continuous and intermittent administration of enteral nutrition as outlined in Clinical Nursing Skills & Techniques: Enteral Nutrition (Perry & Potter, 2014).
A. Physician 's order requires: when to insert, irrigate, type and amount of suction and/or removal an enteral feeding tube, type of feeding tube, volume/rate of solution administered and duration time for replacement if needed.
B. Registered nurses (RN) or Licensed Vocational Nurses (LVN) may insert small-bore weighted and large-bore tubes for the purpose of complete or supplemental nutritional support.
II. The procedure for inserting large-bore NG tube (i.e. Levin, Salem Sump) and small-bore feeding tube (i.e. Dobbhoff), placement and maintenance of feeding tube as outlined in Clinical
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Observe for signs of respiratory distress.
2. Use capnography if available.
3. Measure pH of aspirate from tube if pH strips are available. (Fasting gastric pH is usually 5 or less. Respiratory secretions typically have a pH of 6 or greater.)
4. Observe visual characteristics of aspirate from the tube.
5. Check for position of NG tube in back of throat.
C. Do not use the auscultatory (air bolus) method to determine tube location. (Although widely used in practice, no evidence indicates that the auscultatory method is useful for determining tube location.)
D. Do not use the water bubbling method (holding the proximal end of a feeding tube under water and observing for bubbles upon exhalation) to determine tube location. (There are documented incidents where patient can accidently inhale water through the tube into the lung. A false-negative result can occur when the tube 's ports are occluded by the airway mucosa, and a false-positive result can occur because the stomach often contains air.)
E. Secure tube with tape and mark exit site on tube with ink or markers and document in patient 's medical record.
VIII. Continuous Assessment
A. Perform assessment of placement, position and patency of the
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