Transabdominal Tube Feeding and Care
To access the stomach, duodenum, or jejunum, the doctor may place a tube through the patient’s abdominal wall. This procedure may be done surgically or percutaneously.
A gastrostomy or jejunostomy tube is usually inserted during intra-abdominal surgery. The tube may be used for feeding during the immediate postoperative period or it may provide long-term enteral access, depending on the type of surgery. Typically, the doctor will suture the tube in place to prevent gastric contents from leaking.
In contrast, a percutaneous endoscopic gastrostomy (PEG) or percutaneous endoscopic jejunostomy (PEJ) tube can be inserted endoscopically without the need for laparotomy or general anesthesia. Typically, the insertion is done in the endoscopy suite or at the patient’s bedside. Ultrasound can be used to confirm placement. A PEG or PEJ tube may be used for nutrition, drainage, and decompression. Contraindications to endoscopic placement include obstruction (such as an esophageal stricture or duodenal blockage), previous gastric surgery, morbid obesity, and ascites. These conditions would necessitate surgical placement.
With PEJ tube placement, feedings may begin after 24 hours (or when peristalsis resumes). A PEG tube can be used for feedings within 2 hours of placement in adults and 6 hours in infants and children.1
After a time, the tube may need to be replaced and the doctor may recommend a gastrostomy button—a skin-level feeding tube. Tubes not intended for use as enteral feeding devices, such as urinary or GI drainage tubes, shouldn’t be used because these tubes don’t have an external anchoring device. Use of these tubes may lead to misconnection or tube migration, which may cause obstruction of the gastric pylorus or small bowel.1
Nursing care for patients receiving transabdominal feedings includes providing skin care at the tube exit site, maintaining the feeding tube, administering feeding formula, monitoring the patient’s response to feeding, adjusting the feeding schedule, and preparing the patient for self-care after discharge.
Equipment
For Continuous or Intermittent Feeding
Feeding formula ▪ large-bulb or catheter-tip syringe ▪ 120 mL of water ▪ 4″ × 4″ gauze pads ▪ gravity-drip administration bags ▪ mouthwash, toothpaste, or mild salt solution ▪ gloves ▪ Optional: enteral infusion pump, sterile water.
For Site Care
4″ × 4″ gauze pads ▪ soap ▪ cotton-tipped applicators ▪ skin protectant ▪ normal saline solution ▪ hypoallergenic tape ▪ gloves.
Preparation of Equipment
Always check the expiration date on commercially prepared feeding formulas. If the formula has been prepared by the dietitian or pharmacist, check the preparation time and date. Discard any opened formula within 24 hours of preparation if not used.1
For Continuous Feedings
Commercially prepared administration sets and enteral pumps allow continuous formula administration. Set up the equipment according to the manufacturer’s guidelines. Fill the feeding bag and purge air form the administration tubing. If a prefilled container is available, attach it to the administration set and then purge air from the tubing. Make sure that the feeding bag or container is clearly labeled with a statement such as “WARNING! For Enteral Use Only—Not for IV Use” to prevent administration errors.1
To avoid contamination, hang only a 4-hour supply of reconstituted formula at a time. Sterile, decanted formula can hang for 8 hours. Closed-system formulas can hang for 24 to 48 hours according to the manufacturer’s guidelines.1
For Intermittent Feedings
Prepare the gavage set and administration equipment. Make sure the formula is room temperature. Cold formula may cause cramping.
Implementation
Verify the doctor’s order for continuous or intermittent transabdominal tube feeding.
Review the patient’s medical record to make sure that catheter placement was confirmed before beginning the feeding.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.6
Provide privacy.
Explain the procedure to the patient. Tell him that feedings usually start at a slow rate (for continuous feeding) or slow
volume (for intermittent feedings) and increase, as tolerated. If the patient is receiving continuous feedings, explain that after he tolerates this type of feeding, he may progress to intermittent feedings as ordered.
Assess the patient to determine his risk for aspiration.1
Assess for bowel sounds before feeding, which indicate adequate GI motility, and monitor for abdominal distention
Check the external length of the catheter to determine whether the catheter has migrated.1 If you suspect catheter migration, don’t administer the feeding, and notify the doctor.
Have the patient sit, or elevate the head of the bed at least 30 degrees (45 degrees is preferred) unless contraindicated by the patient’s condition. If the patient can’t tolerate an elevation of this type, use reverse Trendelenburg’s position unless contraindicated.1
For Continuous Feeding
Trace the administration tubing from the patient to its point of origin and then connect it to the feeding tube to make sure that you’re connecting it to the proper port.1,7
Route the tubing in a unique direction; for example, route the tube feeding administration set toward the patient’s feet and the IV tubing toward the patient’s head to prevent misconnections.1,7
If your tube-feeding equipment isn’t color-coded, label the tubing and connectors so staff members can easily identify that they are for enteral use only, not for IV use.1,7
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