NUR 141: SKILL31-3: Irrigating a feeding tube

1. NUR 141: SKILL31-3: Irrigating a feeding tube

2. IRRIGATING A FEEDING TUBE - INTRODUCTION • This is a brief introduction to this skill: • Feeding tubes must remain patent to ensure that liquid nutritional formula can pass through easily. • All types of feeding tubes require routine irrigation to keep a tube patent. • Inability to instill air or fluid suggests that a tube is occluded. • Curdled enteral formula and improperly crushed medications are the most common causes of feeding tube occlusion.

3. ASSESSMENT • 1. Inspect volume, color and character of gastric aspirates (if obtainable). • Excess volume of secretions (more than 250 mL) may indicate delayed gastric emptying. • 2. Assess bowel sounds. • Determines if peristalsis is present. • 3. Note ease with which tube feeding infuses through tubing. • Failure of formula to infuse as desired may indicate developing obstruction. • 4. Monitor volume of enteral formula administered during a shift and compare with ordered amount. • Indicates whether sufficient volume of feeding is infusing. • 5. Refer to agency policies regarding routine irrigation, usually every 4 to 12 hours.

4. planning • 1. Expected outcomes following completion of procedure: • Feeding tube remains patent. • Patient receives prescribed caloric intake. • 2. Explain procedure to the patient. • Decreases the patient’s anxiety. • 3. Position patient in high-Fowler’s (if tolerated) or semi-Fowler’s position. • Reduces reflux and risk for pulmonary aspiration during irrigation.

5. IMPLEMENTATION • 1. Identify patient using two identifiers. • 2. Perform hand hygiene, prepare equipment at patient’s bedside, and apply clean gloves. • 3. Verify Tube Placement (See Skill 31-2) if fluid can be aspirated for pH testing. • 4. Irrigate routinely before, between, and after final medication (before feedings are reinstituted); and before an intermittent feeding is administered. • 5. Draw up 30 mL of water in syringe. Do not use irrigation fluids from bottles that are used on other patients. Patient should have an individual bottle of their own. • This amount of solution will flush length of tube. Water is the most effective agent for preventing tube clogging. Alternative flushing solutions such as cola and fruit juices increase clogging of tubes because of acidity of these fluids.

6. IMPLEMENTATION – CONT’D • 6. Change irrigation bottle every 24 hours. Irrigation trays, which hold both irrigation fluid and syringe, are considered open systems and may be more easily contaminated than sterile water bottles. • 7. Kink feeding tube while disconnecting it from administration tubing or while removing plug at end of tube. • 8. Insert tip of syringe into end of feeding tube. Release kink and slowly instill irrigation solution.

7. Implementation – cont’d • 9. If unable to instill fluid, reposition patient on left side and try again. • Changing patient’s position may move tip away from stomach wall. • 10. When water has been instilled, remove syringe. Reinstitute tube feeding or administer medication as ordered. Flush each medication completely through tube. (see Skill 21-1). • 11. Remove and discard gloves; dispose of supplies in appropriate receptacle. Perform hand hygiene.

8. evaluation • 1. Observe ease with which tube feeding instills through tubing. • A successfully irrigated tube is patent, allowing for free flow of solution. • 2. Monitor patient’s caloric intake. • Total enteral nutrition infuses without difficulty.

9. Unexpected outcomes • 1. Tube cannot be irrigated and remains obstructed. • Repeat irrigation; if unsuccessful, notify health care provider. Tube may need to be removed, and a new tube placed. • 2. Fluid and electrolyte imbalances occur. Insufficient irrigation can cause water deficiency; excessive irrigations can cause fluid volume excess. • Notify health care provider of abnormal electrolyte levels or imbalanced intake and output.

10. Recording and reporting • 1. Record time of irrigation, amount and type of fluid instilled. • 2. Report if tubing has become clogged. • SPECIAL CONSIDERATION – PEDIATRIC: • Irrigation of a tube requires a smaller volume of solution in children: 1 to 3 mL for neonates and 3 to 5 mL for pediatric patients.

11. End of skill • This is the end of your skill. • Your book has not provided a video for this skill, but I have found one on you-tube that may benefit you and the link is as follows: • Irrigating a Nasogastric (NG) Tube • http://www.youtube.com/watch?v=ChsdsUbgmVA • Please remember though, I provided this video to you and it was not from the book. • Feel free to watch the video, but you must follow the instructions from your book. • Remember, as well, to practice this in the nursing skills lab!