Enteral feeding
I am going to start with Enteral feeding because I cannot come up with a mneumonic for it and perhaps writing it out will help. One good thing to keep in mind is that personal cleanliness will not be co-assigned with enteral feeding unless it is a continuous feeding(and a heckuva lot less work) First of all Enteral feeding is any nutrition taken into the GI tract. This means a bottle given to a baby, food off a tray or a G-tube,peg-tube, or a naso gastric tube. The first two are pretty basic as they are things we are accostumed to doing all the time. I handle g-tubes at work,but hey this is the CPNE,no room for error right?
The critical elements for enteral feeding are as follows:
1. Complies with established guidelines.This means wash your hands, use gloves if you will be handling ANY body secretions,measure and record!
2.For ALL feedings
a. selects perscribed feeding. This sounds easy ,but in reality there are soooooooooooo many kinds of feeding (with fiber,high nitrogen,high protein), infant formulas,and do not forget this also means giving the right diet to the right patient. Diets are theraputic as medications sometimes.You would not give tiramisu to a diabetic on a 1200 Kcal ADA diet, a hotdog is a no no for a 4 month old,and a puree diet is a must for some.If it a formula,be it for an infant or an adult, make sure it is the right strength. If it is 1/2 stregth then it needs to be diluted with water in equal amounts.ect. INSPECT the label before you open it.make a big show of this and checking the expiration date.
b. position the pt to promote feeding. This means for a tube feeding that the pt ought to be at least at 45 degrees during and immediately after the feeding. An infant out to have its head elevated also. This is to prevent aspiration.TURN OFF the feeding if you need to lower the head of the bed .(usually for cares)
c. deliver the feeding. The CE will designate what route you will use for delivery. This can include but not limited to: A pump,bolus using a 60 ml syringe,gravity,bottle, intermitent or continuous.The CE will also tell you about any flushes post feeding.
3.BURP the infant under 6 months
4. The feeding should be at room temp. I have read studies that it really does not matter as to digestion about the temp of the feeding but follow protocol here.Some facilities "save" feeding from partially used cans to use later in the fridge. I would open fresh and discard what is not needed.
5.For an intermittent TF
a. How MUCH are you to give??be exact. You will have the means to measure.
b.titrate the flow rate . The CE will tell you the drip rate. This is just like titrating an IV.
c.if this is an NG tube`the location will need to be verified. NG tubes are tricky little devils . They are slender slippery things that can curl up and end up at very inconvenient places, like the lungs soooooooooo we will verify it is indeed in the stomach!!by one of the following methods:
1) aspirates stomach acid using a syringe AND checking gastric PH if indicated.Be sure to note amount of residual because there may be parameters for holding a feeding .Reinstill the stomach acid. I have heard some nurses reason that if they discard the excess contents they can proceed with the feeding ,but doing this will cause electrolyte imbalances. OR
2)instilling 10-20 ml of air (5 ml for kids under 2) while auscultating for the "gurgle"
The hospital MAY also have a policy re: Gtubes or j tubes, so unless you are told, ASK.
d.measures residual...regardless of need to check placement.
e.reinstills...be sure to keep the syringe attached or you have to count it as output and intake.
f.you have a 30 minute window in which to give the feeding of its scheduled time...just like a medication.
g. gives feeding at correct rate by either regulating the drip rate or entering the correct number on feeding pump. There is a +/- 5 gtt per minute margian of error.
6.for a continuous feeding:
OK kids this portion is part of the 20 minute checks!! YOU NEED to verify the rate of flow within 20 minutes of implementation phase by either counting the drops per minute of the formula already up OR by documenting the flow rate setting on the feeding pump onto the PCS form...THEN regulate the drops.
You still will need to verify the NG (and perhaps other tubes) at least once during the PCS by the afore mentioned means as well as checking residual (only if indicated for continuous)
7. record everything:amount ,type,strenth,rate,anything pertaining to gastric content as well as how they tolerate it.
The critical elements for enteral feeding are as follows:
1. Complies with established guidelines.This means wash your hands, use gloves if you will be handling ANY body secretions,measure and record!
2.For ALL feedings
a. selects perscribed feeding. This sounds easy ,but in reality there are soooooooooooo many kinds of feeding (with fiber,high nitrogen,high protein), infant formulas,and do not forget this also means giving the right diet to the right patient. Diets are theraputic as medications sometimes.You would not give tiramisu to a diabetic on a 1200 Kcal ADA diet, a hotdog is a no no for a 4 month old,and a puree diet is a must for some.If it a formula,be it for an infant or an adult, make sure it is the right strength. If it is 1/2 stregth then it needs to be diluted with water in equal amounts.ect. INSPECT the label before you open it.make a big show of this and checking the expiration date.
b. position the pt to promote feeding. This means for a tube feeding that the pt ought to be at least at 45 degrees during and immediately after the feeding. An infant out to have its head elevated also. This is to prevent aspiration.TURN OFF the feeding if you need to lower the head of the bed .(usually for cares)
c. deliver the feeding. The CE will designate what route you will use for delivery. This can include but not limited to: A pump,bolus using a 60 ml syringe,gravity,bottle, intermitent or continuous.The CE will also tell you about any flushes post feeding.
3.BURP the infant under 6 months
4. The feeding should be at room temp. I have read studies that it really does not matter as to digestion about the temp of the feeding but follow protocol here.Some facilities "save" feeding from partially used cans to use later in the fridge. I would open fresh and discard what is not needed.
5.For an intermittent TF
a. How MUCH are you to give??be exact. You will have the means to measure.
b.titrate the flow rate . The CE will tell you the drip rate. This is just like titrating an IV.
c.if this is an NG tube`the location will need to be verified. NG tubes are tricky little devils . They are slender slippery things that can curl up and end up at very inconvenient places, like the lungs soooooooooo we will verify it is indeed in the stomach!!by one of the following methods:
1) aspirates stomach acid using a syringe AND checking gastric PH if indicated.Be sure to note amount of residual because there may be parameters for holding a feeding .Reinstill the stomach acid. I have heard some nurses reason that if they discard the excess contents they can proceed with the feeding ,but doing this will cause electrolyte imbalances. OR
2)instilling 10-20 ml of air (5 ml for kids under 2) while auscultating for the "gurgle"
The hospital MAY also have a policy re: Gtubes or j tubes, so unless you are told, ASK.
d.measures residual...regardless of need to check placement.
e.reinstills...be sure to keep the syringe attached or you have to count it as output and intake.
f.you have a 30 minute window in which to give the feeding of its scheduled time...just like a medication.
g. gives feeding at correct rate by either regulating the drip rate or entering the correct number on feeding pump. There is a +/- 5 gtt per minute margian of error.
6.for a continuous feeding:
OK kids this portion is part of the 20 minute checks!! YOU NEED to verify the rate of flow within 20 minutes of implementation phase by either counting the drops per minute of the formula already up OR by documenting the flow rate setting on the feeding pump onto the PCS form...THEN regulate the drops.
You still will need to verify the NG (and perhaps other tubes) at least once during the PCS by the afore mentioned means as well as checking residual (only if indicated for continuous)
7. record everything:amount ,type,strenth,rate,anything pertaining to gastric content as well as how they tolerate it.
posted by taming the beast at 7:43 PM
1 Comments:
Post note. There will also be a designated flush AFTER an intermittent feeding. Check the assignment sheet for the exact amount. It makes sense to me to flush before but it is not part of the critical elements. Remember EVERYthing is intake that is finished during your implementation phase, formula, flushes,or coffee on the tray.
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