Page 33 - Critical Care Notes

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Nursing Care of the Patient Receiving Enteral
Feeding
■ Use hand hygiene and gloves when setting up or changing feeding
administration set.
■ Label with date, time, and nurse’s name initials on all facets of the
administration set.
■ Sterile premixed formula should hang for <8 hr or per policy.
■ Reconstituted formula exposed to room temperature should hang for
<4 hr or per policy.
■ Check expiration date on formula can.
■ Change administration sets every 24 hr or per policy.
■ Flush tube with water only; avoid juice and carbonated beverages. Flush
tube with 30 mL water every 4 hr for continuous feedings, before and after
intermittent feedings, and after checking residual volume measurement.
Flush with 15 mL water before and after each medication administration.
■ Keep HOB elevated 30°–45°.
■ Consider hanging IV fluids at the head of the bed only. Use foot of the bed
to hang enteral feedings.
■ Assess and monitor serum glucose levels.
■ Assess fluid and electrolyte status. Assess hydration.
Checking Tube Placement
Assessing tube placement continues to be controversial as caregivers try to
balance reliability or accuracy and costs. The following are suggested methods
for verifying enteral tube placement.
■ Obtain chest x-ray or abdominal x-ray. Gold standard for verifying place-
ment. Always obtain, and have someone verify, enteral tube placement
after, initial placement.
■ Aspirate gastric contents and check pH.
■ Gastric aspirate pH 1–5 in fasting patients but may be as high as 6 if
patient is taking medication to reduce gastric acid (famotidine, ranitidine,
pantoprazole).
■ Commercially prepared formulas have a pH close to 6.6.
■ Respiratory secretions have pH >6.
■ Small intestine aspirate pH >6.
■ Visually inspect gastric aspirate. May aspirate only feeding tube contents.
Color varies.
■ Mark location of exit site and note external tube length upon insertion of
feeding tube. Does not necessarily indicate location of tube on subsequent
inspections.
■ Inject 20–30 mL of air into the tube while auscultating over the epigastrium
below the diaphragm. Air in the stomach can be heard via a whooshing
sound. Considered unreliable.
BASICS