1 00:00:01,070 --> 00:00:06,710 Before providing an enteral feeding, obtain the patient's baseline weight and laboratory test results. 2 00:00:07,629 --> 00:00:13,750 Also check the details of the physician's order for the tube feeding and x-ray results for verification of tube placement. 3 00:00:14,410 --> 00:00:20,609 Then check the expiration date on the formula and the integrity of its container, and bring the formula to room temperature. 4 00:00:23,289 --> 00:00:26,850 Next, use tape to secure the tubing to the patient's cheek. 5 00:00:27,269 --> 00:00:47,119 If you're not using a ready-to-hang container, be sure to shake the container thoroughly to mix the formula. 6 00:00:47,520 --> 00:01:08,799 put on clean gloves. Next, 7 00:01:08,799 --> 00:01:12,480 connect the tubing to the feeding bag using aseptic technique. 8 00:01:12,480 --> 00:01:17,420 This nurse is using a Lopez valve to connect the feeding bag to the Dobhoff 9 00:01:17,420 --> 00:01:17,900 tube. 10 00:01:17,900 --> 00:01:36,219 Now fill the feeding bag with the formula 11 00:01:36,219 --> 00:02:03,329 and hang the feeding bag on an IV pole. Then prime the tubing 12 00:02:03,329 --> 00:02:08,270 and let the formula flow through it. Priming is complete when no air remains 13 00:02:08,270 --> 00:02:09,030 in the tubing. 14 00:02:09,030 --> 00:02:12,270 Thread the tubing through the pump 15 00:02:12,270 --> 00:02:41,849 and connect the feeding tube to the Lopez valve. Program the pump with the 16 00:02:41,849 --> 00:02:42,849 prescribed rate. 17 00:02:42,849 --> 00:02:51,289 Place the patient in a high Fowler's position or elevate the head of his bed 18 00:02:51,289 --> 00:02:52,870 to at least 30 degrees. 19 00:02:52,870 --> 00:02:56,530 Maintain this position for an hour after feeding if possible. 20 00:02:56,530 --> 00:03:02,669 If he must remain supine, place him in the reverse Trendelenburg position. 21 00:03:02,669 --> 00:03:06,310 If feeding through a nasogastric tube, you will need to check for a gastric 22 00:03:06,310 --> 00:03:08,030 residual. 23 00:03:08,030 --> 00:03:13,629 To do this, draw up 30 milliliters of air in a catheter-tipped syringe. 24 00:03:13,629 --> 00:03:18,719 Connect it to the end of the feeding tube and inject the air. 25 00:03:18,719 --> 00:03:25,199 Then pull back evenly to aspirate all of the gastric contents. 26 00:03:25,199 --> 00:03:29,219 After noting the amount of the aspirate, verify the feeding tube placement 27 00:03:29,219 --> 00:03:32,900 by checking its pH and appearance, as shown in the video skill, 28 00:03:32,900 --> 00:03:37,639 inserting a nasogastric tube. 29 00:03:37,639 --> 00:03:40,500 If you're using a syringe for an intermittent feeding, 30 00:03:40,500 --> 00:03:46,210 Have the syringe ready and the formula at room temperature. 31 00:03:46,210 --> 00:03:48,870 To administer a bolus or syringe feeding, 32 00:03:48,870 --> 00:03:52,069 pinch the proximal end of the feeding tube. 33 00:03:52,069 --> 00:03:54,150 Remove the plunger from the syringe 34 00:03:54,150 --> 00:03:57,389 and attach its barrel to the end of the tube. 35 00:03:57,389 --> 00:04:00,550 Then fill the syringe with the measured amount of formula 36 00:04:00,550 --> 00:04:12,400 and release the pinched tube. 37 00:04:12,400 --> 00:04:16,259 Raise the syringe up to 18 inches above the insertion site 38 00:04:16,259 --> 00:04:22,569 and let it empty gradually by gravity. 39 00:04:22,569 --> 00:04:24,689 Refill the syringe and administer the feeding 40 00:04:24,689 --> 00:04:29,310 by gravity as needed until the prescribed amount has been given. 41 00:04:29,310 --> 00:04:35,949 To prevent gastric distention, don't let air enter the tubing from the syringe. 42 00:04:35,949 --> 00:04:40,689 If the patient needs an intermittent feeding or continuous drip feeding, attach the tubing 43 00:04:40,689 --> 00:04:52,240 to the proximal end of the feeding tube and set the infusion rate. 44 00:04:52,240 --> 00:04:57,439 Label the bag with the type, strength, and amount of the tube feeding, and with the date, 45 00:04:57,439 --> 00:05:05,449 time, and your initials. 46 00:05:05,449 --> 00:05:09,990 For intermittent feedings, start at the full strength or the ordered concentration for 47 00:05:09,990 --> 00:05:12,629 isotonic formula. 48 00:05:12,629 --> 00:05:18,050 Infuse the formula over at least 20 to 30 minutes by syringe or feeding bag. 49 00:05:18,050 --> 00:05:23,250 Begin with no more than 150 to 250 milliliters per feeding. 50 00:05:23,250 --> 00:05:27,569 Increase by 50 milliliters per feeding per day to provide the correct volume and calories 51 00:05:27,569 --> 00:05:30,889 in 6 to 8 feedings daily. 52 00:05:30,889 --> 00:05:35,509 For continuous feedings, start at the full strength or the ordered concentration for 53 00:05:35,509 --> 00:05:37,610 isotonic formula. 54 00:05:37,610 --> 00:05:41,949 Start hypertonic formula at full strength and a slower rate. 55 00:05:41,949 --> 00:05:45,370 Infuse the formula at the prescribed rate. 56 00:05:45,370 --> 00:05:50,129 Increase the rate slowly each day to the target rate if tolerated. 57 00:05:50,129 --> 00:05:55,009 Administer water via the feeding tube as ordered or between feedings. 58 00:05:55,009 --> 00:06:01,639 When tube feedings are not being administered, cap the proximal end of the feeding tube. 59 00:06:01,639 --> 00:06:06,540 As part of your follow-up care, monitor the patient's intake and output at least every 60 00:06:06,540 --> 00:06:07,399 eight hours.