Enteral Feeding

Specialties MICU


Specializes in Leadership/Critical Care/Surgery/Seniors.

We are updating our enteral feeding procedures. I can't believe the controversies and variations in practice in this topic! Would appreciate your comments on what your facility does with the following issues

1) How do you assess tolerance?

2) What do you use to flush?

tap water/NS/distilled water? why?

3) Do you aspirate small bore tubes placed in the stomach? One surgeon here wants nurses on the surgical floor to aspirate a J-tube!

Thanks a bunch

Hi Stormy,

We aspirate feeding tubes q4h, and if the aspirates are greater than 150ml, return to patient and hold feeds times four hours. WWe do try and aspirate small bore tubes but not always successful, same with G-tubes. Have never aspirated a J tube, it really shouldn't matter.



on our unit it depends on the dr's order, how much per hour the feed is set at etc.... the general rule is we hold for residual twice the amount of the hourly rate and call the doc. flush only with tap water and put back whatever residual you get, it upsets the ph balance of the stomach.


I work with pedi's so my info may vary but,

1) How do you assess tolerance? Check VS & BBS before and after feeds.

2) What do you use to flush? Tap water, unless contraindicated, ie distilled water for a CF or DI child -- cannot tolerate even trace additions of electrolytes. Never NS, because no need to add that expense to the patient.

tap water/NS/distilled water? why?

3) Do you aspirate small bore tubes placed in the stomach? One surgeon here wants nurses on the surgical floor to aspirate a J-tube! Surgeons somtimes have short term goals that are miss represented by them and end up being long term assessments...No need to aspirate a j-tube in my professional opinion. BUT all other tubes are aspirated for content, amt, character. Replaced unless doc order to discard -- which is often an order for reflux babies. If return is in excess of twice the hourly rate then we hold feeds till consult with MD. Problem-- if the person behind you does not flush all meds, feeds out of line (even something as short as a mic-key) it WILL clog. Also, sm bores do not aspirate well, but do a tolerance assessment and ascultate while pushing in 3cc of air to fix the placement issues.

Thanks for your time

Hi..this might help please see the attachment....salmi

Our policy is as follows 1. aspirate for residual Q4hrs. if residual > the amount pt. receives in 4hours, return residual and turned pump off for 4hrs./ but recently some Docs have been writing specific orders on what to do if residual high.

2. We use flexiflow pump and system is two bags one for tube feeding supplement and the other we fill with water- the pump has an automatic time it delivers flush and it will deliver set amount otherprogramed into the pump. You can disable the flush option and change the amounts if ordered so.

3. No, we do not aspirate on sm.bore tubes placed in the stomachs. Surgeons preference

4. We also do bloodsugar checks bid for the first 48hrs.

Specializes in Leadership/Critical Care/Surgery/Seniors.

Thanks for all your help everyone. Our dieticians came up with the same algorithm as Salmi suggests. We have been trialling it in the unit, and it is going very well. We have reduced inconsistencies with our practice tremendously. Our new enteral feeding manual will soon be complete!

Thanks again.

Hi fellow nurses, can anyone help me I have being informed as an ex Team Leader that there is an RN out there who is telling support staff to plunge coke into PEG's, I know this is unacceptable but have no way of stopping this practice in the community, any ideas?? Mercadies

1 We aspirate Q4h, > 200, we discard and cut TF in half. 2nd time, TF off and MD notified.

2 We flush with sterile water simply b/c well, its sterile and is readily available for us

3 We dont aspirate small bore tubes, we insert an NG/OG as well to check residuals even if small bore is transpyloric, we do aspirate peg tubes but not j tubes

hope this helps!

never heard of coke into PEGS, but then again i'm not a nurse yet, but I have been a patient many times, and on an NG tube they often flushed it with coke to try and un clog it...is that what they are trying to do with the G tube?

hey Maripossa88, thanks for your response, I imagine that is what the goal is to unclog PEGS , but if the procedures were followed correctly ie medication admin then there wouldnt be a prob??? All I see would be disintegrated tubing and more costs with discomfort for the seriously impaired person on the receiving end.......

yeah, it was kind of weird that they used coke. they didn't have the automatic water flush when I was on an ng like some do in a seperate bag. They'd flush it with coke, it'd work for a little bit then they'd just end up changing the tubing anyway. Jevity can be pretty sticky, especially when the tube comes out at night and it gets all over your face :D

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