Feeding tube/position

Nursing Students CNA/MA

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I have a resident with a feeding tube. I know he needs to be upright at least a 40degree angle when connected.

He has skin break down on his bottom. He is in his wheel chair most of the day because of "school" and in the bed evenings with the feeding tube connected. He is severly retarded and cannot communicate much at all.

My question is, Can he be placed on his side when the feeding tube is connected while at a 40deg angle? He seems to really like being on his side and will attempt to roll on his side (but can't without assistance). And with the skin break down on his bottom.......

Each nurse I ask, I get a different answer.

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At my facility, we do a 30 degree tilt

Ask your nurses if that is acceptable. The priority is to prevent the client from aspirating his feed. Make sure every single nurse you work with is aware of the skin breakdown. They need to start putting in place a plan to prevent it from getting worse.

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We also do a 30 degree angle but we still reposition every 2 hours from back to right to back to left, even during the feed.

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We do a 30 degree angle, as well...but you still need to reposition at least every two hours - maybe more often because of the breakdown (when we have residents with skin issues or who are high risk for skin issues, we reposition every 1 hour). Is there any way you could reposition him while in his wheelchair, as well? Sitting up on his bottom for hours without moving isn't good for the breakdown, either. I agree with the PP - make sure the nurses who work with him are aware of the breakdown.

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Turning while in an upright position is possible with a feeding tube, just be sure that the tube is not kinked, coiled, or obstructed in any way during the position change. It is important to turn to prevent skin breakdown and respiratory issues. You can ask the nurse to check to see if there is a cushion for the wheelchair to take some of the pressure off of the client's bottom.

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Specializes in Acute Rehab, IMCU, ED, med-surg.

It sounds like your facility may not have a policy for this, but you should check nonetheless. Failing that, HOB at least 30 degrees and Q2 hour repositioning (can do this even when resident is in the chair - use a folded sheet under the resident's bottom as a mini "draw" sheet and tuck the pillow under that if the resident is heavy or has a hard time being tilted to reposition. Bless you for being caring about skin and pressure ulcers! :yes:

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I have a resident with a feeding tube. I know he needs to be upright at least a 40degree angle when connected.

He has skin break down on his bottom. He is in his wheel chair most of the day because of "school" and in the bed evenings with the feeding tube connected. He is severly retarded and cannot communicate much at all.

My question is, Can he be placed on his side when the feeding tube is connected while at a 40deg angle? He seems to really like being on his side and will attempt to roll on his side (but can't without assistance). And with the skin break down on his bottom.......

Each nurse I ask, I get a different answer.

The simple answer is yes....left side over the right. Think about the position of the stomach and lying on the right side might make aspiration more likely. Bless you for caring about your patient. Be sure to check with hisw nurse that there si not another reason why he can't lie o n his side.

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Very simply put, make sure patient is at least 30 degrees for duration of tube feeding and at least an hour after meal. Second, turning from side to side does not matter at all. Not quite sure what Esme12 was talking about when they said "left over right" and the decreased chance of aspiration if on the left side. Visualize the stomach and on the right side of the stomach is the pyloric sphincter (the valve that goes from the stomach to the small intestine), so the patient being on the right side could facilitate more stomach emptying and DECREASE the chance of aspiration into the lungs. So, in the end does not matter, just make sure the tubing does not become kinked or misplaced when repositioning and keep that HOB up to 30 degrees throughout and an hour after tube feeding.

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Thank you for all your answers. The nurse knows about the break down. The resident leaves the facility for about 7 hours a day for "school". He is "out of our care" for that amount of time and in the care of another program. His wheel chair tilts back. I have no idea what they do at "school" since he comes and goes before my shift.

I do position him at least every 2 hours. I just wanted to make sure it could be done on his side. He seems to really like laying on his side. When he sees me come in his room he will turn his top half of his body to the side...all I have to do is get his bottom half into position. :)

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I think the school needs to be repositioning him as well. Home and school must be on the same page. Does he get changed at school?

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