Tube Feeding Question

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I know we have been taught to STOP/HOLD a tube feeding whenever we place the patient flat for short term procedures like baths, turning, etc. But I want opinions if this ritual makes sense and why. For example, to place a patient flat for pulling up in bed, say 5 minutes for a fresh pad etc. why stop the tube feeding since the patient will be getting maybe 5 cc of feeding more or less. I understand it is policy normally to DO this but what is your opinion of the science behind it? One GI doctor told me it really does not matter or make sense for a few minutes if the feeding is 75cc/hr or less. Another GI doctor said absolutely hold it but could only say "that is the policy" but could not explain how a few cc's for short term would lead to emesis or aspiration. Your thoughts pro/con/whatever. And if you have any case studies/science behind it not just "it's policy where I work". Thanks my colleagues for any thoughts.

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I don't know. I love your question.

I hate the many things nurses do that when you stop and think about it make no sense. I'm afraid no one is going to bother to do a long term study on your question. In other words I would be surprised if you get a clear black and white answer.

One doctor or nurse will say this, another will say that. One institution's policy will say don't hold the feeding, another institution's policy will say hold the feeding. If it is your policy you are stuck with doing it in spite of it not making sense or even a doctor saying you don't need to do it.

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it's not just about emesis or aspiration, it;s because of acid reflux. Thats the #1 reason when i was g-tube trained to stop/hold a feeding.

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Huh? Explain the relationship with acid reflux? Never heard that but glad to hear your views. The only rationale I have ever heard is the threat of emesis or aspiration but again want to stress if this makes sense for the few cc's that come out of a tube in 5 minutes more or less. Don't want to stifle your thoughts however as maybe you have the answer...thanks.

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Specializes in Medicine.

Here is an article I found helpful. Hopefully it works!

http://www.healthsystem.virginia.edu/internet/digestive-health/nutritionarticles/apr03opillaarticle.pdf

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Specializes in Psych/CD/Medical/Emp Hlth/Staff ED.

While it would be nice to see more research on everything we do, the rationale behind this is pretty strong. With a feeding tube in, the sphincters that normally prevent stomach contents from flowing back up to the level of the trachea are kept open due to the feeding tube. With liquid stomach contents and nothing preventing retrograde flow, it's easy for a patient to aspirate tube feeding even if flat for only a few minutes.

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actually.....I was taught that the feed should be shut off 30 minutes prior to putting patient flat for more than a minute or two.....and of course with a G-tube, the thought about retro grade flow is moot.

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Specializes in ER, ICU.

I've thought the same thing myself. Let's say they have 30ml in there. You roll them for a linen change which might take 3 minutes. In that time, your TF running at say 30ml/hr would have infused 6ml. But, what if you get called away and come back to find TF drooling out of their mouth? My interpretation is that it is just a good habit. By turning it off you don't have to take the time to think what was their last residual, how fast is the infusion, how long will they be supine? It's like putting your seat belt on for a short trip. Hopefully it is just a habit to minimize the risk of aspiration, hope this helps. So, I see your point, but on my watch I try to do everything to maximize safety.

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Specializes in Psych/CD/Medical/Emp Hlth/Staff ED.

The rate is only one factor. If you had just started the tube feed when the patient is laid flat, then only the amount infused during that time would be the amount in the stomach that could aspirate. But since tube feeding does not pass through the stomach instantaneously, you also have to consider the residual tube feeding still in the stomach when the patient is laid flat, which is usually far more than the few cc's that will have infused during the time the patient is flat.

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Specializes in CVICU-ICU.

Very good question and the reason most nurses say to do it is the usual "thats what I was taught" however there really is no rationale that makes sense to me anyway. I will explain my reasoning and I would be interested if someone could explain why my reasoning isnt right other than its what we've all been taught.

Lets say the feeding is running at 40 cc/hr and I am going to lay the patient flat for a 2-5 minutes turn/linen change...the stomach will already have tube feed in it that hasnt absorbed yet so therefore even if the feed is turned off there is still a chance that whats in the stomach could cause aspiration. Now if you were to tell me that its been turned off for 30-60 minutes prior to a turn that I could understand because the feed has had time to absorb.

Nurse2033--your reasoning makes sense to be because you are thinking ahead of possible things that could happen that would cause the patient to be flat for longer than 2-3 minutes so thats a good rationale.

HamsterRN---Im curious to hear your strong rationale because even if the feed is off while turning there is still stomach content that could cause aspiration.

I did have someone explain to me once that the reason we do it is not so much to prevent the stomach contents for being aspirated but that there is a chance that the actual tube could migrate into the lungs while patient is supine and therefore that would cause the feed to flow into the lungs...now that makes sense however if we go with that logic that would mean we should check placement of the tube each and every time we reposition the patient.

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Specializes in Psych/CD/Medical/Emp Hlth/Staff ED.

HamsterRN---Im curious to hear your strong rationale because even if the feed is off while turning there is still stomach content that could cause aspiration.

That was actually my point; it's not just the rate of infusion that needs to be considered due to the stomach contents, which is why the policy where I work is that it is to be off for 30 minutes prior to laying the patient flat.

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Specializes in NICU, Post-partum.
I know we have been taught to STOP/HOLD a tube feeding whenever we place the patient flat for short term procedures like baths, turning, etc. But I want opinions if this ritual makes sense and why. For example, to place a patient flat for pulling up in bed, say 5 minutes for a fresh pad etc. why stop the tube feeding since the patient will be getting maybe 5 cc of feeding more or less. I understand it is policy normally to DO this but what is your opinion of the science behind it? One GI doctor told me it really does not matter or make sense for a few minutes if the feeding is 75cc/hr or less. Another GI doctor said absolutely hold it but could only say "that is the policy" but could not explain how a few cc's for short term would lead to emesis or aspiration. Your thoughts pro/con/whatever. And if you have any case studies/science behind it not just "it's policy where I work". Thanks my colleagues for any thoughts.

How long could it possibly take to stop/restart a feeding?

I can tell you exactly the reason and I'm surprised that the GI physician didn't think it was necessary...because it is absolutely necessary.

Your risk of regurgitation is the greatest right after a meal.... and depending on their condition, it may be a little of the feeding or they could projectile it right out...then you have the risk of aspiration right behind it.

If you have neuro patients, "no tone" on the outside very frequently equals reduced tone on the inside...that means that the sphincter designed to keep the feeding into the stomach (which remains partially open from the tube), may not be functioning properly....this too, increases regurgitation and aspiration risk.

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