Routine gastric residual volumes (GRV) are not performed unless ordered by an Authorized Prescriber (AP), and the patient has other signs and symptoms of feeding intolerance. Symptoms of feeding intolerance may include:
Abdominal pain, firmness, or distention, or,
Feeling of fullness, or,
Nausea, vomiting, or diarrhea.
Confirmation of feeding tube position is required prior to starting enteral feed. Gastric fluid pH and x-ray are the gold standard for confirmation of tube placement (ASPEN, 2024).
Gastric fluid pH testing should occur:
Immediately before intermittent feeding, and,
Every 4-6 hours when continuous feeding can be paused, and,
At least 1 hour after any medication is given.
Confirm the tube's external length measurement every 12 hours, PRN (e.g., if out of place), and compare to the documented initial measurement.
Date and initial bedside enteral feed supplies upon opening. Replace enteral feed supplies every 24 hours or if contaminated.
Rinse syringes with tap water (depending on facility water practices) and allow to air dry.
Prepare medication for administration, individually, one at a time.
Do not combine medications when crushing or dissolving.
Do not use beaded components, enteric-coated tablets or extended-release capsules due to increased risk of clogging.
Consult with pharmacist regarding safety and efficacy of administering prescribed medication via the enteral access device route.
Monitor for early signs of occlusion and treat promptly.
Medications are never added to nutrition or flush bags for infusion.
Maintain the head of bed (HOB) at 30°- 45° angle (unless contraindicated) during continuous feeds and for at least 1 hour after intermittent feeds completion to reduce risk of aspiration.
Oral (toothbrushes, mouth rinses and approved oral lubricants) and nasal care (gentle cleansing with moistened q-tip and approved water-based lubricant) should be provided as frequently as needed to prevent drying of mucous membranes.
Supplemental information identified by clinical educators and/or leadership.
If provided, view a demonstration from an HCP competent in use of enteral pump in your practice setting. If not provided, request a demonstration from a colleague who is competent in the use of the enteral pump.
Use the DH Checklist feature (second tab, after Topic), include Pre, Procedure and Post, and save as PDF or print.
Demonstrate competency in skill by working with an Educator or another HCP competent in the skill to:
Complete, sign and date the Kangaroo OMNI™ Operations Checklist, and,
Review, observe, and demonstrate (with return demonstration) the DH skill using the Administering Pump-Assisted Enteral Nutrition, and,
Have the DH Checklist signed by an Educator or an HCP competent in the skill who has assessed your skill and agrees on your competency
The decision to be considered competent in the return demonstration(s) is mutually agreed upon by the HCP providing the demonstration and the HCP competent in the skill.
Save completed and signed checklists for your records.
To maintain competency:
Complete a competency self-assessment on an annual basis, or as needed if the skill is not part of your regular practice.
