Tube Feeding Using the Bolus Method (Nursing)

00:00 Alright, so I want to show you a bolus feeding, for example. So, one thing to keep note, I want my patient's head of bed at least 30 degrees. So I'm also going to give them a little bit of protection here just in case anything spills. And again, I want to talk about positioning for your patient. Anytime tube feeding is going, a bolus feeding, or enteral feedings, the head of the bed of the patient should be at least 30 degrees. Now, this is really important for aspiration and we want to reduce that risk. So remember, head of bed up anytime you deliver anything through their tube. Okay, so now let's take a look at a bolus feeding. So, we have our piston syringe here and I'm going to take this out. Alright, so a couple of different places. You can either put the med port but sometimes this med port is not even there on these valves so I'm going to put it in this piece. And this fits just snugly right in here.

01:13 Now, I'm going to make sure my Lopez valve is turned on. So again, you see those arrows are nice and turned that way. So we can open up the flow. Okay, so if you need to check if the patient's nasogastric tube is in the right place, you can always take the piston syringe and pull back and check for gastric contents. But for this demonstration, it's already in place. Okay, so now I've got my piston syringe on here. Before we do anything, we want to make sure we clear and flush out the tubing. So this is just normal tap water. So one thing also to note when you're putting in tap water for someone's GI system, try to do something lukewarm, maybe something doesn't shock their system. So here's a little bit of tap water.

02:06 Be careful not to spill. And I'm going to make sure and then we're going to deliver this to the patient. Now, how you see me doing this at this point, I'm holding it high, letting gravity do its job and let that going into the tubing. So it's up to you on how you do this. I try to do it by gravity if at all possible, but if your tube feeding or your flush needs a little help, you can always put the piston syringe in here and gently press down. So now that I've flushed with my tubing, I'm going to take my tube feeding and I'm going to administer that. Now many times when you're flushing a nasogastric tube, sometimes the physician's going to order a specific amount of flush, so pay attention for that. And then remember, it's just normal tap water. So now I'm going to give my bolus tube feeding. So, again, I'm going to use this by gravity, I'm not going to force it too much and this one may need a little help and just so you can see that. I'm going to take my piston, put this in here and gently apply pressure. So one thing I want you to see, notice how after the tube feeding is in the tube, I don't want to keep pushing because all of this air is going to go in to their abdomen. So as soon as the tube feeding is in, I'm going to let go or actually even better let me stop, turn off my stopcock so I don't push a bunch of air, I'm going to take out my piston plunger, then I'm going to turn this back on straight for the flow and then I'm going to flush tap water through the tube. And this one may need a little help. And so we're going to take our piston and you see just very light pressure is all it needs to flush the line. And then once that's in, I'm going to turn my Lopez back to my off position and I'm going to disconnect my tubing.

04:37 And then make sure I put the cap back on. Alright, so that's a good demonstration of a bolus feeding. And again, it's usually a set amount, a set type of nutrition, and a set amount of water that maybe your patient needs for nutritionally or hydration. And real quick before we go, I want to show you one last thing. So with continuous feeding, most of the time you're going to see it out of a bag or something like this and it's going to be controlled by the pump. It's really nice because you're going to be able to deliver the tube feeding and program how much you need then you're going to be able to program how much water also you need to flush behind it, and the pump does it all for you. One quick thing I just want to show you is how it connects. So depending if it's by gravity or by pump, the connection's pretty much the same. So at the bottom of the tubing, just like you saw earlier, we're going to disconnect this, we're going to take this off and we're going to put this in here on the feeding port, make sure it's in securely, and don't forget to turn on your Lopez valve.

05:44 So that's why continuous tube feeding is going to look like. So one quick note about continuous tube feeding. Your physician will typically let you know what rate they want it at.

05:54 Now know that we don't start continuous tube feeding at the exact rate that the physician asked you to do it. So that may sound kind of crazy but what we will do is titrate slowly up to that goal rate that's ordered by the physician. Now we do that because we want to make sure the patient is tolerating that feeding. So here is a great example. Maybe the physician wants the continuous tube feeding to run at 50 ml per hour. We will not start it right at 50 ml per hour right when we start the new tube feeding for the patient. We may start it at like 10 or 15, and there are some variations on this, 10 or 15 ml per hour. Give it maybe an hour or so, come back and check, make sure the patient's lung sound clear, the respiratory status is okay, and they're digesting properly. Now, if they're still doing well we may up that about another 10 or 15, and we will do this slowly and assess our patient to make sure they're tolerating their feeding.