Nursing management of enteral tube feedings

Abstract

To describe the management practices of nurses when providing care to patients receiving enteral tube feedings. A descriptive study was conducted with use of questionnaires distributed to registered nurses (RNs). A midwestern university medical center. A total of 235 questionnaires were distributed to RNs. Two hundred nineteen were considered eligible and 180 were usable. This represents an 82% response. A 43-item questionnaire with a return envelope was placed in the mailbox of RNs. Descriptive statistics were used to analyze data. (1) Checking the flow rate of enteral feeding: Flow rates were checked between 1 to 4 hours by 70% of the nurses, whereas 16% checked every 8 hours, and the remaining 14% checked every 12 hours or longer. (2) Flushing the enteral tube: Ninety-four percent of respondents indicated they regularly flushed the enteral tube before each feeding (29%), after each feeding (43%), and every 4 hours (59%). The types of irrigants that were used for flushing included tap water, sterile water, and sterile normal saline solution. (3) Method of unclogging obstructed tubes: An irrigant solution is the primary intervention reported by nurses to unclog tubes (94%). The types of solutions reportedly used most frequently were carbonated beverage (81%), sterile water (49%), dissolved papain (46%), and tap water (42%). (4) Checking residuals: Most RNs (95%) reported that they check residuals every 4 hours; of these, 50% stated they discard residuals, and 49% stated that they readminister residuals. In regard to the volume of residual deemed to be excessive, 50% of the respondents stated that an amount greater than or equal to 100 ml is excessive. (5) Administering medications: Flushing the enteral tube with water is reported to be done before (47%) and after (95%) giving medicines. When multiple medicines are given, 38% report flushing the enteral tube between each medication. The findings of this self-report study suggest that practices regarding management of enteral feedings vary widely among nurses.