Student: Person Trained:
School Nurse/Trainer: Position:
Feeding formula/solution): Amount:
Frequency (# times/day):______Time for each feeding: ______
Feeding to be completed in ______minutes Device Type:______Pump: _____Yes _____No
Position during feeding: ______After feeding:
Amount of water for flushing tubing: Burping/venting ordered: _____Yes _____No
Medication ordered: _____ before _____ after feeding _____ N/A Checking residual ordered: _____Yes _____No
Procedure/Skills / Initial Training / Explanation/Return Demonstration
Date / Date / Date / Date / Date
A. / States name and purpose of procedure.
B. / Properly prepares for feeding:
1. / Identifies student’s ability to participate.
2. / Reviews universal (standard) precautions.
3. / Reviews student’s IHP and each order by the healthcare provider, listed above.
4. / Understands feeding formula must be delivered at room temperature.
5. / Identifies where the procedure is done and
student’s activity level.
6. / Identifies possible problems and appropriate
actions.
C. Identifies supplies:
1. / Type and size of gastrostomy device.
2. / Feeding solution in container (bag) at room-temperature.
3. / 60 cc catheter-tipped syringe or other container for feeding; e.g., bottle or bag.
4. / Clamp or cap for end of tube.
5. / Pole to hold feeding container.
6. / Pump and IV stand (if used).
7. / Tap water, gloves, and tape.
D. / Procedure:
1. / Washes hands with soap and water.
2. / Assembles supplies/equipment.
3. / Positions student and explains the procedure.
4. / Washes hands, puts on gloves.
5. / Checks condition of G-tube site; e.g., for redness, bleeding, and/or leaking.
6. / If checking for residual is ordered, go to F.1.
Feeding Bag:
1. / Pours feeding/fluids into feeding container, runs feeding through tubing to the tip, and clamps tubing.
Procedure/Skills - Continued / Initial Training
Date / Explanation/Return Demonstration
Date / Date / Date / Date
2. / Hangs bag on pole at height required to deliver prescribed flow. (If pump is used, places tubing into pump and sets flow rate.)
3. / Connects tubing of feeding bag with G-tube.
4. / Opens clamp on tubing and adjusts flow to prescribed rate. (If pump is used, opens clamp completely.)
5. / For a continuous feeding with a pump, adds
more fluid to bag when empty.
6. / Checks rate and flow periodically and adjusts
if needed.
7. / When single feeding is completed (bag
empty), clamps feeding bag tubing, & removes.
Feeding with Syringe:
1. Removes plunger from feeding syringe and
inserts catheter tip of syringe into G-tube.
2. / Pours room-temperature feeding/fluids into syringe.
3. / Elevates syringe and unclamp tubing.
4. / Continues to pour feeding into syringe as contents empty into stomach.
5. / Raises or lowers syringe to adjust flow rate as ordered.
Flushes tubing, after feeding, feeding bag:
1. / Adds enough lukewarm water to feeding bag to clear formula from tubing and flushes the tubing.
2. / Clamps feeding bag tubing.
3. / Removes the feeding bag from G-tube.
Flushes tubing, after feeding, syringe:
1. / Pours prescribed amount of water into syringe
and flushes tubing.
2. / Removes the feeding syringe, after flushing the tubing with water.
If burping/venting the G-tube is ordered:
1. / Connects 30-60 ml. catheter-tipped syringe with barrel/plunger removed to the G-tube.
2. / When finished, removes barrel of syringe.
E. / Procedure after feeding and flushing:
1.. / Clamps tubing and reinserts cap into end of tubing.
2. / Applies dressing, if needed, using universal precautions
3. / Removes gloves, washes hands with soap & water.
4. / Makes sure tubing is secure and tucked inside clothing, not inside diaper or underpants.
5. / After feeding, positions (or resumes activity), according to student-specific guidelines.
Procedure/Skills - Continued / Initial Training
Date / Explanation/Return Demonstration
Date / Date / Date / Date
6. / Washes feeding bag/catheter-tipped syringe and
other reusable equipment with warm, soapy water. Rinses thoroughly, dries, and stores items in clean
area. Stores formula as instructed.
7. / Documents feeding, residual amount (if
ordered), and feeding tolerance on feeding log.
8. / Reports any changes in feeding tolerance to school nurse and parent/legal guardian.
E. Medication administration, if ordered:
1. / Administers medication before or after
feeding, according to student-specific IHP.
2. / Flushes tubing with water before or after administering medication, as ordered.
3. / Documents medication on medication administration record/log.
F. / Checks residual, if ordered:
1. / Before feeding, insert the catheter-tipped syringe (with plunger) to the adapter tubing.
2. / Unclamp the tubing and gently draw back on the plunger to remove any liquid or medication that may be left in the stomach.
3. / Return residual to stomach. Clampadapter tubing.
School Nurse Initials/Date:
Signature:
Attach to student’s IHP and file in IHR. Revised Sept. 1, 2016