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Enteral Feeding
& Aspiration Precautions

How to safely deliver nutrition through a feeding tube while protecting the airway from aspiration.

NCLEX-RN

What Is Enteral Feeding?

Enteral feeding delivers liquid nutrition directly into the gastrointestinal (GI) tract through a tube. It is used when a patient cannot eat by mouth but still has a functioning GI tract.

Common Feeding Tube Types

NG Tube
Nose to stomach. Short-term use (< 4–6 weeks).
NJ Tube
Nose to jejunum. Bypasses stomach to reduce aspiration risk.
PEG Tube
Surgically placed into stomach. Long-term use.

What Is Aspiration?

Pharynx Esophagus (to stomach) Trachea (to lungs) Aspiration = into lungs

The Core Rule: Elevate the HOB

\(30^\circ-45^\circ\)
Head of Bed (HOB) raised

Verify Tube Placement

1
X-ray is the gold standard for confirming initial placement of a new NG tube before first use.
2
Check gastric pH (aspirate fluid): a pH of \( \leq 5.5 \) suggests stomach placement.
3
Check the external tube marking at each use to confirm the tube has not migrated.

Key Distinction: Gastric Residual Volume

Gastric residual volume (GRV) is the amount of formula left in the stomach. High GRV means the stomach is not emptying, which raises aspiration risk.

Low GRV
Stomach emptying well. Continue feeding as ordered.
High GRV
Often \( \geq 250\text{ mL} \) (per policy). Hold feeding and reassess.

How to Administer a Feeding

1
Position: Raise HOB to \(30^\circ-45^\circ\) and verify tube placement.
2
Check GRV per policy; hold if elevated.
3
Flush the tube with water before and after feeding to maintain patency.
4
Administer room-temperature formula at the ordered rate.
5
Keep HOB elevated 30–60 min after feeding; document.

Example 1: Coughing During Feeding

A patient receiving a continuous tube feeding begins coughing and showing decreased oxygen saturation. What is the nurse's first action?

Example 2: High Residual Volume

Before a scheduled bolus feeding, the nurse aspirates 300 mL of gastric residual. Facility policy says hold for GRV \( \geq 250\text{ mL} \).

1
Hold the feeding (\(300 \text{ mL} \geq 250 \text{ mL}\)).
2
Return the aspirate to the stomach to preserve fluids and electrolytes.
3
Reassess in 1 hour and notify the provider if it remains elevated.

Example 3: Clogged Tube

A feeding tube becomes clogged and the pump alarms. What should the nurse do?

Common Mistakes

✕ Lying Flat
Feeding with the HOB flat (or lowering it after) greatly increases aspiration risk.
✕ Skipping Placement Check
Feeding without confirming tube position can deliver formula into the lungs.
✕ Trusting Air Auscultation
The "whoosh" air-bolus method is unreliable as a sole confirmation.
✕ Discarding Aspirate
Throwing away gastric residual wastes fluids and electrolytes.

Quick Reference Table

Action Standard
HOB elevation\(30^\circ-45^\circ\) during and after feeding
Keep upright after30–60 minutes
Placement confirmationX-ray (new tube); pH \( \leq 5.5 \)
Hold for GRVOften \( \geq 250\text{ mL} \) (per policy)
If aspiration suspectedSTOP feed, suction, assess
Tube patencyFlush with water before & after

You're Ready to Test Yourself

Question 1 of 5

During a tube feeding, the nurse should keep the head of the bed elevated to which range?

Question 2 of 5

A patient on continuous feeds suddenly coughs and the \( \text{SpO}_2 \) drops to 88%. What is the nurse's first action?

Question 3 of 5

Which method is considered the gold standard for confirming initial placement of a newly inserted NG tube?

Question 4 of 5

The nurse aspirates 320 mL of gastric residual before a bolus feeding (policy: hold if \( \geq 250\text{ mL} \)). What should the nurse do?

Question 5 of 5

What is the best way to maintain patency and prevent a feeding tube from clogging?

Great Work!