ENTERAL FEEDING -Primary care provider orders the type and frequency of amounts to be administered.

- Standard formula: 1 Kcal per milliliter of solution with protein, fat, carbohydrates, minerals and vitamins in specified proportions. - can be given intermittently or continuously. Intermittent feeding- administration of 300 to 500ml of enteral formula several times per day. - Stomach is the preferred site for this feeding. - Distension and aspiration should be monitored. Continuous feeding- generally administered over 24hour period using infusion pump that guarantees constant flow rate. - Used when small bore gastric tubes are in place or when gravity flow is insufficient to instill the feeding. Cyclic feeding- continuous feeding that are administered less than 24hours. - Indicated with administration at night, allow the client to eat regular meals through the day. Open system- use an open top container or syringe for administration. Provided in flip to cans or powdered formulas that are reconstituted with sterile water. - Should have no more than 24hours poured at one time Closed systems- prefilled container that can hang safely for 48hours if sterile technique is used. Before: 1. Determine food allergies 2. Assess clinical signs of dehydration and malnutrition. 3. Assess tolerance to previous feedings. 4. Check for expiration date on commercially prepared formula Equipment: 1. Correct type and amount of feeding solution 2. 60ml tip syringe 3. Clean gloves 4. Large syringe or calibrated feeding bag 5. Measuring container from which to pour the feeding 6. Water at room temperature Procedure: 1. Introduce self and verify the clients identity using agency protocol. 2. Perform hand hygiene and observe infection control procedures 3. Provide privacy foe this procedure if the client desires. 4. Assess tube placement. 5. Assess residual feeding content. 6. Administer the feeding. Feeding bag - Hang labeled bag from an infusion pole about 30cm above the tubes point of insertion into the client. - Clamp the tubing and add the formula to the bag. - Open the clamp, run the formula through the tubing and reclamp the tube. - Attach the bag to the feeding tube and regulate the drip by adjusting the clamp to drop factor on the bag.

Syringe - Remove the plunger from the syringe and connect the syringe to a pinched or clamped NGT. - Add the feeding to the syringe bottle. - Permit the feeding to flow in slowly at the prescribed rate. RAISE OR LOWER THE SYRINGE TO ADJUST THE FLOW NEEED. Pinch or clamp the tubing top stop the flow for a minute if client experiences discomfort. Prefilled bottle with deep chamber - Remove the screw on cap from container and attach though administration set with drip chamber and tubing. - Close the clamp on the tubing - Squeeze the drip chamber to fill it to one third to one half it capacity - Open the tubing clamp run the formula through the tubing, and reclamp the tube. - Attach feeding set to the feeding tube and regulate the drip rate to deliver the feeding over the desired length of time or attach to a feeding pump. 7. If another bottle is not immediately hang, flush the feeding tube before all the formula ha run through the tubing. 8. Clamp the feeding tube 9. Ensure client comfort and safety 10. Dispose of equipments properly 11. Document all relevant information