Gastrostomy Tube Feeding - Skills Checklist
Form Title
Date
-
Month
-
Day
Year
Date
Skilled Nurse's Name
First Name
Last Name
Nurse's Email
example@example.com
Manager's Email
example@example.com
Competency Validation Checklist
*
Knowledgeable
Demonstrated
Instructed
Some Follow up needed
1. Washes hands
2. Explains procedure to child
3. Gathers equipment and supplies.
4.Prepares formula and additives/medications as ordered. Pours formula into enteral feeding bag, if not using RTH set. Fill tubing with formula and clamp tubing.
5. Positions infant/child with head elevated if tolerated. Elevate HOB; hold infant/toddler in lap or place in infant seat; place toddler/child in high chair or seat.
6. Provides infant with pacifier, if tolerated.
7.Inspects tube insertion site and surrounding stoma/skin.
8. Unclamp the gastrostomy tube
9. Verifies proper tube placement. Measures length of external tube. Checks for residual of previous feeding. If residual present, measures amount and proceeds with feedings/holds feeding/delays feeding per physician order/ agency protocol. Test pH of residual, per agency protocol.
10. Attaches large catheter tip syringe, with plunger removed to the end of the gastrostomy tube for bolus feeding. Attaches enteral feeding tubing for enteral pump feeding or gravity feeding.
11. Fills syringe with formula. Initiates bolus feedings as needed with gentle push of syringe plunger, but removes plunger and completes feeding by gravity only. Adds formula gradually to provide complete volume ordered.
12. Regulates flow of formula by adjusting height of syringe, monitoring child's response and adjusting rate of flow as needed.
13. Rinses gastrostomy tube with small amount of water to prevent tube from clogging.
14. Clamps tube.
15. Removes syringe/tubing from gastrostomy tube.
16. Verifies tube placement and secures tube to abdomen to minimize movement.
17. Keeps child positioned with head elevated on right side for 30 minutes following feeding.
18. Documents indication for procedure, conducting procedure and patient's tolerance of procedure.
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