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Nash-Rocky Mount Public Schools
Student Health Services
Gastrostomy Tube (G-Tube) Feeding Procedure
Gravity Bolus or Continuous Feeding by Pump Method
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A gastrostomy is a surgical opening into the stomach through the surface of the abdomen. A
flexible rubber tube (G-tube) or a gastrostomy-feeding device (G-button) is placed into the
opening and allows for nutritional formulas, fluids, and/or medications to be delivered directly to
the stomach. The device remains in place at all times and is closed between feedings to prevent
leakage of the stomach contents. Feedings are given by either the bolus (over 10-30 min.) or
continuous method (adjusting flow rate, using tubing valve or pump). An adapter with tubing is
connected to the G-button for feeding. The gastric device may also be used to release air/gas
and to measure/drain residual gastric contents.
G-Tube
Written healthcare provider orders/directions and parent/legal guardian permission and provision of formula are required for
tube feeding at school. Ready-to-feed commercial formula is recommended. Homemade blenderized formula recipes risk
inaccurate mixing, which may alter the nutrients and calorie content; separation of solids and liquids in the solution, which may
clog the tube; and contamination due to improper handling, preparation, or storage. If a blenderized formula is brought to
school, it should be refrigerated until mealtime and warmed to room temperature by holding the container with the formula
under warm water for several minutes. A microwave should not be used for this procedure due to its uneven heat distribution.
Procedure
1.
Wash hands.
2.
Assemble equipment:
 Formula at room temperature
 60-ml/cc catheter-tipped syringe or other container
for feeding (e.g., bottle, bag)
 Clamp or cap for end of tube (optional)
 Water, if prescribed  Feeding pump, if prescribed
 Tape
 IV Pole (optional)
 Gloves
Explain the procedure to the student at his or her level of
understanding. Encourage the student to participate as
much as possible.
Position student.
3.
4.
5.
6.
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8.
9.
Wash hands. Put on gloves.
Check G-tube site for redness, tenderness, swelling,
irritation, presence of pus, bleeding, or leakage.
If checking the residual is ordered:
 Insert the catheter-tipped syringe (with
barrel/plunger) to the G-tube.
 Unclamp the tubing and gently draw back on the
plunger to remove any liquid or medication that may
be left in the stomach.
 Return residual to stomach.
 Clamp tubing, disconnect the syringe, and remove
plunger from syringe.
Reinsert catheter tip of syringe into tubing.
Unclamp tube, and allow bubbles to escape.
Copies to designated staff and EAP Notebook. File original in IHR.
Points to remember
Anticipating the tasks to be done, the risk involved, and the
personal protective equipment needed will enhance protection
of both the caregiver and student.
Identify size and type of G-tube.
Some students get cramps if the feeding solution is too cold.
Shake can well to mix. Check expiration date.
Water is used to flush tubing after feeding.
Tape is used to secure the G-tube to clothing.
By encouraging the student to assist in the procedure, the
caregiver helps the student achieve maximum self-care skills.
Student may be sitting or lying on right side with head elevated
at a 30-degree angle. When positioning student, make sure
clamp is not pressing on skin.
Report abnormal findings to the school nurse, immediately.
Notify the parent/legal guardian.
Note the amount. Adjust the feeding volume according to
healthcare provider’s orders, if a residual is present. If the
residual is greater than recommended, hold feeding, wait 30–
45 minutes, and check again.
Revised Feb. 2016
Nash-Rocky Mount Public Schools
Student Health Services
Gastrostomy Tube (G-Tube) Feeding Procedure
Gravity Bolus or Continuous Feeding by Pump Method
Procedure for gastrostomy tube (G-tube) feeding: gravity bolus or continuous feeding by pump method (continued):
Procedure
Points to Remember
If medications are prescribed, administer before or after feeding, according to student-specific orders in IHP.
10. The feeding may be delivered by syringe, bag, or bottle.
Be alert to any unusual changes in the student’s tolerance of
Feeding Bag:
the feeding. Nausea/vomiting, cramping, or diarrhea may
indicate that the feeding is being given too quickly or the
 Clamp the tubing on the feeding bag and add roomformula is too cold.
temperature formula to the bag; then unclamp and
allow formula to fill the tubing to the tip; then, reclamp. Hang bag on pole.
 If using a pump, place tubing into pump mechanism
and set for proper flow rate.
 Connect tubing of feeding bag with G-tube.
 Unclamp tubing on feeding bag.
 If not using a pump, adjust flow rate, using clamp on
feeding tube or raising/lowering the bag.
 If using a pump, press start.
For continuous feeding, add more formula when bag is empty.
 When bag is empty, clamp feeding bag tubing.
Feeding with Syringe:
Syringe should be held 6 inches above level of stomach or at
prescribed height. Keep syringe partially filled to prevent air
 Remove plunger from feeding syringe and insert
from entering stomach.
catheter tip of syringe into G-tube.
 Pour room-temperature formula into the syringe.
 Elevate syringe and unclamp tubing.
 Continue to pour feeding into syringe as contents
empty into stomach.
 Raise or lower syringe to adjust flow rate as ordered.
11. Flush tubing, after feeding.
Water will clear tubing of formula and medications. Flushing
Feeding Bag:
the G-tube with water after a feeding prevents clogging.
 Add enough lukewarm water to feeding bag to clear
formula from tubing and flush the tubing.
 Clamp feeding bag tubing.
 Remove the feeding bag from G-tube.
Syringe:
Depending on the age and capabilities of the student, have him
 Pour prescribed amount of water into syringe and
or her assist with the feeding by holding syringe or pouring
flush tubing.
fluid into it.
 Remove the feeding syringe, after flushing the tubing
with water.
12. If burping/venting the G-tube is ordered: Connect 30-60
Burping/venting allows the tubing to be open to air and
ml catheter-tipped syringe with barrel/plunger removed to release of gas bubbles from the stomach.
the G-tube. When finished, remove barrel of syringe.
13. Clamp tubing and reinsert cap into end of tubing.
14. Apply dressing, if needed, using standard precautions.
15. Remove gloves. Wash hands with soap and water.
16. Make sure tubing is secure and tucked inside clothing, not Tubing may be taped to shirt.
inside diaper or underpants.
17. Refer to student-specific guidelines regarding position and
activity after feeding.
18. Wash catheter-tipped syringe and other reusable
Most open formula is good for 48 hours when refrigerated.
equipment in soapy water. Rinse thoroughly, dry, and
The exceptions are some elemental formulas that are only
store in a clean area.
good for 24 hours. Open formulas should be stored in clean
plastic, labeled containers (not the original can) in the
refrigerator. Formula should be discarded after 48 hours.
19. Document feeding, residual amount, and feeding
Report to school nurse and parent/legal guardian any changes
tolerance on feeding log. Document medication on
in the student’s usual feeding tolerance pattern.
medication administration record/log.
Copies to designated staff and EAP Notebook. File original in IHR.
Revised Feb. 2016
Nash-Rocky Mount Public Schools
Student Health Services
Gastrostomy Tube (G-Tube) Feeding Procedure
Gravity Bolus or Continuous Feeding by Pump Method
Possible problems that are an emergency and require immediate attention
Observations
Facial color changes and/or
Breathing difficulty
Reason
This may be due to aspiration of
feeding into lungs.
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Actions
Stop feeding immediately.
Call nurse, if not present.
Continue to assess situation.
Institute Emergency Action Plan, if problem
continues.
Call 911.
Notify parent/guardian.
Possible problems that are not emergencies and require contacting school nurse and parent
Observations
Nausea and/or cramping
Reasons
Feeding rate may be too fast and/or
feeding formula may be too cold.
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Vomiting
Same as above or student may have
an illness.
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Blocked G-tube
May be due to inadequate flushing or
very thick fluid.
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Redness, soreness, irritation,
bleeding, pus, or drainage
around G-tube site
Leaks don’t usually cause problems
except minor irritation. Infection may
be present f the stoma site is red,
sore, swollen, and/or leaking pus or
blood.
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G-tube falls out
G-tube may be pulled by accident.
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Actions
Check rate of feeding; decrease, if too fast.
Check temperature of formula; if too cold, stop
feeding, let formula get to room temperature, then
administer.
If problem continues, contact school nurse and
parent/legal guardian.
Same as above.
If all of the previous items have been checked, stop
feeding.
Call school nurse and parent/legal guardian.
Remove residual, if ordered.
Never force fluid through the G-tube.
Try a catheter-tipped syringe filled with warm
water, held high to facilitate movement of fluid.
Try to draw back plunger of syringe.
If blockage remains, notify school nurse and
parent/legal guardian.
Make sure tubing is not too loose/not being pulled.
Check G-tube site for leakage of
feeding/medication; if present, clean stoma
site/skin with soap and water.
Refer to student- or equipment-specific guidelines
for cleaning instructions.
Notify school nurse and parent/legal guardian of
gastrostomy site problems.
Cover the site with a dry dressing or large bandage.
Do not attempt to replace tube or place anything
else in the tract.
Notify school nurse and parent/legal guardian.
The G-tube will need to be reinserted only by
trained personnel to prevent closure of tract.
The healthcare provider needs to be called, if:
Stoma red, sore, swollen, or bleeding Pus leaks from stoma Fever without a cause (cold) Pain during feeding Vomiting
Source: Supporting Students with Special Health Care Needs: Guidelines and Procedures for Schools.
3rd Edition. 2014. Stephanie M. Porter M.S.N., RN, Patricia A. Branowicki, MS, RN NEA-BC. FAAN, &
Judith S. Palfrey M.D.
Copies to designated staff and EAP Notebook. File original in IHR.
School Year:
Revised Feb. 2016