[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Nutrition and elimination](https://durgical.com/en/nursing/areas/nutrition/) › Enteral feeding: checking the tube, feeding and care # Enteral feeding: checking the tube, feeding and care - Procedure Before using the tube, check its position, raise the head of the bed to 30–45°, flush with water and watch tolerance. Updated Nov 5, 2026 ## Key points - X-ray is the standard to confirm position after the tube is placed: do not feed before it. - Before every use, compare the tube's external mark with the length recorded after the X-ray. - Listening for insufflated air (the 'whoosh') cannot tell stomach from lung: it is not reliable. - Aspirate pH (5.5 or less suggests stomach) is an alternative under some protocols; formula and some medications change it. - Head of bed at 30–45° unless contraindicated. - Gastric residuals per protocol; flush the tube with water before and after every feed and every medication. ## What it is Enteral feeding delivers formula to the stomach or bowel through a tube (nasogastric, gastrostomy or jejunostomy) when the gut works but the patient cannot eat or swallow safely. The most serious complication is aspiration. That is why tube position is confirmed by X-ray after insertion and checked again before every use. Listening for insufflated air is not a reliable method. ## Indications - A working gut with inability to eat or swallow safely. - Stroke, Parkinson's disease or reduced consciousness. - Mechanical ventilation. - Obstruction of the oropharynx or oesophagus. - Hypercatabolic states, such as extensive burns. ## Contraindications and precautions - Do not feed or give medications until the X-ray confirms the initial position. - If respiratory signs appear, hold feeds and medications until position is verified. - Head of bed at 30–45° unless contraindicated; use sedatives sparingly. - Trace the line from the patient to the bag before connecting: prevents connecting formula to an IV line. - Every residual aspiration raises the risk of clogging: do it only per protocol. ## Equipment - The ordered formula, checked against the order and its date. - Feeding pump or gravity set, with enteral connectors that do not fit IV lines. - An enteral syringe of the size the protocol sets. - pH strips if the protocol uses them. - Water for flushing, gloves and the record of the tube length. ## Step by step (and why) - Check the order, identity and that the X-ray confirmed the initial position — it is the confirmation standard. - Raise the head of the bed to 30–45° and keep it there while feeding, unless contraindicated — reduces aspiration. - Before every use, compare the external mark with the recorded length — a change suggests the tube has moved. - If the protocol says so, test the aspirate pH — 5.5 or less suggests stomach; formula can change it. - Do not rely on listening for air or on how the aspirate looks — neither tells stomach from airway. - Trace the line to its source before connecting — prevents connecting formula to an IV line. - Check residuals only per protocol; do not stop feeds for a single residual without other signs of intolerance. - Flush with water before and after every feed and medication, at intervals on continuous feeds and each shift — prevents clogging. - Watch for bloating, nausea, vomiting, diarrhoea, cramps and respiratory signs — detects intolerance and aspiration. - Document formula, rate, flushes, tolerance and the skin at the tube site. ## Complications - Aspiration and aspiration pneumonia: the most serious complication. - Tube clogging from too little flushing, residual aspiration or poorly prepared medications. - Misconnection of formula to an IV line. - Intolerance: bloating, nausea, vomiting, diarrhoea, cramps or constipation. - Skin or nasal injury from tube pressure, and tube dislodgement. ## Next step: when to call for help - Coughing, breathlessness, abnormal breath sounds or falling saturation: stop the feed and call. - The external mark has changed or the tube is out: do not use it, assess the patient and call. - A clog that does not clear with water: call; do not use juices or fizzy drinks, which make it worse. - Persistent vomiting, bloating or diarrhoea: call. - Abnormal electrolytes or blood glucose as ordered: call. ## Test yourself Think of the answer, then tap the question to see it. ## What is the standard to confirm the position of a newly placed feeding tube? An X-ray. No formula or medication is given until it confirms the position. ## Why is listening for insufflated air not trusted? Because the sound can be heard even when the tube is in the airway or oesophagus: it does not reliably show the position. ## How high is the head of the bed kept during enteral feeding? Between 30 and 45°, unless contraindicated, to lower the risk of aspiration. ## When is a feeding tube flushed? Before and after every intermittent feed and every medication, at intervals during continuous feeding and at least once a shift, with water and per protocol. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/enteral-feeding-checking-the-tube-feeding-and-care/) ## Connections ## Related 2 - [Nasogastric tube: insertion and checking its position](https://durgical.com/en/nursing/nasogastric-tube-insertion-and-checking-its-position/) - [Dysphagia and aspiration precautions](https://durgical.com/en/nursing/dysphagia-and-aspiration-precautions/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Nursing Skills, 17.2 Basic Concepts of Enteral Tubes](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Skills_(OpenRN)/17%3A_Enteral_Tube_Management/17.02%3A_Basic_Concepts_of_Enteral_Tubes) (Open RN (Chippewa Valley Technical College), LibreTexts, 2021); [Nursing Advanced Skills, 5.3 Nasogastric and Feeding Tubes: Applying the Nursing Process](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Advanced_Skills_(OpenRN)/05%3A_Insert_Nasogastric_and_Feeding_Tubes/5.03%3A_Applying_the_Nursing_Process) (Open RN (Chippewa Valley Technical College), LibreTexts, 2023); [Nursing Fundamentals, 14.3 Nutrition: Applying the Nursing Process](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/14%3A_Nutrition/14.03%3A_Applying_the_Nursing_Process) (Open RN (Chippewa Valley Technical College), LibreTexts, 2021). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. 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