Feeding Fiona — Enteral Feeding & Aspiration Prevention: Head of Bed Up, Placement Verified
One flat-lying tube feeding is all it takes to turn nutrition into pneumonia
Fiona's tube feeding is running while she lies flat because she slid down in bed. She starts coughing, and her oxygen saturation dips.
Fiona receives tube feedings after a stroke left her unable to swallow safely. Aspiration is the feared complication. Placement is verified by x-ray after insertion and reconfirmed before each feeding or medication by checking the exit-site mark, aspirating gastric contents and checking pH (gastric aspirate is typically 5.5 or less). The head of the bed stays elevated at least 30 to 45 degrees during feeding and for 30 to 60 minutes afterward. Gastric residuals are checked per policy; high residuals, new coughing, or a drop in saturation mean stop the feeding and reassess. Flush the tube before and after feedings and medications, and give medications separately, not mixed into the formula.
Read Feeding Fiona's full story →The story arc
The setup
After a stroke, Fiona fails her swallow screen and a feeding tube is placed for nutrition.
The turn
She slides down in bed and the feeding keeps running with her nearly flat.
The crisis
Fiona coughs, her voice sounds wet, and her oxygen saturation falls.
The save
The feeding is stopped, she is repositioned upright, placement and residual are rechecked, and the tube is flushed before restarting.
NCLEX study section — Enteral Feeding & Aspiration Prevention: Head of Bed Up, Placement Verified
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Safety & Infection Control
Take this chapter into practice questions on the same topic.