# Place the steps for starting a scheduled enteral feeding through an established gastric tube in the correct order.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=395525&lang=en  
> language: en  
> subject: Nutrition and Oral Hydration  
> category: BCC

## Question

Place the steps for starting a scheduled enteral feeding through an established gastric tube in the correct order.

Verify the client, feeding prescription, formula, route, rate, expiration, and scheduled water flush.

Start the feeding at the ordered rate, then monitor tolerance, tube position, intake, and response.

Elevate the head of the bed to at least 30° unless contraindicated and assess the abdomen and feeding tolerance.

Trace the tubing to the correct enteral port and verify external tube length and placement according to facility policy.

Flush with the prescribed water and connect the prepared enteral feeding system using clean technique.

## Explanation

First verify the complete order and product. Position the client and assess tolerance, then trace the line and verify that the established tube has not migrated. Flush as prescribed and connect only to the enteral port. Start at the ordered rate and continue monitoring and documentation.

## In-depth explanation

Correct sequence
Verify → position and assess → trace and confirm tube position → flush and connect → start and monitor.

Why this is correct
A complete enteral order includes the client, formula, access route, rate or volume, and water flushes. Head-of-bed elevation reduces aspiration risk. Line tracing prevents misconnections, and a change in external tube length can indicate migration. Placement must be checked using accepted facility methods; injecting air and listening over the stomach is not a reliable confirmation method. Monitoring continues after initiation because intolerance and displacement can develop during therapy.

Scope note
This sequence applies to an established tube. A newly inserted blindly placed tube requires initial placement confirmation according to facility policy before feeding.Reference
1ASPEN Safe Practices for Enteral Nutrition TherapyOrder verification, placement checks, head-of-bed elevation, administration, and monitoring

## Clinical scenario

Established adult enteral access
The client is stable and has an existing gastric feeding tube. Initial placement was previously confirmed. Follow the prescription, manufacturer instructions, and facility placement-verification policy.

## Key concepts

- **Enteral Feeding** — Nutrition delivered through the gastrointestinal tract by tube.
- **Aspiration** — Entry of gastric contents or secretions into the airway.
- **Tube Patency** — The tube is open and able to deliver feeding or medications.

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