The Big Picture
Some people have trouble chewing or swallowing food. They might need a liquid nutritional formula delivered through a feeding tube instead of eating food normally. This type of feeding is called enteral nutrition or gavage.
Different feeding tubes reach different parts of the digestive system. Tube feeding also brings important safety concerns, especially aspiration. A CCA needs to understand the care plan, notice problems, report important changes, and stay within the limits of the CCA role.
Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.
Quick tip: Tap, click, or press Enter on any term with a dotted underline and an ⓘ icon to see its plain-English definition.
Start Here If You’re Overwhelmed
Focus on these core ideas:
- Enteral nutrition gives nutrients through the gastrointestinal tract using a feeding tube.
- Feeding tubes include NG, nasointestinal, G, GJ, J, and PEG tubes.
- Aspiration is a major complication of some tube feedings and needs immediate attention.
- Follow the client’s care plan and facility or agency policies when helping with tube feeding care.
- A support worker should never insert a feeding tube, test the position of the tube, or give the first dose of a tube feeding.
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Course Notes: Key Ideas You Need to Know
What Enteral Nutrition Means
Enteral nutrition gives a nutritional formula through a feeding tube into the gastrointestinal tract. Gavage means tube feeding.
A person might need enteral nutrition when food does not move normally from the mouth through the esophagus and into the stomach. Reasons listed for tube feeding include:
- cancers of the head, neck, or esophagus
- trauma or surgery involving the face, mouth, head, or neck
- dysphagia caused by paralysis
- coma
- dementia when the person no longer knows how to eat
The formula usually contains protein, carbohydrates, fat, vitamins, and minerals. Facilities commonly use commercial formulas, though a dietary department sometimes prepares the formula.
Types of Feeding Tubes
Nasogastric Tube
A nasogastric (NG) tube travels through the nose into the stomach. A physician or nurse inserts it.
Nasointestinal Tube
A nasointestinal tube travels through the nose into the small intestine. A physician or nurse inserts it.
Gastrostomy Tube
A gastrostomy tube, or G-tube, enters the stomach through a surgically created opening.
Gastro-Jejunostomy Tube
A gastro-jejunostomy tube, or GJ-tube, gives access to both the stomach and the jejunum, which is the middle part of the small intestine.
The tube usually enters through a G-tube opening. A narrower, longer tube continues through the stomach and into the small intestine.
A GJ-tube is used when the client has a high risk for aspiration or when a tube cannot go into the stomach. A physician must insert the GJ-tube in a hospital.
Jejunostomy Tube
A jejunostomy tube, or J-tube, enters the intestines through a surgically created opening into the jejunum.
PEG Tube
A percutaneous endoscopic gastrostomy (PEG) tube is a type of G-tube.
The physician passes a lighted instrument called an endoscope through the mouth and esophagus into the stomach. The physician makes a puncture through the skin into the stomach and inserts the tube through that opening.
Long-Term Feeding Tubes and Ostomies
Gastrostomy, jejunostomy, and PEG tubes provide long-term enteral nutrition.
An ostomy is a surgically created opening used to drain waste or feed a client. An ostomy might be temporary or permanent.
In many facilities and agencies, the nurse handles the formula through the enteral site. The physician orders the type and amount of formula for the client.
Scheduled Feedings
A physician might order scheduled feedings. Scheduled feedings usually happen four times each day.
A scheduled feeding might use:
- a syringe
- a rigid plastic container
- a feeding bag
A scheduled feeding usually provides about 400 mL over 20 minutes. The amount and rate match those of regular meals.
The physician also specifies the client’s daily water amount. The usual recommended amount listed here is 2 000 mL/day.
Continuous Feedings
Continuous feedings use electronic feeding pumps.
Nasointestinal and jejunostomy tube feedings are always continuous.
Depending on regional differences, continuous feedings are sometimes kept cold with ice chips around the container to prevent microbial growth. The formula warms as it travels through the tubing.
The formula reaches the client at room temperature. Cold fluid creates a risk of stomach cramping. During continuous feeding, the nurse adds formula as needed.
CCA action: Follow facility policies and the client’s care plan whenever you help care for a client receiving enteral feeding.
Why Tube Placement Matters
Nasogastric and nasointestinal tubes travel through the esophagus toward the stomach or small intestine. During insertion, a tube might enter the respiratory tract by mistake.
This creates a risk of aspiration, pneumonia, and death. An X-ray usually checks correct tube placement after insertion.
Several things might move a tube after placement:
- coughing
- sneezing
- vomiting
- suctioning
- poor positioning
- a confused client pulling on the tube
A displaced tube might move from the stomach or intestines into the esophagus and then into the airway.
Who Checks Tube Placement
In a facility, the nurse checks tube placement before every scheduled feeding.
For continuous feeding, the nurse checks placement every 4 to 8 hours, depending on facility or agency policy.
The nurse attaches a syringe to the tube and removes gastrointestinal secretions. The nurse then measures the pH. Stomach contents and intestinal contents have different pH readings, so the reading helps show whether the tube has moved.
Regurgitation and Aspiration Risk
Regurgitation means food flows backward from the stomach into the mouth.
Regurgitation creates an aspiration risk with nasogastric, gastrostomy, and PEG tubes. Delayed stomach emptying and overfeeding are common causes of regurgitation.
To help prevent regurgitation:
- The client should be sitting or in a semi-Fowler’s position during feeding.
- The client should remain in this position for 1 to 2 hours after feeding.
- The left-side-lying position should be avoided because it prevents stomach emptying.
This positioning promotes movement of formula through the gastrointestinal system and helps prevent aspiration.
Nasointestinal and jejunostomy tubes have a lower risk of regurgitation. Formula travels slowly and enters the small intestine directly.
The stomach handles larger amounts of food at one time than the small intestine. During normal digestion, food moves slowly from the stomach into the small intestine.
Signs of Aspiration
Aspiration means fluid or an object enters the lungs.
Aspiration is serious because it creates a risk of breathing problems and infection. It is a major complication of nasogastric and nasointestinal tube feedings.
Watch for:
- coughing or choking during feeding
- difficult, noisy, rapid, or shallow breathing
- a wet or gurgly voice
- pale or bluish lips
First: If you think aspiration has occurred, stop the feeding immediately.
Then make sure the client sits upright and has a clear airway. Call for medical help.
Other Problems to Report Immediately
Aspiration is the major risk related to tube feeding. Other potential problems include diarrhea, constipation, and delayed stomach emptying.
Report immediately:
- nausea
- discomfort during tube feeding
- vomiting
- diarrhea
- a distended, enlarged, swollen abdomen
- coughing
- indigestion or heartburn
- redness, swelling, drainage, odour, or pain at the ostomy site
- elevated temperature
- signs and symptoms of respiratory distress
- increased pulse rate
- complaints of flatulence
Comfort Measures for a Client With a Feeding Tube
A client with a feeding tube is usually NPO. NPO stands for nil per os, meaning “nothing by mouth.”
Dry mouth, dry lips, and a sore throat sometimes cause discomfort. If allowed, the client might suck on hard candy or chew gum.
A tube in one nostril sometimes leads the client to breathe through the mouth. Comfort care includes:
- frequent oral hygiene
- lip lubricant
- mouth rinses
- sometimes placing an ice bag outside the throat for soreness
Give this care according to your supervisor’s directions and the client’s care plan.
Caring for the Nose and Securing the Tube
Nasogastric and nasointestinal tubes sometimes irritate the nose or place pressure on it.
Clean the nose and nostrils every 4 to 8 hours, according to agency or facility policy. Reposition the tube slightly away from the nostril so it does not press against it.
Tube pressure sometimes changes the shape of the nostril or causes pressure sores. Tape or a tube holder helps keep the tube secure. Foam cushions on tube holders reduce pressure on the nose and reduce repeated taping.
Frequent retaping can irritate the nose. The tube can also be secured to the client’s clothes with tape, or by looping a rubber band around the tube and pinning the rubber band to the clothes with a safety pin.
The tube also needs enough slack for client movement. A tube that is too tight or too loose creates a risk of displacement .
Know the CCA Role Limit
A support worker might care for a client with tube feeding at home or help a nurse with tube feeding in a facility.
You should never:
- insert a feeding tube
- test the tube’s position
- give the first dose of a tube feeding
Some home care agencies permit support workers to start feeding pumps or pour formula into feeding bags or containers for established gastrostomy and jejunostomy tubes.
These tasks require delegation by a nurse. A home care nurse teaches the task either individually or through an agency course. In most situations, the worker needs retraining for each new client, depending on provincial, territorial, agency, or facility policy. The retraining process supports competency in the delegated task.
The person teaching the delegated task holds responsibility for making sure the five rights of delegation are followed for the tube feeding.
Nova Scotia CCA Note
Sorrentino’s Canadian Textbook for the Support Worker, 5th Edition describes some tube-feeding tasks as delegated tasks. In Nova Scotia, the current Continuing Care Assistant Occupational Standards of Practice gives a more specific meaning to delegation.
A delegated intervention is outside the CCA Occupational Standards of Practice. A regulated health-care professional who has authority to delegate transfers the intervention to a CCA who has received the required additional training and has been judged competent. The delegation applies to the specific client and/or situation and does not automatically transfer to another client. Each employer also defines the CCA’s scope of employment, meaning the duties allowed in that specific job and workplace. (novascotiacca.ca)
Why this matters in Nova Scotia: Do not treat previous training or delegation as automatic permission to perform the same delegated intervention for another client or in a different workplace. Follow the care plan and your employer’s policies.
Official source: Continuing Care Assistant Occupational Standards of Practice
Last checked: September 20, 2026
Exam Clue Words
- Always: Nasointestinal and jejunostomy tube feedings are always continuous.
- Immediately: Stop the feeding immediately if you think aspiration has occurred.
- Report: Report listed problems such as vomiting, diarrhea, abdominal swelling, coughing, elevated temperature, respiratory distress, and increased pulse immediately.
- Follow the care plan: Follow facility policies and the client’s care plan when helping with enteral feeding care.
Fast Review
Use these points for a fast review before a quiz or exam. Focus on tube locations, feeding schedules, aspiration, and the CCA role.
- Enteral nutrition delivers nutritional formula into the gastrointestinal tract through a feeding tube.
- Gavage means tube feeding.
- NG tubes enter the stomach. Nasointestinal tubes enter the small intestine.
- G-tubes enter the stomach, GJ-tubes reach the stomach and jejunum, and J-tubes enter the jejunum.
- Gastrostomy, jejunostomy, and PEG tubes provide long-term enteral nutrition.
- Scheduled feedings usually occur four times daily, with about 400 mL over 20 minutes.
- Nasointestinal and jejunostomy feedings are always continuous and use an electronic feeding pump.
- For nasogastric, gastrostomy, and PEG tube feedings, the client should be sitting or in semi-Fowler’s position during feeding and remain in this position for 1 to 2 hours afterward to help prevent regurgitation and aspiration.
- Signs of aspiration include coughing or choking, abnormal breathing, a wet or gurgly voice, and pale or bluish lips.
- If aspiration is suspected, stop the feeding immediately, sit the client upright, make sure the airway is clear, and call for medical help.
- A support worker should never insert a feeding tube, test tube position, or give the first dose of a tube feeding.
- In some home care agencies, support workers start feeding pumps or pour formula into feeding bags or containers for established G-tubes and J-tubes only when a nurse delegates the task and provides the required teaching.
Final Pep Talk
There are several tube names, locations, safety rules, and role limits in this topic, so review them in small groups. Focus first on where each tube goes, the signs of aspiration, and the three tasks a support worker must never perform.