Closed Enteral Feeding System (Adults)
Closed Enteral Feeding System is tube feeding formula that is available in sterile, ready-touse plastic bags. A Covidien 924 pump is used and the closed enteral feeding system can be used
for either intermittent/bolus or continuous feeds. The benefits of a closed system include improved
patient safety, decreased contamination risk, reduced nursing time, reduced tubing cost and
formula wastage.
Nursing Administration
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Wash hands with soap and water before starting.
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Collect supply - use Covidien 924 Safety Screw Spike Set, #775759.
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Check the bag label to ensure the correct formula is used, check the expiry date and
condition of the bag.
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Label the bag with patient name, date and time.
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Shake bag well.
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Close the roller clamp on the spike set.
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Place bag on flat surface, remove purple cap from formula bag.
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Using clean technique, remove the spike cover and insert the purple spike into the port
of the formula bag, turn it clockwise until tight. Give it an additional ½ turn to secure the
fit.
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Hang the bag on an IV pole and start the pump.
Additional Considerations:
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Continue to order enteral formulas in VAX as ml/hr.
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Use a new spike set with each new formula bag.
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Do not re-spike a bag with new tubing if it has already been spiked.
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No medication, contrast, water can be added to the sterile formula bag.
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For patients on intermittent feeds or when feed is off, use the same cap from the spike
set to cover the tip of the feeding tube. When the tip is connected, tape the cap to the
pump for future use.
FAQ about Closed Enteral Feeding System
What is the hang time for closed enteral feeding systems?
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Closed enteral feeding formulas and bags can be safely hung for 24 hours. The closed enteral
feeding system can be disconnected and reconnected within the 24 hours period for intermittent
feed.
In what volumes are closed enteral feeding formulas available?
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Formulas are available in either 1000 mL or 1500 mL. This will vary depending on the product.
Please read the labels to confirm package size.
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The formula rate ordered can be used to calculate the number of bags needed for 24 hours.
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For further questions, discuss with your unit Dietitian.
How are bags stored? Do they require refrigeration and need to be kept out of the light?
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The bags are all stored at room temperature. No refrigeration is required.
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Keep bags out of direct sunlight.
Do you use new tubing and SpikeRight® Plus sets with each new bag that is hung?
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Yes. A new set is used for every new bag, up to a maximum hang time of 24 hours. The old
tubing is discarded with the bag after 24 hours.
Can you re-spike a bag with new tubing after a bag has already been spiked?
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No. The manufacturer (Nestle) does not recommend re-spiking tube feed bags.
When a patient has intermittent feeds, is there a cap available to cover the tube feed tip
while feeds are being held?
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Yes. A cap comes with each spike set and can be taped to the pump when tip is in use. Cap can
be used to cover tip when the patient is disconnected from the tube feed.
How do you set up a closed enteral feeding system for gravity feeds?
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Gravity feeding will not be possible with a closed feeding system.
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To provide a “bolus type” of infusion for closed systems, a pump will need to be used.
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Set the enteral feeding rate required to infuse the desired volume as per orders.
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Follow unit’s protocols on enteral feeds (e.g. assessing tolerance).
Does the tubing need to be flushed?
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Tubing that comes with the closed feeding system does not need to be flushed, but you will still
need to flush any other tubing entering the patient (i.e. Nasogastric/Gastrostomy/Jejunostomy
Tubes).
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Your existing site or zone policies and procedures regarding feeding tube management/flushing
are not impacted by the implementation of the closed enteral feeding system and should be
referred to regarding the flushing of the actual feeding tube (NG, J-tube, G-tube, etc)
Are all formulas available in closed systems?
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No. There are specialized enteral formulas that are not available in closed systems (e.g. Suplena
and elemental formulas in packet form (e.g. Vivonex)).
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Home enteral feeding programs will continue to use open systems.
What literature is available to support the use of closed enteral feeding systems?
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A table of the most recent closed enteral feeding system literature has been prepared. Contact
your unit Dietitian.
Formula Available for Closed System as of April 2015
Formula
Isosource HN Fibre
Indications
Standard tube feed with fibre
Size
1.5 L
Isosource 1.5
High caloric with fibre – 1.5 cal/mL
1.5 L
Nutren 2.0
Hi caloric density – 2 cal/ml
1L
Novasource Renal
Renal High Protein
1L
Resource Diabetic
Low carbohydrate, high protein,
diabetic formula
1.5 L
Peptamen AF 1.2
Peptamen 1.5
High protein semi-elemental
High caloric semi-elemental
1L
1L