A Licensed Practical Nurse (LPN), also known as a Licensed Vocational Nurse (LVN) in some states, provides direct patient care under the supervision of a registered nurse (RN) or physician. Tube feeding, or enteral nutrition, delivers liquid formula and medications directly into the stomach or small intestine when a patient cannot safely eat or drink. Whether an LPN can perform tube feedings is not nationally standardized. This ability is heavily dependent on the specific regulations established by each state and the policies of the employing facility, which determine the scope of tasks an LPN is legally permitted to perform.
The Role of State Boards of Nursing
The legal foundation for all nursing practice, including that of the LPN, is defined by the Nurse Practice Act (NPA) within each state. This legislation establishes the boundaries of practice, dictating whether tube feeding tasks fall within the LPN’s authorized scope. Because the NPA varies significantly, what is permitted in one state may be prohibited in another.
LPN practice is dependent or directed, meaning the LPN must function under the supervision of a Registered Nurse or a physician. This structure often involves delegation, where the supervising nurse assigns the LPN specific, routine tasks related to the patient’s care plan. The LPN’s role focuses on implementing the established care plan, not performing the initial comprehensive assessment or developing the plan of care. Therefore, LPNs must consult the specific rules and advisory opinions published by their state’s Board of Nursing to understand their professional boundaries.
Routine Tube Feeding Tasks for LPNs
When a feeding tube is already in place, confirmed to be correctly positioned, and the patient’s condition is stable, LPNs are authorized to manage the day-to-day administration of enteral nutrition. A common responsibility is the administration of bolus feedings, which delivers a specific volume of formula over a short period using a syringe or gravity. LPNs also manage continuous feedings, which involves setting up and monitoring the infusion pump to deliver formula at a prescribed hourly rate.
LPNs perform several routine tasks to maintain the tube and administer nutrition.
- Flushing the feeding tube with water to maintain patency and prevent clogging (typically 30 milliliters before and after each feeding or medication).
- Administering prescribed oral medications through the tube, which requires crushing non-enteric-coated pills, dissolving them, and administering them separately.
- Providing site care for established tubes, such as Percutaneous Endoscopic Gastrostomy (PEG) or G-tubes, by cleaning the stoma site.
- Assessing the stoma site for signs of irritation, drainage, or infection.
Procedures Outside the LPN Scope
While LPNs manage routine care, several complex or high-risk procedures typically fall outside their legal scope and are reserved for Registered Nurses or physicians. A restriction is the initial insertion of a nasogastric (NG) tube or an orogastric (OG) tube. This procedure carries a significant risk of accidental placement into the lungs, requiring advanced assessment skills to confirm correct positioning. Similarly, the management of tubes placed into the jejunum (J-tubes), which bypasses the stomach, is restricted because these tubes require complex monitoring and carry a higher risk of metabolic complications.
Assessment and Crisis Management
LPNs are restricted from performing the initial, advanced assessment when a new, acute complication arises, such as severe aspiration, sudden tube dislodgement, or signs of peritonitis. Although an LPN collects data and reports changes, the comprehensive analysis and formulation of a new plan of care in a crisis scenario is a function of the RN.
Total Parenteral Nutrition (TPN)
The administration of Total Parenteral Nutrition (TPN), an intravenous method of feeding, is a complex procedure restricted to RNs. This restriction is due to the high risk of infection, fluid shifts, and metabolic imbalances associated with central line access.
Facility Policies
Facility policy may impose further restrictions. A hospital or long-term care center can limit an LPN’s duties even if the state’s Nurse Practice Act permits them.