A Licensed Practical Nurse (LPN) provides foundational patient care under the supervision of a Registered Nurse (RN) or a physician. Enteral nutrition, or tube feeding, delivers specialized liquid nutrients directly into the gastrointestinal tract, bypassing the mouth. This procedure is used when a patient has a functioning digestive system but cannot safely consume enough food orally. LPNs are typically trained for the routine maintenance and administration of these feedings, though authorization depends on the specific state and facility.
Routine Tasks for Enteral Feeding
LPNs are authorized to perform standardized, ongoing procedures associated with established enteral feeding tubes, such as gastrostomy (G-tubes) or nasogastric (NG) tubes. Their primary task is administering prescribed formulas, either continuously via a pump or through scheduled bolus feedings. This involves preparing the formula, setting up the pump rate, and monitoring the patient’s stability during the process.
LPNs are responsible for maintaining tube patency by flushing the tube with water before and after administering formula or medication to prevent clogging. They also provide routine site care for percutaneous tubes, cleaning the skin around the insertion site to prevent infection and monitor for irritation. Additionally, LPNs administer approved oral medications that have been crushed and dissolved via the feeding tube. The LPN monitors the patient for feeding tolerance, assessing for symptoms like abdominal distension, nausea, or diarrhea.
Why Scope of Practice Varies
The ability of an LPN to perform specific procedures like tube feeding varies because it is governed by a multi-tiered system of regulation. The foundational authority is the state’s Nurse Practice Act (NPA), which legally defines the scope of practice for all licensed nurses. Some states explicitly include feeding tube maintenance within the LPN’s scope, while others are more restrictive or require specific training.
Even when the state NPA permits a task, the individual healthcare facility’s policy often dictates a more conservative scope. Facilities may reserve certain tasks for Registered Nurses (RNs) due to the complexity of the patient population or the need for independent assessment. Before an LPN performs any specialized task, they must have documented evidence of specific training and validated clinical competency to ensure safe practice.
Procedures LPNs Cannot Perform
LPN practice typically excludes procedures requiring complex, independent patient assessment or the initiation of high-risk therapies. One procedure often restricted to RNs is the initial insertion of nasogastric (NG) or nasojejunal (NJ) tubes. Although some state boards permit LPNs to insert NG tubes under strict conditions, initial placement carries a significant risk of misplacement into the lungs, demanding the advanced assessment skills of an RN.
LPNs are also restricted from administering complex intravenous therapies, including Total Parenteral Nutrition (TPN). TPN is a high-concentration solution delivered via a central line, requiring frequent patient assessment for metabolic complications or fluid and electrolyte imbalances. Furthermore, LPNs are not authorized to perform the initial, comprehensive patient assessment or create the nursing care plan, as these functions are reserved for the RN. If an established feeding tube becomes dislodged or a severe complication like aspiration occurs, the LPN must immediately report the event to an RN or physician rather than independently managing the acute crisis.