An elderly male client who is unresponsive following a cerebral vascular accident (CVA) is receiving bolus enteral feedings through a gastrostomy tube. What is the best client position for administration of the bolus tube feedings?

• A. Prone
• B. Fowler's
• C. Sims'
• D. Supine

Answer: (B)

Preventing aspiration during enteral feeding is the priority. Keeping the patient in a semi-upright position (Fowler’s) during bolus feedings places the head of bed elevated, typically 30–45 degrees, so gravity helps keep stomach contents below the esophagus and reduces the chance that reflux will reach the airway. This is especially important for someone who is unresponsive after a stroke, since protective airway reflexes are diminished and the risk of aspirating feed is high. Positions that lower the head or lie flat—such as prone or supine—greatly increase the risk of aspiration. A side-lying position can be less protective for feeding administration. So, administering bolus tube feedings with the patient in Fowler’s position best protects the airway while feeding.