GUIDE TO TUBE FEEDING FOR PATIENTS AND FAMILIES
Contact Information:Doctor’s Name:Doctor’s Number:Hospital number:GUIDE TOTUBE FEEDINGFOR PATIENTSAND FAMILIESFloor extension:CCAC contact number:Community Dietitian’s Name:Dietitian’s Number:Homecare Nurse:Name of Formula:Rate of Feed:(1)
TEACHING CHECKLIST – ENTERALFEEDSContents:PagePatient Teaching Check List .3Checklist for Patients and Families . 5Questions for Your Doctor . .7Weight Chart . .8What is tube feeding? . . .9Where does feeding tube go? .10Caring for Feeding Tube .12Feeding Tube Procedure .13Preparing Your Feed or Flush .14Starting Your Feed .17Taking Medication .21Cleaning up . .23Positioning During Feeding .24How to Prevent and Unclog a Feeding Tube .25Buying Your Formula .26Life with A Feeding Tube 26Call Your Doctor When .301.Review of supplies and how to obtainand cleaning of supplies2. Review rate and type of feedingformula3. Review of diet and fluid replacement4.Review of proper positioning for feeds5. Management and prevention of cloggedtubes6. Review when to call doctor/home carenurseManagement of Enteral Feeds1. Gathers supplies and equipment2. Checks expiration date on formula3. Draws up appropriate amount of waterto flush feeding tube4. Flushes Feeding tube before and aftermedication5.Closes roller clamp on feeding tube6. Pours formula into feeding bag7. Hangs feed bag on pole higher thenhead8. Set pump9. Opens roller clamp; primes tube10. Connects feed bag to feeding tube;starts feed; disconnects when feed done11. Cleans all equipment(2)DateTeachingDoneDateTeachingDone
edDateIndependentCHECKLIST FOR PATIENTS AND THEIRFAMILIESBefore leaving the hospital use this checklist to makesure you have the information you will need athome to manage your feeding tube. Type of feeding formula I will need and howmuch do I use each day Do I know what time of day I should be givingmyself my amount of formula Where do I get the feeding formula and howmuch should I have on hand How much extra water should I give myselfand are there any times when I should givemyself extra water Have I/ my family members been shown howto start and stop feeds, and have I been giventhe opportunity to practice Have I/my family members been shown howto give medication through the feeding tubecan my medications be crushed or beprovided in liquid form Do I know what position is best for me whilebeing fed through the feeding tube Do I know how to clean and care for theequipment I will use to give myself formula(4)(5)
Do I know how to care for the skin around thefeeding tube and what to observe aboutthe skin Do I know how to keep my feeding tubefrom becoming clogged Do I know what to do if the feeding tubeis blocked and I am unable to push in anywater or formula What do I do if my tube comes out Do I know if my doctor/dietitian needs me tomonitor my weight and how often If I am able to eat or drink by mouth, doI know if my doctor/dietitian needs me tomonitor the amount and /or type of foodsand drinks I consume Do I know what I should do about routinemouth care- whether I am able to eat anddrink or not Do I have any concerns about my activitiesthat I will be doing, and managing my feedingtube- for example bathing, swimming, sports,traveling etc. Do I know when I need to be concerned andcall my doctor and do I have the phonenumber I would call Do I know how to get in contact with myCommunity Care Access Centre if I havequestions/concerns/supply of equipmentissues(6)QUESTIONS FOR YOUR DOCTOR:(7)
WEIGHT:The information presented is for educationalpurposes only. It is not intended to replace advicefrom your health care provider. Weigh self weekly If you are gaining or losingweight call yourdietitianWHAT IS A FEEDING TUBE?WEIGHT CHARTDATEWEIGHTDATEWEIGHT Tube feeding is used to provide liquid food(nutrition), water (hydration) and medications Some reasons for a feeding tube are:1. Difficulty swallowing2. Having a type of surgeryafter which you cannoteat3. A way of providing extracalories to keep yourstrength4. Treatments like radiationwhich make it difficult toeat Tube feeding can provide extra nutrition andhydration even if you are able to eat and drink The length of time you may require tubefeeding can vary from weeks to many monthsor years(9)(8)
TYPES OF FEEDING TUBES:JEJUNOSTOMY TUBE (known as J-TUBE)GASTROSTOMY TUBE (known as G-TUBEor PEG-TUBE) In which the tube goes through the stomachwall and the tip of the tube is in the stomach The tube goes through an opening in theskin of the abdomen and the tip of the tubeis in the first part of the small intestinecalled the jejunumWHERE IS THE TUBE IN MY BODY?YOU HAVE A: (nurse to box) (10)GASTROSTOMY (G-TUBE or PEG TUBE)JEJUNOSTOMY (J-TUBE)(11)
CARING FOR FEEDING TUBE: Tube is marked at skin level for baseline forlater comparison Monitor length of tube; notify doctor or callyour home care nurse if the tube has becomelonger or shorter If tube slips out a little or completely, DONOT EAT BY MOUTH OR USE TUBEFEEDING TUBE PROCEDURE:Before you start, gather all the equipment you willneed. The picture shows the supplies and equipmentyou will need.SYRINGE AND CUP OF WATER FOR FLUSHINGAND GIVING MEDICATION DO NOT TRY TO PUSH OR PUT TUBEBACK IN STOMACH If tube starts to leak, stop using it and call yoursurgeon or home care nurseFORMULA Check insertion site for skin breakdown,irritation, rednessEND OFTUBINGWHICHCONNECTSTO YOURBODY Flush feeding tube with warm tapwater every hours. This will help keepthe tube patent Flush feeding tube before starting your feedsand when your feeds are done. Flush feeding tube before and after medication DO NOT LET CONNECTOR TOUCH ANYDIRTY SURFACE(12)FEEDING BAG WHICH HOLDS THE FORMULA(13)
4. Draw upml of warm waterin your syringePREPARING FOR YOUR FEED OR FLUSH:1. Ensure all equipment is clean. Your feedingbag can be reused for days if youclean it carefully after each use2. Wash your hands withsoap and water3. Formula should be at room temperature.Unopened formula does not need to berefrigerated. However,open cans may be keptin the fridge for 24hours. Allowrefrigerated formula towarm to roomtemperature for ½ hour before using. Afterthe 24 hours, any remaining formula mustbe thrown in garbage5. Close the clamp or bend feeding tube6. Open the capon the feedingtube7. Insert the endof the syringeinto the end ofthe feedingtube8. Open the clamp or unbend feeding tube(15)(14)
9. Push water intothe tube.Be careful – avoidexcessive force asthis may tear thetubeSTARTING YOURFEED:1. Check the expiry date oncan of formula10. Close the clamp2. Shake the formula well to11. Remove the syringe and reclose tubemix*Important to give yourself extra waterflushes during hot and humid conditions*3. Close the roller clamp on feeding(16)tube to prevent formula fromdripping out of feeding bag(17)
*Go to #8 if not using a pump4. Pour formula intofeeding bag7. Set pump up according toyour manual. The manualwill show you how to filldrip chamber, set the flowrateRate is5. Close lid on feeding bag6. Hang the feeding bag onan IV pole which is higherthan your head(18)8. Open the roller clamp. Letthe formula flow throughthe tip9. Squeeze the drip chamber to get formula to flowto end of tubing.10. Open the cap ofyour feedingtube andconnect the tipof the deliveryset to your tube(19)
11. Start feed: if using a pump push the start buttonTAKING YOUR MEDICATIONTHROUGH YOUR FEEDING TUBEFor Gravity feed open the roller clamp andadjust the rate of flow by opening or closing theroller lamp12. Stop pump when feed is finishedor forGravity feed; close roller clamp whenfinished13. After feed is finished, flush your feedingtube with warm waterFollow steps 4-11 on page 15 and 16 forflushing feeding tube14. Disconnect the tip from your feeding tube andreplace the cap at the end of the feeding tubeALWAYS TAKE MEDICATION BYMOUTH IF ALLOWEDSUPPLIES: CLEAN SYRINGE 60MLLUKEWARM WATER IN CLEAN GLASSMEDICATIONSCUP FOR MEDICATION AND CRUSHERHOW TO GIVE MEDICATIONTHROUGH FEEDING TUBE:FLUSH FEEDING TUBE WELL WITHWARM WATER BEFORE AND AFTERMEDICATION.ASK YOUR PHARMACIST IFMEDICATION COMES IN LIQUID FORM.Go to cleaning up on Page 23(21)(20)
LIQUID MEDICATION Draw up dose in syringe Push medication through feeding tubeTABLET Crush tablet into fine powder Mix with warm water Push medication through feeding tubeCAPSULE WITH POWDER Pull capsule apart Place powder in cup and mix withwarm water Push medication through feeding tubeREMEMBER: DO NOT PUT MEDICATION IN THEFEEDING BAG DO NOT MIX ANY MEDICATIONWITH THE FORMULA(22)CLEANING UP:1. Wash equipment with warm water and vinegarmixture; * See Below*2. Close the feeding bag and shake well3. Open the roller clamp and let the water drainout5. Repeat until feed bag looks clean6. Wipe down with clean towel and hang to air dry7. Store equipment in a covered container untilnext feed8. Wipe feeding pump down regularly to keep itcleanOnce a day you should clean your feeding setwith vinegar and water. Mix ¼ cup vinegar with 1 cup warmwater Pour into feeding bag Run it through to the end of the tubingand close clamp Let it sit for ½ hour in the sink Empty bag out and rinse with warmwater as above(25)(23)
CLEANING SYRINGE: Remove plunger from the syringe and washboth parts in warm soapy water Rinse well with warm water Air dry on clean towel Clean daily and after each time medicationgivenFeeding container and its tubing should bereplaced with a clean set every 24 hoursSyringes should be changed every 2 weeks ifgiving medication through it or monthly if onlyflushing feeding tubePOSITIONING DURING FEEDING: DO NOT lie flat when feeding For night feeds – minimum 30 degreespropped up if sleeping (2 pillows) You may sit up in a chair or propped up in bedat 45ᵒ Stay upright for at least 30 minutes after feed isfinished If you start coughing, choking or havedifficulty breathing, stop your feed and callyour doctor(24)HOW TO PREVENT A BLOCKED TUBE: Always crush medication well before givingthrough your feeding tube Always flush your feeding tube before andafter your feeds. This will help keep the tubeclean and prevent formula buildup Always flush your feeding tube before andafter medication Always flush your feeding tube every 4 hoursor 8 hours over nightUNCLOGGING A FEEDING TUBE: Check to see if feeding tube is kinked Try flushing your tube with warm water twoor three times. Use a syringe when flushing Push water gently and then increase pressurefor a few 5 seconds Pull back a few times for a few minutes If unable to clear wait 15 minutes and try again Pancrelipase (Creon 10) or Sodium Bicarbonate- Crush 1 tablet, mix with water and syringethrough clogged tube slowly Maximum 3 tablets per day If you cannot clear the blockage, call yourhome care nurse, family doctor or go to thenearest hospitalDO NOT PUT ANY OBJECT INTO THETUBE TO TRY AND CLEAR BLOCKAGE(25)
BUYING YOUR FORMULA:The enteral feed and supplies ordered bythe hospital dietitian may be providedfor you by your local Community Care AccessCentre (CCAC). Your hospital CCAC case managerwill assess your case and inform you of thissituation.ACTIVITY: Slowly increase your activity; Start by takingshort walks tohelp build up your strength, improvecirculation No strenuous activity or sports until cleared byyour doctor No heavy lifting for 4 to 6 weeks. Nothingmore than a bag of groceries: 10 pounds or 4kgThe enteral feed can be obtained through localpharmacies if not covered by CCAC.Call your pharmacy ahead of time to ensure theyhave your formula in stock.LIFE WITH A FEEDING TUBE:MOUTH CARE: Mouth care is very important Don’t forget to brush your teeth and tongue atleast 3 times a day(26)SHOWER/BATHING: You may shower or bathe.Use mild soap to prevent irritationEnsure tube feeding end is closed/clampedRemove your dressing from around tube first,bath, dry area well and apply new dressing ifrequiredTRAVELING:Short, Long or Local Trips: Make a list of items you willrequire ahead of time Pack formula and supplies Take extra supplies with you(27)
Out of Country Trips: Plan a few weeks ahead Make a list of items you will require If travelling overseas you will require anadapter; you will have to purchase an adapterespecially for your pump Easiest method is to run your pump on abattery. While you are still home run yourinfusions on battery to see how long they willlast and then pack accordingly.(9V batteries can be purchased in mostcountries) Another option would be to infuse feed bygravity feeding Pack 2 days of enteral supplies and keep thisbag with you Pack remaining supplies in suitcase Always pack extra supplies for emergencies Extra weight of luggage for pump, formulaand supplies Travel letter indicating medical needs Travel insuranceDouble check with Airport securityregarding restrictions with liquids in yourcarry-on luggage(28)Important Information: Speak with your home care nurse about howyou can purchase supplies if needed Doctor’s number for emergencies Place a copy of your doctor’s letter in yoursupplies and have one with you Pharmacy phone number List of medications Know where the nearest hospital isSWIMMING: Once area around the tube site is well healed;speak with your doctor first Only if water is safe; salt water orocean is considered the safest; thenpool water Least safe place to swim is pond or lake due tohigh bacterial content Cover feed tube site with tegaderm or specialpouch which you can get from anEnterostomal NurseCHECK WITH YOUR DOCTOR FOR CARE OFTUBE PRIOR TO SWIMMINGYou can read more about travel and swimming atthe Oley Foundation: www.oley.org(29)
CALLYOUR DOCTOR IF ANY OF THEFOLLOWING OCCURS: YOUR TUBE FALLS OUT, PLACE A CLEANDRY GAUZE OVER AREA ANDGO TO EMERGENCY. IT IS NOTLIFE THREATENING. Your tube is clogged and you cannotunclog it Your tube is longer or shorter than usual Your feeding tube site changes in color, iswarm to touch, or is oozing liquid You have any abdominal pain You have nausea and vomiting for 1 day You have diarrhea for more than 2 days You are constipated for more than 3 days You have a temperature of more than 38.5 C or101 F You have difficulty breathingIf you have any questions regarding your surgery,please contact your surgeon(30)Michael Garron Hospital Toronto East Health Network825 Coxwell Avenue, Toronto, Ontario, M4C 3E7www.tehn.caDeveloped by Anita Brown RPN, IBCLC, Denise Roberts RN, Chris SabyRN.Consulted with Jessica Quan Registered Dietician; Irene Smith RN CCACCopyright 2012Photographs included in pamphlet are owned by the clinicians whoprovided them. They may not be copied or reproduced.References:Brunner & Suddath’s Text Book of Medical Surgical NursingOley Foundation www.oley.orgBC Home Parenteral & Enteral Nutrition (BCHPEN) Programwww.bchomenutrition.orgDietitian’s Guide to Tube Feeding for Patients and Families; TEGHCommunity Care Access(Rev December 2019)
to flush feeding tube 4. Flushes Feeding tube before and after medication 5.Closes roller clamp on feeding tube . 6. Pours formula into feeding bag : head 8. Set pump . 9. Opens roller clamp; primes tube : 10. Connects feed bag to feeding tube;
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1. Look up the 24 Hour Total Volume of Tube Feeding in the Enteral Feeding Order Ex: 1200 ml 2. Verify the tube feeding hourly goal Ex: 1200ml / 24 hours 50 mL /hr 3. Calculate the amount of Shift Tube Feeding (STF) Ex: 50ml x 8 hours 40 0 mL 4. End of Shift record Volume Fed (VF) off the feeding Pump Ex: 350mL 5.
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