Introduction to Home Tube Feeding
Summary
TLDRThis video educates viewers on managing home tube feedings for individuals with special nutritional needs. It covers different types of feeding tubes, proper feeding techniques, tube care, and potential side effects. The video also discusses methods like bolus and continuous infusion feeding, flushing procedures, medication administration, and checking gastric residuals. Additionally, it provides tips for mouth care, managing side effects, and emphasizes the importance of following medical advice for a successful tube feeding experience.
Takeaways
- 🍼 **Types of Feeding Tubes**: There are three types of feeding tubes: Nasal Enteric (NG or NJ), Gastrostomy (PEG), and Jejunostomy (J-tube).
- 📝 **Tube Prescription**: A registered dietician will explain the tube prescription, including the formula name, daily amount, feeding schedule, and extra water needed.
- 💧 **Feeding Methods**: Two methods are used for tube feeding: Bolus feeding (larger amounts, 3-6 times a day) and Continuous Infusion (using a pump, 8-24 hours).
- 🧪 **Formula Storage**: Unused formula should be stored in a covered container in the refrigerator and discarded after 24 hours if opened.
- 🚿 **Flushing the Tube**: Flush the feeding tube with lukewarm water before and after feedings to prevent clogging and provide necessary fluids.
- 💊 **Medication Administration**: If unable to swallow, medications can be given through the tube, but should not be mixed with feeding formula unless instructed by a doctor.
- 🔍 **Checking Residuals**: Checking the amount of gastric fluid left in the stomach is important to ensure proper stomach emptying, especially before each feeding.
- 🩹 **Tube Site Care**: Daily cleaning of the tube site is crucial to reduce infection risk, and dressings should be changed as needed.
- 🌡️ **Potential Side Effects**: Be aware of side effects like diarrhea, constipation, nausea, and aspiration, and take appropriate steps to manage them.
- 📚 **Instruction Booklet**: A tube feeding instruction booklet is provided for reference, summarizing all discussed points and tailored to individual needs.
Q & A
What are the three types of feeding tubes mentioned in the script?
-The three types of feeding tubes mentioned are: 1) Nasal enteric feeding tube (NG tube or ND/NJ tube), 2) Gastrostomy tube (commonly PEG tube), and 3) Jejunostomy tube (J tube).
What is the difference between a bolus feeding and continuous infusion feeding?
-Bolus feeding involves receiving a larger amount of formula three to six times per day, with each feeding lasting 15 to 20 minutes. Continuous infusion uses a pump to control the flow of formula into the tube, lasting from 8 to 24 hours, sometimes referred to as cycled feedings.
How should unused formula be stored and what should be done with formula that has been open for more than 24 hours?
-Unused formula should be stored in a covered container in the refrigerator. Any formula that has been open for more than 24 hours should be discarded.
What is the proper position for receiving a tube feeding, and how long should this position be maintained after a bolus feeding?
-The proper position for receiving a tube feeding is sitting, if possible. If in bed, the head of the bed should be raised to at least a 45-degree angle. This position should be maintained for at least an hour after a bolus feeding and throughout the night for continuous or cycled feedings.
How often should the feeding tube be flushed and what is the purpose of this?
-The feeding tube should be flushed before and after each feeding and while giving oneself medicine. The purpose of flushing is to prevent tube clogging and to provide extra fluid that the body needs.
What should be done if medications need to be taken through the feeding tube?
-If medications are in liquid form, they can be injected into the feeding tube using a syringe. If medications are in pill form, they must be crushed to a fine powder or dissolved in warm water first. After administering the medication, flush the tube with a small amount of water to ensure all medicine is given and to prevent clogging.
How can one unclog a feeding tube and what steps should be taken?
-To unclog a feeding tube, disconnect it from the bag, attach a syringe, and flush the tube with 30 to 50 milliliters of warm water. Apply mild pressure and gently pull back and forth on the syringe. Repeat this several times. If the clog persists, contact a dietitian for further methods.
What is a residual and why is it important to check it?
-A residual is the amount of gastric fluid left in the stomach between feedings. It is important to check the residual to ensure the stomach is emptying properly, which can be done before each feeding through a PEG tube.
How should the site around a gastrostomy or jejunostomy tube be cared for to reduce the chance of infection?
-The site around a gastrostomy or jejunostomy tube should be cleaned daily with mild soap and water in a circular motion. If there is a dressing on the site, it should be changed daily or when wet or dirty.
What are some potential side effects of tube feeding and what steps can be taken to address them?
-Potential side effects include diarrhea, constipation, nausea, aspiration, dehydration, and abdominal discomfort. Steps to address these include adjusting the rate of feeding, increasing physical activity, using more water flushes, checking for signs of dehydration, and contacting a doctor for persistent issues.
Outlines
🌟 Introduction to Tube Feeding
This paragraph introduces the concept of tube feeding for individuals with special nutritional needs. It explains the necessity of receiving liquid nutrition through a tube as prescribed by healthcare providers. The video aims to familiarize viewers with different types of feeding tubes, including nasal enteric (NG or NJ), gastrostomy (PEG), and jejunostomy (J-tube). It also covers the supplies required for daily tube feeding, the process of feeding, care for the tubing, personal care, and potential side effects. Additionally, it mentions the provision of written instructions tailored to the individual's feeding regimen, including the type of formula, daily amounts, feeding schedule, and extra water needs.
💧 Tube Feeding Methods and Flushing Techniques
This section discusses two primary methods of tube feeding: bolus feeding, where a larger volume of formula is administered three to six times a day, and continuous infusion, which uses a pump for a controlled flow over 8 to 24 hours. It also details the flushing of feeding tubes with lukewarm water before and after feedings to prevent clogging. The paragraph provides a step-by-step guide for flushing, including the use of a syringe, and emphasizes the importance of checking the residual gastric fluid to ensure proper stomach emptying. Additionally, it advises on the proper administration of medications through the feeding tube and how to handle clogged tubes.
🧽 Cleaning and Maintenance of Feeding Tubes
This paragraph focuses on the daily care required for feeding tubes, including cleaning the site around gastrostomy or jejunostomy tubes to reduce infection risk. It outlines the process of cleaning the tube site with mild soap and water, checking for skin or tubing changes, and reporting any redness or swelling. For nasal enteric tubes, it advises on maintaining the position of the tube's black mark and securing the tube with tape or a bridle. The paragraph also covers what to do if a tube becomes loose or falls out, emphasizing the urgency of replacing the tube within 24 hours.
🌡 Managing Side Effects and Additional Care Tips
The final paragraph addresses potential side effects of tube feeding, such as diarrhea, constipation, nausea, and dehydration, providing tips for management. It also discusses the importance of mouth care when unable to take food orally and offers advice for maintaining oral hygiene. The paragraph highlights the need to monitor for signs of dehydration and to adjust fluid intake accordingly. Additionally, it provides guidance on dealing with abdominal discomfort, aspiration risks, and when to seek medical attention for persistent symptoms or complications. The video concludes with a reminder to follow the individualized instructions provided by healthcare professionals and to consult with them for any questions or concerns.
Mindmap
Keywords
💡Nutrition in liquid form
💡Feeding tube
💡Bolus feeding
💡Continuous infusion
💡Flushing the feeding tube
💡Residual
💡PEG tube
💡Dehydration
💡Constipation
💡Aspiration
Highlights
Introduction to feeding tubes and supplies for daily tube feeding at home.
Explanation of three types of feeding tubes: nasal enteric, gastrostomy, and jejunostomy.
Description of bolus feeding and continuous infusion methods.
Importance of proper formula storage and handling.
Guidelines for sitting during feeding and maintaining an elevated position post-feeding.
Instructions on how to flush the feeding tube with water to prevent clogging.
Procedure for administering medication through the feeding tube.
Techniques for unclogging a feeding tube.
How to check the gastric residual to ensure proper stomach emptying.
Caution regarding the potential for feeding tubes to come loose and the importance of maintaining their position.
Daily cleaning of the gastrostomy or jejunostomy tube site to reduce infection risk.
Tips for maintaining oral hygiene when unable to take food orally.
Potential side effects of tube feeding, including diarrhea, dehydration, constipation, and aspiration.
Advice on what to do if a feeding is missed or if there are changes in weight.
Emergency actions to take if the feeding tube falls out.
Receiving a tube feeding instruction booklet for reference.
Transcripts
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because of your special needs your
healthcare provider has advised that you
should receive nutrition in liquid form
through a tube the formula your
healthcare provider has prescribed is
calculated specifically for your
nutritional needs this video will
introduce you to your feeding tube and
the supplies you need to carry out your
daily tube feeding at home you will
learn about the different types of
feeding tubes and supplies the proper
way to go through the tube feeding
process how to care for your tubing and
yourself and the side effects associated
with tube feeding you will also receive
written instructions to read and take
home these instructions will contain
specific information you need about your
tube feedings there are three types of
feeding tubes the first is called a
nasal enteric feeding tube this tube has
passed through the nose and advanced
until the tip rests either in the
stomach or in the small intestine if the
tip of the tube rests in the stomach it
may be called a nasal gastric or NG tube
if the tip of the tube rests in the
intestine it may be referred to as an ND
tube for nazo duodenal or NJ tube for
nazo JooJoo kn'l the second type of tube
is the gastrostomy tube a doctor places
this tube through the abdomen into the
stomach there are many kinds of
gastrostomy tubes the most commonly used
is the percutaneous endoscopic
gastrostomy tube which is also called a
PEG tube the third type of feeding tube
is a jujin ostomy tube or J tube for
short this tube is placed by a doctor
through your abdomen into your small
intestine bypassing your stomach a
registered dietician will explain your
tube prescription to you this will
include the name of the formula the
amount you will take daily your feeding
schedule and the amount of extra water
you will need the products you are
prescribed may be different if you have
any questions regarding your feeding
tube and - prescription please contact
your dietitian
there are two terms we use for the
methods which you will feed the first is
called a bolus feeding this means you
will receive a larger amount of formula
three to six times per day and each
feeding will last 15 to 20 minutes with
the bolus method the formula can either
be given from a bag or drawn up into a
syringe and then fed into the tube
the second feeding method is called
continuous infusion this method uses a
pump to control the flow of formula into
your tube these feedings can last from 8
to 24 hours
this method is sometimes referred to as
cycled feedings when you cycle your tube
feeding you are increasing your feeding
rate while shortening the actual time
you are on the feeding this can free you
from having to receive the tube feeding
24 hours a day make sure you check with
your doctor or dietitian before cycling
your tube feeding when it's time for
your feeding you will need to gather
your supplies supplies include formula a
syringe and a cup of lukewarm tap water
depending on your method of feeding you
may also need a feeding bag a feeding
pump and an IV pole whichever type of
feeding or formula you use there are
some general guidelines to follow for
properly using and storing of your
formula
always store unused formula in a covered
container in the refrigerator throw out
any formula that has been open for more
than 24 hours check the expiration date
on all cans or cartons of formula
always throw out formula containers that
are past this date always allow
refrigerated formula to warm to room
temperature before using it for your
feeding you should sit during your
feeding whenever possible however if you
must take your feeding in bed raise the
head of the bed to at least a 45 degree
angle
keep your head elevated at least an hour
after our bolus feeding and throughout
the night if you are using a continuous
infusion or cycled method in bed
if you have any questions regarding the
tube feeding process please contact your
dietitian to help avoid tube clogging
and to provide extra fluid that your
body needs you will need to flush the
feeding tube with water a few times a
day you can do this with a syringe and
lukewarm tap water syringes come in
different sizes a common size is 60
milliliters which is about 1/4 of a cup
or 2 fluid ounces
do not use cold water as this may cause
cramping in your abdomen you should
flush your tube before and after each
feeding and while you are giving
yourself medicine this will help make
sure that your tube does not become
clogged with any medication or formula
for bolus feedings water flushes should
be given before and after each feeding
with continuous and cycled feedings you
will do water flushes four to six times
a day the amount of water you should use
for flushing is calculated into your
feeding prescription this water is your
fluid intake for the day here are the
steps for flushing your feeding tube
fill a clean cup or bowl with lukewarm
water put the tip of the syringe in the
water with the plunger in place
gently pull up the plunger to draw water
into the syringe clamp or fold the
feeding tube to prevent stomach
secretions from running out and then
open the cap on the feeding port put the
tip of the syringe in the feeding port
unclamp the tube and then gently push
down on the plunger to push the water
through the tube clamp the tube remove
the syringe and close the cap on the
feeding port if you have any questions
when flushing your feeding tube please
contact your dietitian
if you are unable to swallow your
medicines you may need to take them
through your feeding tube do not add
your medicines to your feeding bag
unless your doctor has told you to do so
if your medicine comes in a liquid form
you can use the syringe method to inject
the prescribed dose of medication into
your feeding tube if your medicine is
only available in pill form it must be
crushed to a fine powder or dissolved in
warm water first please remember to
check with your pharmacist or doctor
before crushing any medication after the
dissolved medicine has been put into the
tube flush the tube with a small amount
of water this will ensure that all
medicine is given and will prevent the
tube from clogging do not use formula
juice or other fluids to flush your tube
if you have any questions when taking
your medications please contact your
dietitian
if your tube becomes clogged the formula
will not be able to run through the tube
the best way to keep a tube from
clogging is to flush it with water if
you are using a tube feeding bag and the
formula will not run through the tube
check to make sure that the bag is not
empty that the clamp is in the up or
open position and that the tubing is not
twisted or kinked if the formula still
does not run the clog is probably in the
feeding tube itself to unclog the tube
disconnect your feeding tube from the
tube on the bag attach the syringe and
flush the tube with 30 to 50 milliliters
of warm water you may need to apply mild
pressure if you are not able to dislodge
the clock gently pull back and forth on
the syringe repeat this several times do
not pull on the feeding tube itself
check with your dietitian for other
methods of unclogging your feeding tube
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the residual is the amount of gastric
fluid left in your stomach between
feedings to ensure that your stomach is
emptying properly check the residual
before each feeding
you can check residual fluid through a
PEG tube do not attempt to check
residual fluid through a small bore
feeding tube such as core pack as they
are easily blocked and dislodged if you
have a jejunostomy mezzo duodenum or
nazo jejunal tube you will not need to
check the residual here's how to check
the gastric residual fluid attach the
end of the syringe to your feeding tube
and gently pull back on the plunger to
withdraw the stomach contents check the
amount in the syringe depending on the
amount of aspirated gastric residual you
will replace those contents back into
your body through the feeding tube it
contains things your body needs take the
syringe and flush the tube with 30
milliliters of warm water this prevents
the tube from clogging if your stomach
is empty you may not get any residual
which is fine your dietitian will
explain how often and for how long you
should check the gastric residual
be aware that your tube can come loose
this can cause problems if the tip of
your tube is no longer in the proper
location your tube will have a black
mark on it when you leave the hospital
with a nasal enteric tube take note of
the distance between the black mark on
the tube and your nose try to keep the
mark in the same position each day the
nasal enteric tube is often fastened to
the skin with tape this keeps the tube
in place and reduces the chance that it
will come loose the tube can also be
kept in place using a tube bridle or
strap to keep the tube from becoming
accidentally loosened call your doctor
if the tube moves 2 inches in either
direction if your feeding tube falls out
go to the nearest emergency room as soon
as possible to have it replaced
do not wait more than 24 hours
[Music]
if you have a gastrostomy or a jujin
ostomy tube you will need to clean the
site around your tube every day this is
the best way to reduce the chance of
infection if you have a dressing on this
site this should also be changed every
day or when it gets wet or dirty here's
how to clean your tube site always wash
your hands thoroughly with soap and
water clean the tube site area in a
circular motion with mild soap and water
use a cotton tip swab to clean the area
closest to the tube site check for any
changes in the skin or tubing and report
any redness or swelling to your doctor
if you are taking your feeding through a
tube that goes through your nose the
tube may cause mild soreness or fit
crusty mucus around your nostrils it is
important to clean your nostrils at
least once a day with a washcloth or
cotton swab moistened with warm water if
you have any questions when caring for
your feeding tube site please contact
your nurse
if you are unable to take anything by
mouth your mouth may get dry or you may
have bad breath
here are some tips to help prevent this
brush your teeth tongue and gums
frequently rinse your mouth several
times a day use mouthwash or 1 teaspoon
of salt or baking soda in an 8 ounce
glass of water
try sugarless gum or sugarless candy if
your doctor allows it don't lick your
lips use lip balm or petroleum jelly to
avoid chapped lips you may have
additional instructions for mouth care
if you've had surgery radiation therapy
or bleeding in this area potential side
effects with tube feeding include the
following
since the tube feedings our liquid your
stools may be softer than usual however
if you have frequent watery stools with
six or more bowel movements each day you
have diarrhea here are some steps you
can take to relieve diarrhea if you use
a continuous infusion feeding method
slow down the rate of the tube feeding
call your dietitian to determine how
much to adjust your feeding for bolus
tube feedings slow down the rate of the
tube feeding divide the feedings into
smaller amounts and take them more often
for example if you usually take one can
of formula every four hours you can
change to half a can every two hours
diarrhea may also be caused by spoiled
formula or poor hand-washing always wash
your hands before giving the tube
feeding here are some formula reminders
always store unused formula in a covered
container in the refrigerator throw out
any formula that has been open for more
than 24 hours check the expiration date
on all cans or cartons of formula always
throw out formula containers that are
past this date always allow refrigerated
formula to warm to room temperature
before using it for your feeding if you
do get diarrhea you will need to take
extra fluids you can do this by
increasing the amount of water you drink
or use to flush the feeding tube or you
may need to use an oral rehydration
solution to flush your tube ask your
dietitian for suggestions if you still
have diarrhea after 2 or 3 days be sure
to call your doctor he or she may want
to change your formula or give you a
medicine to help control diarrhea
[Music]
this means that the body is not getting
enough water usually your formula and
the water used to flush your tubing
should meet your fluid needs however if
you have been sweating more than usual
or if you are running a fever or if you
have diarrhea you may become dehydrated
this can become very serious to prevent
dehydration make sure that you use all
the extra water you need each day if you
have a gastrostomy tube for
decompression or venting you should
check the amount of drainage from the
tube contact your doctor or dietitian to
find out what kind of extra fluid is
needed to replace your fluid losses and
how much you will need most tube
feedings are low in fiber which may mean
that you have fewer bowel movements
however if you haven't had a bowel
movement in three or four days or if
your stools are hard you are constipated
to release the constipation try
increasing your physical activity if you
can you can also take more water or
increase water flushes through your tube
when you feel sick to your stomach or
get heartburn changing the way you give
the feeding may help if you are on
continuous feedings slow down the rate
of the tube feeding call your dietician
to determine how much to adjust your
feeding if you are on bolus tube
feedings slow down the rate of the tube
feeding divide the feedings into smaller
amounts and take them more often if the
nausea continues hold the feeding for a
few hours and call your doctor if you
are not it for more than 24 hours
sometimes vomit or saliva is inhaled
into the lungs this is called aspiration
aspiration can be very serious and can
lead to complications if you vomit while
taking your tube feeding stop the
feeding right away and call your doctor
to prevent vomiting and aspiration check
your gastric residual when you feel full
or nauseated keep the head of your bed
raised at least 45 degrees and never
sleep in a flat position while you are
feeding if you ever begin to choke Koff
up formula wheeze or have trouble
breathing stop the feeding right away
and call your doctor if you are having
trouble breathing call 911 ambulance
sometimes you may feel some abdominal
discomfort this may be caused by using
formula that is too cold remember to
allow formula to warm to room
temperature before feeding from time to
time you may miss a feeding this is not
a problem
as long as it does not happen on a
regular basis if you've missed a feeding
and would like to make it up make sure
you follow the instructions for your
feeding prescription
please call your doctor if any of the
following situations are happening to
you diarrhea for more than two to three
days constipation for more than three to
four days nausea or upset stomach for
more than 24 hours
vomiting signs of dehydration such as
thirst dry mouth weakness fever or small
amounts of dark strong smelling urine
losing or gaining more than two pounds a
week
missing feeds for more than one day
fever weakness or other unexplained
symptoms the skin around the tube
becomes red or swollen the area around
your nose becomes red swollen or
indented if your feeding tube falls out
go to the nearest emergency room as soon
as possible to have it replaced
do not wait more than 24 hours
you'll receive a tube feeding
instruction booklet to read and take
home it provides a summary of everything
we've discussed in this video keep in
mind that products and equipment you
receive may be different from what we've
used in this program your dietitian will
discuss your individual needs with you
if you have any questions please do not
hesitate to ask thank you again for
choosing cleveland clinic for your care
you
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