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How do feeding tubes work?

Hi, my name is Katelynn Maniatis, and I'm a registered dietitian here

at Sunnybrook. Over the next few minutes, we will be discussing

methods of insertion, benefits, care

and feeding of gastrostomy or G tubes.

The gastrostomy or G tube is a feeding tube

that goes through the skin and abdominal wall and allows

liquid nutrition and medications to be

administered directly into the stomach.

G tubes provide a route to deliver nutrition and medication to those who

are having difficulty swallowing

or cannot take enough food by mouth. G tubes help prevent weight loss,

maintain nutritional status and

minimize risk of aspiration. Individuals with cancer,

ALS or those who have had a stroke or trauma

often required G tubes.

Oral intake is encouraged even after G tube insertion.

G tubes can provide liquid nutrition formulas

as either a sole source of nutrition or

to supplement oral intake.

G tubes may be placed by gastroenterology

or interventional radiology. Gastroenterology will insert a

percutaneous endoscopic gastrostomy tube

or PEG tube using an endoscope

which travels through the mouth down the esophagus and into the stomach

to guide tube insertion. Interventional radiology

will use x-ray technology to aid in the insertion

of the tubes. G tubes can be inserted on an inpatient or outpatient basis.

Before your G tube is inserted, you'll be advised not to have anything to eat

for midnight before the night of the procedure. Following tube insertion,

you'll be instructed to either drink clear fluids such as water or apple juice

or be provided with IV fluids to maintain hydration.

Following an abdominal examination by your physician

you'll be able to begin using the G tube

and resume oral intake of regular solid foods

if appropriate.

If swallowing function improves

or risk of aspiration is minimized transitions can be made back to

oral intake. Tubes can be removed and the removal procedure will vary depending on

the method of insertion.

Clean the skin

under the tab and around the tube every day with a Q-tip dipped

in normal saline. Imagine the Q-tip is an arm on a clock

and clean in a clockwise manner around the tube. When you're in the shower

clean the skin around the tube with a mild soap and water and ensure that you

dry the area completely when you're done.

Do not take baths and gauze

dressing is not necessary unless you're having drainage from

the tube site. Clean the tube and stoma site daily.

Wash your hands thoroughly before

completing any tube checks and ensure that you're gently lifting the sides of the tube to

examine the skin around the area.

Signs of infection include fever,

redness, tenderness and

any discharge that may be discolored

or foul-smelling. Secure the free end of the tube

with tape on the abdomen or with a stretch gauze band.

Check to see if the mark on your skin is at the same point

as it was when it was initially placed. Do not pull on the tube

because it can dislodge.

There are two methods that can be utilized when feeding through the G tube:

syringe feeding and feeding by gravity.

Remember to sit in an upright position during feeding and for 30 to 45 minutes

after feeding to prevent regurgitation. The first step would be to wash your

hands thoroughly.

Next, fill the syringe with 60 millimetres of

lukewarm water. Strain out the feeding tube

and check tube placement. The mark on the tube should be the same place as when it

was placed

initially. Hold the tube above stomach height

or pinch the tube and open the stopper or tube tip.

Place the tip of the syringe into the end of your feeding tube

and plunge the water through the tube. Cap the tube tip.

Now you're ready to set up your feeding set.

The first step is to shake the formula well. Make sure you wipe off the top of

the formula can with a clean damp paper towel

and don't forget to check the can for the expiration date.

Close the roller clamp so this means you'll be rolling the clamp down

on the feeling set. Pour the desired amount of formula into the bag

and hang it above head level. Remove the plastic cover

from the tip of the feeding set and insert the tip of the feeling set

into your feeding tube. Open the roller clamp,

so roll it up, to start the feeding. You can adjust the rate that the feed runs

through by opening and closing the ruler clamps. So just simply roll it up or

down

to slow down or speed up the rate. At the end of feeding, close the roller clamp and

disconnect the feeding set from the feeding tube.

Finally flush your tube with 60 millimetres of lukewarm water

and close the feeding tube.

You would follow the same steps to flush your tube with water

as you would if you were using a gravity feeding. The next step would be to

fill the syringe with formula the same way in which you would with water.

Open the tube tip and place the tip of the syringe

into the end of your feeding tube and slowly push the formula in.

Refill the syringe until you've used the desired amount of feed.

After feeding, run another 60 milliliters of

lukewarm through the tube to flush it clear. Hold the tip above stomach

level

or pinch the tube and disconnect the syringe from the tube.

Close your feeding tube.

Medications can be administered through the feeling tube

but just check with your pharmacist to ensure that your medications

are crushable and don't require a liquid form,

which may also be available. Ensure that you're flushing with

water before and after medication administration

and do not mix the medications with the feeding

formula. After feedings,

clean the syringe parts with warm soapy water

and let them air dry. A bottle brush may be useful for cleaning the syringes.

Once per day, soak the syringe parts as well as the feeding set

in a mixture of a quarter cup of vinegar and one cup of water

for five minutes. Rinse with fresh water

and ensure that you're allowing this fresh water to run through the tubing

of the feeling set. Store the supplies

in a container or zip lock bag in the refrigerator

to decrease the risk of bacterial growth.

Do not put substances other than medications or tube feeding formulas

through the tube as they may cause blockage. Sometimes

medications and feeding formula can get stuck

in the tube and cause blockage. This is why you want to ensure that you're

always flushing the tube before and after administration.

If you do see that there is some build up in your tube

when you're flushing, try and apply a bit more force or pressure with that syringe

that you're flushing through.

If this doesn't relieve the blockage then

contact your health-care professional.

Do not pull on the tube because it can dislodge.

If your tube does fall out, it needs to be replaced

as soon as possible. Clean the area and cover with a sterile gauze pad

and come to the hospital as soon as you can.

Always sit upright in a chair or in bed

when feeding. Cover your formula cans

and store them in the refrigerator for up to 24 hours

after they've been opened. If you have a feeling

of uncomfortable fullness or bloating

slow down the rate of feeding. If you're using

a feeding set roll that roller clamp down

to decrease the rate and if you're syringe feeding

then slow down the force or the rate that you're

pushing through the formula. For more information

speak with your registered dietitian or visit the clinical nutrition section

of the Sunnybrook website.