a

Introduction to Home Tube Feeding

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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

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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

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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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