What Is an Enteral Feeding Tube?
Your Feeding Tubes 1 SAMPLE Stoma tract Surgical Patient Education Patient Surgical eling eling d moist (similar to the inside of your mouth) mouth) your of inside the to d moist (similar ainst your body your ainst d in shape Gastrostomy feeding tube
Have no fe Have Lie flat ag flat Lie Are roun redAre an
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Enteral refers to within the digestive system or intestine. system digestive the refers or within intestine. to Enteral your feeding food liquid enter tubes to allow Enteral a tube. The through soft, or intestine stomach flexibletube enters a surgically created opening in the abdominal wall is tube stomach the in enterostomy An called ostomy. an called is intestine A tube small the in called a gastrostomy. on The abdomen the site where tube the is a jejunostomy. inserted called is a stoma. The location stoma depends the of specificon your abdomen.operationyour shapetheand of Feeding Tube?
Most stomas: What Is an Enteral Enteral an Is What 2
Who Needs an Enteral Feeding Tube? Cancer, trauma, nervous system and digestive system disorders, and congenital birth defects can cause difficulty in feeding. Some people also have difficulty swallowing, which increases the chance that they will breathe in food (aspirate). People who have difficulties feeding can benefit from a feeding tube. Your doctor will explain to you the specific reasons why you or your family member need a feeding tube. For some, a feeding tube is a new way of life, but for others, the tube is temporary and used until the problem can be treated or repaired.
Low-profile feeding tube
American College of Surgeons • Division of Education Your Feeding Tubes 3 Oral Cavity Esophagus Throat/Pharynx Trachea Stomach Large Intestine/Colon Large Nasal Cavity Sigmoid Colon Sigmoid SAMPLE Rectum Lung Sphincter Surgical Patient Education Patient Surgical Anus Stomach Ileum Esophagus Small IntestineSmall When food the reaches down broken it is stomach, very pieces. into small the into thenIt moves small intestine, where enzymes down break food thick into liquid. This thick liquid passes further where nutrients, water vitamins, and intestine, small the through absorbed.are intestine large the The through then passes liquid absorbed is from stool the colon. becomes the It in Water (colon). rectum. the out through moves more solid eventually and When food enters your oral cavity (mouth), the lips and tongue tongue and lips the When food oral cavity your enters (mouth), The (pharynx) throat. back the the of throat it toward the move is from leading passageway mouththe nose and to the esophagus and larynx back the At box). (voice two throat, the of tubes form. The (airway) trachea The lungs. the carries to air esophagus (feeding tube) food the into down moves When stomach. the food the esophagus, into moves of openingthe top the at (sphincter) esophagus the stop to the upward tightens food. the of movement The pharynx acts a doorway. as When the food passing, is opening the to airway closes. Understanding Your Digestive System UnderstandingYour 4 Types of Feeding Tubes and How They Are Inserted The type of feeding tube and the procedure to place it will depend Stomach on the patient’s condition, age, Port and other health factors. Feeding (outside body) tubes can vary in length and G-tube ends here number of ports or openings. GJ-tube ends here The main types of tubes include: Jejunum f Long gastric tubes (section of connect directly to tubing small intestine) or syringes for feedings. They may have 1 or 2 ports as well as a port for placement of water into the internal balloon.
f Low-profi le gastric tubes or gastric buttons lay fl at on the abdomen when not in use and require an extension set to be attached for feedings. They also may have a port for placement of water into the internal balloon.
f Gastro-jejunostomy tubes (GJ-tubes or low-profi le GJ-buttons) pass through the stomach and into the small intestine (jejunum). Feedings and medication can be delivered into the stomach or small intestine depending on the patient’s needs. These usually have separate ports for the stomach and the jejunum as well as a port for placement of water into the internal balloon.
f Jejunostomy tubes (J-tubes) enter the jejunum (small intestine) directly and allow slow feedings to the jejunum only. These look similar to long gastric tubes.
American College of Surgeons • Division of Education Your Feeding Tubes 5 bolster PEG Tube External SAMPLE Port Clamp Surgical Patient Education Patient Surgical Percutaneous radiologic gastrostomy (PRG) is the name of name the of is (PRG) radiologicPercutaneous gastrostomy where procedure a G-tubeanother stomach. the placed in is done under is local procedure This sedation. with anesthesia The on image X-ray continuous a fluoroscopy, by viewed abdomen is A puncture needle made a large with is the through a monitor. so that opening then created A larger stomach. the is skin over tube can be inserted gastrostomy the The stomach. the tube into balloon a bumper and internal held an with on stomach the is in outside.the These can be either long tubes or low-profiletubes. The long tube a have also may Y-port allows that for one to side connect directly theto feeding opening an and for medications The water. and often is “PEG” term used describe to G-tubes.all Percutaneous endoscopic gastrostomy (PEG) is the name of a a name of the is (PEG) gastrostomy endoscopic Percutaneous Placement whereprocedure a G-tube endoscopy. placed by is tube can be done a PEG of under local sedation. with anesthesia inserted is on end the (endoscope) tube a light with A narrow A puncture stomach. the into down mouth the moved and in needle made stomach, the large with is skin the over through a heavyand endoscope. The the pulled it by string is through string out mouth the attachesand comes a long which tube, to A out and skin the of stomach the incision. then pulledis into bumper and stomach, the on end the tube the of it inside keeps from outside. the a bolster place These it in keeps initially are long can be tubeslater. low-profile that changed to devices PERCUTANEOUS RADIOLOGIC RADIOLOGIC PERCUTANEOUS TUBES (PRG) GASTROSTOMY PERCUTANEOUS ENDOSCOPIC TUBES (PEG) GASTROSTOMY 6
SURGICAL G-TUBES AND SKIN-LEVEL DEVICES/ LOW-PROFILE BUTTONS
Surgical gastrostomy tubes are inserted in the operating room under general Safety cap anesthesia. Either a minimally invasive approach (laparoscopy) or a standard open operation (surgery) is used to insert the Feeding port feeding tube through the abdominal wall into the stomach. The tube has an internal balloon or bumper to hold it in place, but the stomach is also sutured (sewn) to the inside of the abdominal wall. Many pediatric patients receive a laparoscopic primary low-profi le/button device. Long tubes may be changed to low-profi le tubes once the tract has healed—usually 6 weeks to 3 months later, depending on the technique. Balloon port
Low-profi le button
Feeding extension set
Balloon port G-button Safety cap Skin level
Abdominal wall
Low-profi le button Stomach wall
American College of Surgeons • Division of Education Your Feeding Tubes 7 Gastrojejunal (GJ) tubeGastrojejunal (GJ) SAMPLE Surgical Patient Education Patient Surgical When feedings are delivered into the small intestine by either by intestine small the When feedings delivered into are GJ-tube feedings, continuous or J-tube, be must they slow, does. stomach the food store cannot like intestine the since A jejunostomy (J) tube is also used when also tube feedings is (J) need A jejunostomy to a of time the placed at They stomach. the usually bypass are The operation related be but canalso placed radiologically. J-tube The tube inserted is is intestine. the of wall the through secured on outside the abdomen, the of balloon a small and intestine). (small jejunum the inside place help it in keep may The GJ-tube two has ports: gastric and jejunal. The gastric port access used to is “G”) (marked used usually is and stomach the for medication. The jejunal port used for is feeding. “J”) (marked Gastrojejunal or GJ-tubes are used when feedings need the bypass to mouth, esophagus, stomach. and These tubes or low-profile devices are usually inserted through the existing healed tract a G-tube. of The from tube the moved end is by intestine small the into stomach imaging. X-ray under wires guide They be can also positioned by an of time the or at endoscopy occasionally Theseoperation. are of first the placed as any tubeby methodsthe described above. JEJUNOSTOMY (J) TUBESJEJUNOSTOMY (J) GASTRO-JEJUNAL (GJ) TUBES GASTRO-JEJUNAL TUBES (GJ) 8 Feeding Tube Supplies Your supplies are usually delivered to your home. Supplies may include syringes, a feeding bag, a pole, feeding solution, a pump, and a backpack for carrying the pump.
SYRINGES
There are different types and sizes of syringes used with tube feedings. Large 60 mL syringes are used to give bolus syringe feedings, flush or check placement of a tube, or vent a tube. Smaller 10 mL syringes are generally used to flush children’s tubes or give medication. Smaller 5 mL syringes are generally used to inflate the balloon that holds the tube in the stomach with water. There are markings on the outside of each syringe that you can use to measure how much formula or water to give.
Slip-tip syringe Catheter-tip syringe
Twist-tip syringe Transition adapter
American College of Surgeons • Division of Education Your Feeding Tubes 9
tube connector SAMPLE ENFit feeding set feeding to
safety features will have ENFit twistwill have connector Surgical Patient Education Patient Surgical all feeding tube syringes and feeding sets When the connector transition complete, is For more information, go to www.stayconnected.org to go information, more For to feedingto tube 2015 transition connector 2015 Image credit Global to Enteral Device Supplier Association (GEDSA) In 2015, a conversion took place to enable all feeding enable all to tube took place connectors conversion a 2015, In syringesand onlyother feeding fit to other tubeandsupplies not will adapters conversion, During this body. the enter tubes that be used between syringes still tubes and so older may supplies the of be supplied any with may be used feeding with tubes. You When the seen below. syringes, connectors, adapters or various feeding connectors syringes tube and all complete, is conversion twist secure connection. the will that tip ENFit™ an have will FEEDING TUBE CONNECTORS TUBE FEEDING 10
FEEDING TUBE BAGS AND EXTENSION SETS
A feeding tube bag holds the feeding solution. The bag is filled with feeding solution through the opening at the top.
Feeding tube bags can attach to a pump to deliver a consistent flow of feeding or hang for Fill the feeding bag gravity flow. The bag has clamps that open and close.
One end of the extension/feed set is attached to the feeding device while the other end is connected to the food source. Between feeds, the extension/ feed set can be removed after flushing the device at the end of the feeding. Extension sets are often Tubing clamped replaced every 1 to 2 weeks.
Feeding extension set
American College of Surgeons • Division of Education Your Feeding Tubes 11 SAMPLE Surgical Patient Education Patient Surgical ding bag is empty bagding is s a kink feeding the in tube s a blockage the in If i there the of feeding flow If i there If fee the f f f f f f If there is any drainage at the site, gauze dressings may be placed around may dressings gauze site, the at drainage any If is there after for first the days stomathe site inserted.the few tubeis they But be to not usedare feeding the routinely of care for everyday tube. If the pump is running on batteryrunning If pump the is alert that alarms it has you power, problems: following about the Feeding pumps come in a variety in Feeding come pumps of some and sizes, portable are for travel. The pump can be attached a pole to on wheels or a backpack. placed in An enteral feeding The enteral feedingsAn a steady pump can deliver rate. at electricalpump is orbattery operated, it can and be or purchased rented The will medical supplycompany from a medical supply company. instructions you sethelp for pump give the its and you up use. GAUZE DRESSINGSGAUZE PUMPS AND POLES ANDPUMPS POLES 12 13
American College of Surgeons • Division of Education Feeding Tube Skills: Mouth and Skin Care, Feeding, Giving Medication, and Tube Replacement 13 SAMPLE Surgical Patient Education Patient Surgical r lips moist to prevent cracking. If needed, prevent moist to r lips cream. a lip use e DVD, then just follow each of the steps. the of each follow then just e DVD, ue to brush your teeth with a soft brush twice a day. a soft teeth with your brush ue to twice brush a day.
Contin Keep you Keeping your mouth and skin clean is essential. essential. mouth skin and is Keeping your clean th Watch f f f f f f f f
Infants or the elderly who do not have teeth will need to have need teeth will Infants or elderly have the to who do have not rubbed or sugarless gums their chips Ice a moist with cloth. allowed. are mouth moist can if help you gum your keep Call your doctor or nurse if you have any continued continued any doctor your Call or nurse have if you red skincracked or mouth problems. Some patients with gastrostomy and jejunostomy tubes will also be tubes also will jejunostomy and Some gastrostomy patients with taking food taking not mouth. are If by you mouth anything and by importantstill it is tube, mouth clean. your keep enteral an to have SKILL: MOUTH CARE MOUTH SKILL:
Watch and Review Watch Mouth and Skin Care SKILL Care Skin and Mouth 14 15
SKILL: SKIN CARE
ff It is important to keep the skin around the feeding tube stoma site clean and dry. After a gastric button or long tube is inserted, there may be a small amount of redness or yellowish fluid around the new stoma site.
ff The fluid will dry and crust around the site.
ff Clean around the stoma with mild soap and water, and apply a small gauze dressing with a “Y” cut into the center to allow the gauze to sit around the tube. Use a dressing for the first 2 to 3 days and then remove. Clean around the stoma after that while bathing, and do not use lotions, ointments, or creams on the skin.
ff Rotate the gastric button or tube after cleaning the skin to prevent skin breakdown due to pressure.
ff If you have had a PEG or PGJ procedure, there may be a dressing on the site. It is often left in place for one or two days. If the site is healed, remove the dressing. Clean the site once a day with soap and water, and keep the site dry.
ff You should not attempt to rotate the tube with a PEG or PGJ insertion because it is stitched (sutured) in place.
American College of Surgeons • Division of Education Feeding Tube Skills: Mouth and Skin Care, Feeding, Giving Medication, and Tube Replacement 15 SAMPLE A large syringe is inserted into the feeding tube syringe is insertedA large the feeding into is added to port Feeding set. or extension/feed the through gravity by the syringe and flows tube. feeding to allow bag is filled and elevated A feeding feeding tube port the through flow to feeding tube. the feeding into pump The a pump. to bag is attached A feeding a set period of over be given to feedings allows or continuously. times in a day several time: over Surgical Patient Education Patient Surgical ostomy tube. The delivery tube. feeding method and ostomy
There are several different ways to feedthe through ways different There several are gastr be provider. care will health determined your by Watch the DVD, then just follow each of the steps. the of each follow then just DVD, the Watch f f
f f
Direct/Syringe/Gravity Direct/Feeding Bag/Gravity Direct/Feeding Feeding Pump
Gastrostomy Tube SKILLGastrostomy Tube Feeding through a Feeding Delivery Methods and Devices and Methods Delivery Feeding Methods of Feeding of Methods Watch and Review Watch 16 17 About Your Feeding Solution ff The type of enteral feeding you will be getting is based on your overall health and medical condition. Your health care provider will give you the type, amount, rate, and delivery method for your feedings. See your discharge instructions.
ff Check your feeding solution—always check the label and expiration date of the feeding solution. Do not use if the expiration date has passed.
ff Cover and refrigerate all unused, open containers or prepared feeding solutions. Always label the container with the date and time it was opened.
ff Feeding solution used straight from the container can hang for up to 8 hours. Feeding solution that is mixed with water, powder, or other liquids can be hung for up to 4 hours. Breast milk can also be hung for 4 hours. Dispose of open feeding solution if it has not been used in 24 hours.
ff Opened powdered formula can be stored for up to 30 days.
ff Breast milk can be stored in the refrigerator for 2 days before being discarded. Dispose of fortified breast milk after 24 hours.
ff If the feeding solution has been stored in the refrigerator, warm it to room temperature by holding the container under warm tap water or setting it in a bowl of warm water.
ff Do not microwave feeding, as hot spots and uneven heating can occur with this method.
ff Be sure that feeding tubes are flushed before and after each feeding with the amount of water recommended by your physician.
Type of formula Maximum Hang Time Formula straight from the container 8 hours
Formula mixed with water, powders, or other liquids 4 hours Breast milk 4 hours
American College of Surgeons • Division of Education Feeding Tube Skills: Mouth and Skin Care, Feeding, Giving Medication, and Tube Replacement 17 set for G-button Extension Gauze Small syringe syringe Feeding Feeding SAMPLE bag Feeding Feeding Surgical Patient Education Patient Surgical A feeding syringe feeding bag or extension/feed An forset (optional) buttons only A feeding pump are if you (optional) feeding continuously Feeding solution the ush fl to Water tube after feeding needs or adult infant, A child, position be upright an to in during the entire feeding. child or a small infant An be arms. heldmay your in be may or adult A child seated in a chair. If during feeding the given is someone or to bed, night the in who the keep is to goal the is head the and Elevate stomach. the head higher than upper body a 30- to 45-degree to by angle or a bolster. pillows several using along feeding the with If option, small an eating is portions on. or chew suck to be should available Check label the on feeding. the expiration and date passed. has Do if expiration the use not date warm If feeding the been has stored refrigerator, the in under container the holding by temperature room to it or settingwarm tap water a bowl it in warm of water.
f f f f f f f f f f f f Skills Done before Each Feeding 3. SKILL: POSITION FOR FEEDING FEEDING FOR POSITION SKILL: 3. 2. SKILL: GATHER THE EQUIPMENT THE EQUIPMENT GATHER SKILL: 2. 1. SKILL: PREPARE THE SOLUTION FEEDING PREPARE SKILL: 1. 18 19
4. SKILL: ATTACH THE EXTENSION/FEED SET FOR G-TUBE BUTTONS ONLY
The feeding extension set needs to be connected and disconnected from the feeding source and feeding device before and after each feeding.
ff Wash your hands with soap and water.
ff Open the safety cap on the G-tube button.
ff Hold the G-tube button firmly between 2 fingers.
ff Line up the black marks on the end of the extension feed set with the marks on the feeding cap.
Line up the black lines Rotate the extension set a ¾ turn
ff Insert the extension/feed set securely into the button or port marked “gastric.”
ff Turn no more than a ¾ turn clockwise to lock.
ff Make sure the feeding set is locked in securely.
American College of Surgeons • Division of Education Feeding Tube Skills: Mouth and Skin Care, Feeding, Giving Medication, and Tube Replacement 19 Unclamp the tube Pour syringe feeding Pour Remove syringe plunger Remove
Pull backPull on syringe plunger Unclamp tube deliver to feeding SAMPLE
Surgical Patient Education Patient Surgical eeding is finished, pour water eeding finished, pour water is eeding set warm, with he feeding tube and the allow ightly on the plunger to remove remove on plunger the to ightly d an extension/feedd an set he extension set and e tube and remove the syringe. the e tube remove and our the recommended amount amount recommended the our nt, child, or adult should should or adult child, nt, soapy water and letand it air-dry. water soapy for a G-button, disconnect the extension/feed the set turning by button port or counterclockwise. t Remove f the Wash When f the For thetube. syringe the flush into to mL, 30 mL to routinely 20 is adults, this children. mL for young 10 5 mLand to th Clamp The infa sitting minutes forremain 30 upright after feeding. the use If you Slowly p Slowly t Unclamp thetube. through feeding The flow to over feedingin normally flow will Lifting minutes. 20 syringe the to 15 and a faster in flow, result higher will syringe the a in lowering result will The holdnot syringe may flow. slower formula, of so you amount entire the times. it several fill to have may Wash your hands with soap with water. and hands your Wash back t Pull close the button the close safety cap. it from feeding the syringe, set and the Attach empty the plunger aside. feeding syringe feeding the to port or extension set. of feeding solution into the syringe. the feedingof solution into f f f f f f f f f f f f f f f f f f f f Please see page 17 and follow steps for Skills 1, 2, and 3 and 2, 1, for steps Skills follow and seePlease page 17 (and 4 if you have a low-profiletube) have 4 if you (and SKILL: FEEDING DIRECTLY THROUGH A SYRINGE THROUGH SYRINGE A DIRECTLY FEEDING SKILL: WITH GRAVITY (BOLUS SYRINGE FEEDING) SYRINGE (BOLUS GRAVITY WITH 20 21
SKILL: GRAVITY FEEDING WITH A FEEDING BAG
Please see page 17 and follow steps for Skills 1, 2, and 3 (and 4 if you have a low-profile tube)
Follow all previous instructions for positioning for feeding, attaching the extension/feed set, and checking for placement and function.
ff Wash your hands with soap and water.
ff Connect the feeding bag and the extension tubing and extension feed set if used.
ff Clamp the feeding bag. Add the required solution to the feeding bag with the lower end clamped.
ff Unclamp and clear or prime the feeding bag so that the solution flows through the tubing to the tip of the feeding Fill the feeding bag extension feed set, and clamp the tubes.
ff Open the safety cap on the feeding tube. If used, connect the feeding bag or extension set.
ff Raise the feeding bag to the required height, open the clamps on the feeding bag and extension/feed set and allow the feeding to flow over 15 to 20 minutes.
ff When the feeding is finished, pour in the prescribed amount of water or use a syringe to flush the feeding tube with water. Flush the feeding tube
ff Clamp the feeding set and gravity bag tubing and remove.
ff Wash the feeding bag and set with warm, soapy water, rinse and hang to dry.
Washing the feeding set
American College of Surgeons • Division of Education Feeding Tube Skills: Mouth and Skin Care, Feeding, Giving Medication, and Tube Replacement 21 Set the rate the Set Prime the pump
Fill theFill feeding bag Attach extension/feed set SAMPLE
Surgical Patient Education Patient Surgical afety cap attach and disconnect the feeding eeding extension and e tubing attaching by e tubing to the the to e tubing ould be flushed with water ould be flushed water with ag feeding with solution. rate, unclamp the rate, he end feeding the of bag nd water. water. nd tubing and push the “Start” button. Wash the f the Wash least at set warm, with water soapy let and it air-dry. rinse, a day, once set or feeding extension set, if used. Set the sh Tubes Clamp and the feedingthe tube the bag to feeding tubes. the set clamp and Attach th Insert t extension/feed the into tubing set. b the Fill Open s the Wash your hands with with hands your Wash a soap Prepare th at the end the a feeding of at or every 4 to feeding. continuous during hours 6 the endthe feeding the of the set to feeding tube or G-button. Turn the pump the on hold and Prime the Turn the solution button, flush will which tubing. the of end the through feeding pump. f f f f f f f f f f f f f f f f f f f f Please see page 17 and follow steps for Skills 1, 2, and 3 and 2, 1, for steps Skills follow and seePlease page 17 (and 4 if you have a low-profiletube) have 4 if you (and SKILL: FEEDING WITHFEEDING SKILL: PUMP A 22 23
SKILL: FEEDING THROUGH A JEJUNOSTOMY TUBE
Please see page 17 and follow steps for Skills 1, 2, and 3 (and 4 if you have a low-profile tube)
Feedings through the jejunum part of the small intestine bypass the stomach. This decreases the risk of food refluxing back into the esophagus and the risk of aspiration or liquid going into the lungs. Because the stomach normally helps to break down food, a special type of jejunal feeding may be required.
ff Follow the same procedure for feeding with a pump. The feeding will go into the port labeled “Jejunal.” You will also see a port labeled “Gastro.” This is usually used for giving medication or venting the stomach.
ff Jejunal feedings may be started slowly and given in small amounts to be increased as tolerated.
ff If you see feeding return through the gastric port of a GJ-tube while venting, contact your Low-profile button health care provider immediately. This may mean that the GJ-tube has moved or migrated from its placement.
SKILL: VENTING OR BURPING
You or a family member may experience bloating before, during, or after feeding. If this occurs, gas in the stomach and intestinal tract needs to be relieved.
ff Wash your hands with soap and water.
ff You can vent and release gas by attaching an open syringe or extension feed set to the G-tube. Raise the tube and syringe about 6 inches above the stomach so stomach contents can pass up and down the syringe but won’t spill over.
ff Coughing with the safety cap open also releases air from the stomach. Venting with a syringe ff When a stoma is new and not matured, a full stomach can sometimes result in leakage around the tube. Leakage around the stoma can lead to skin breakdown around the site. Talk with your care provider about adjusting the rate of the feeding—you might have to give it more slowly.
ff If you have a fundoplication procedure— in which the upper part of the stomach is wrapped around the lower end of the esophagus and is stitched in place—the feeding may need to go in more slowly or allow for continuous venting of gas.
American College of Surgeons • Division of Education Feeding Tube Skills: Mouth and Skin Care, Feeding, Giving Medication, and Tube Replacement 23 Jejunal Bal. Gastric Balloon SAMPLE Flushing afterFlushing medication
Surgical Patient Education Patient Surgical edications with with edications octor form. prescribe a liquid in medications to an onean medication d medications d the to feeding bag. ng a pump feeding, you ls can bels opened. crushed or capsules or a crusher A pill cations should be should mixed cations ctor. The doctorsee ctor. check should to a pharmacist and ter each medication each with ter
lly, crushed medication is not crushed not medication is lly, w each of the steps. the of w each
Never ad Never When usi af Flush the tube feeding, breast milk, needthe off will feeding to shut to give medication. Some feedings will effect.interfere a medication’s with All mediAll easier are they so that water with insert feeding the to tube. into Do mix not m other. or each with If more th needed, is feeding tube flush the always with between water each medication. You should be given a list of medications with directions with medications of be should a list from given You do your d Ask your Ask if pil Typica if any current medications interact medications tube the with current feedings. if any Watch the DVD, then just then just DVD, the Watch follo given through the jejunostomy port jejunostomy the through given a GJ-tube;of be through given it may port gastric the tube. the Ask of your instructions. for provider care health small plastic container with a twist tip that crushes pills into very into pills a twist with crushes container plastic that small tip be needed. powder or pieces may small Some not are medications be to “SR” crushed, especially marked those meant or “sustained without medications a doctor’s consent. any Do take not release.” the recommended amount of of amount recommended the water and restart the feeding. f f f f f f f f f f f f f f f f f f f f f f Giving Medication SKILL Overview Watch and Review Watch 24 25 Giving Medication SKILL
SKILL: GATHER YOUR SUPPLIES
1. Medication 2. Feeding syringe 3. Bottle of water for flushing tubing after medications 4. Feeding tube extension/feed set (if needed) 5. Clamp (if needed)
SKILL: GIVING THE MEDICATION
ff Wash your hands with soap and water.
ff Make sure you or your child or infant is in an upright position, just as for feeding.
ff For pump feedings, stop the feeding and open the G-tube button or feeding tube port.
ff Attach the feeding extension set to the G-button if you are using one:
zz Hold the G-button firmly with two fingers, and hold the extension set with your other hand. zz Line up the black lines on the button and tubing. zz Hold the tubing up while attaching to the button to prevent backup of stomach contents into the tubing. zz Gently but firmly push the tubing into the button, and turn clockwise in the direction of the arrow to lock it into place.
ff Draw up the water in the syringe. Attach the syringe to the feeding extension or feeding port of a long gastrostomy or jejunostomy tube.
ff Unclamp the tubing and flush with the water in the syringe.
ff Reclamp the tubing and remove the syringe.
American College of Surgeons • Division of Education Feeding Tube Skills: Mouth and Skin Care, Feeding, Giving Medication, and Tube Replacement 25 SAMPLE Medicine cups Drawing up medication Feeding port Feeding and medication ports Medication port Surgical Patient Education Patient Surgical curate dose of dose of curate dication into into dication e syringe the to medication yringe apart, extension the it and wash and set ding tubes or e same steps, he date and time the medication the time and given. was he date Pull the s the Pull Record t Attach th th Using Draw the back water mixed with syringe. the into up Most fee extension sets have a feeding port a and medication port. the Close feeding port open and medicationthe port for medications. delivering the close you sure Make portmedication when using the feeding port. Pour thePour required dose methe of ac the Draw medication a syringe. into a second medicineUse cup mix medication the to with with medications (Mix water. to 5 and mL for adult an 30 unless mL for a child, 10 fluids are restricted). flush with water after water with each flush medication. have If you a G-button, the remove feeding extension set and safety the close the cap at end button the of after delivery. medication let and dry. them well air rinse warm,with water; soapy a medicine cup. feeding extension set or feeding tube, unclamp the deliver and tube, the medication. the Clamp tube syringe. the remove and f f f f f f f f f f f f f f f f 26 27 Replacing the Gastrostomy Tube SKILL
Watch and Review
ff Watch the DVD, then just follow each of the steps.
Overview It is possible for the gastrostomy tube to accidentally come out. DO NOT PANIC. The site may bleed a little, stomach contents may leak out of the stoma, and there may be some pain or discomfort. Cover the stoma with a clean, dry cloth.
ff A replacement tube should be reinserted within 3 hours. If nothing is placed back in the tract, it will close over and may require an operation to replace the gastrostomy.
ff If the gastrostomy/G-tube has been in place for less than 2 months, it will have to be replaced by a medical professional. This is to make sure the tube has entered the correct location.
ff If the gastrostomy has been in place for more than 2 months, replacement can be safely attempted if the caregiver has been trained to do so.
ff Do not attempt to change your device without proper training from your health care provider.
SKILL: GATHER YOUR SUPPLIES
1. The tube that has fallen out (if it is a balloon-type tube) or a replacement gastrostomy tube 2. A 5 or 10 mL syringe 3. A feeding or irrigation syringe 4. A cup of water or surgical lubricant for moistening the gastrostomy tube 5. pH paper
American College of Surgeons • Division of Education Feeding Tube Skills: Mouth and Skin Care, Feeding, Giving Medication, and Tube Replacement 27 gastrostomy tubegastrostomy inserting the in tube Lubricating the tube Replacing a low-profile Testing the balloonTesting before SAMPLE
Surgical Patient Education Patient Surgical evice is through the stoma stoma the through is evice
r hands with soap and water. The procedure does not have The does procedure have not soapwith water. and r hands he balloon from current the ull back on the tube to make sure sure back make on tube the ull to w the water back out to back out to water w the ment of the tube may be painful. Your doctor may have prescribed doctor have may be tube the of painful.ment Your may e-inserting inspect a tube, new the he end new the lubricated of lacement
it is firmly in place. firmlyin place. it is Gently p Once the d the Once gastrostomy tube smoothly into the stoma stoma the tube smoothly into gastrostomy tract. be should It fit. But a snug if it does be a wrong at it may smoothly, pass not wrong the cavity. lead and angle to Insert t Deflate t Deflate Withdra the balloon.deflate the With balloon lubricant apply deflated, water-based balloon the to part tube. the of Before r balloon and end the tube the of device at for recommended the injecting by inflation easy for balloon the size water of device amount There mL). 5 or 10 syringe a small with (usually twoare ports for on one feeding tube: the is the balloon. for inflating is other the and Replace helpful. some Placing pain medication gel or topical stoma the site. for around G-tube the around anesthesia provides also geltopical that may site be Wash you Wash beto sterile because stoma tract the a sterile not body is cavity. site, inflate the insertingby balloon inflate a site, syringe balloon the the with valve into water. of amount recommended tube by withdrawing the water from water the withdrawing tube by tube. the balloonthe remove and f f f f f f f f
f f f f f f f f Tube rep Tube Preparing thePreparing patient SKILL: REPLACE THE GASTROSTOMY TUBE GASTROSTOMY THE REPLACE SKILL: 28
ff You may check the tube position if directed by your physician. Attach a syringe and extension/ feed set to the feeding port, and pull back on the syringe to see if any stomach contents come back through the tube.
ff Check the fluid with the pH paper. Stomach contents should look clear Testing gastric pH to yellow and slightly creamy and have a pH between 1 and 5.
ff If the contents are green or clear and the pH is 6 to 8, the tube may be in the small intestine.
If there is any doubt about the placement of the tube, do not give the feeding. Call the nurse or physician for instructions.
SKILL: JEJUNOSTOMY TUBE REINSERTION
Patients and families do not reinsert the jejunostomy tube themselves. It should be done by a medical professional who will take X-ray photos to show that the tube is inserted at the right point in the small intestine before feedings are begun. Contact your physician or staff for advice on what to do if the jejunostomy tube needs to be replaced. Your doctor may have you insert a soft rubber tube or gastrostomy tube to keep the stoma site open until the jejunostomy can be replaced. Do not feed through the soft tube unless your doctor directs you to do so.
American College of Surgeons • Division of Education Problem Solving and Emergencies 29 SAMPLE Surgical Patient Education Patient Surgical
h foul-smelling pus, or sputum, blood ain e feeding immediately. in an upright sitting upright the an in position or elevate ess of breath ess wing difficulty ive sweating e or feeling sleepiness of h color of the skin caused by lack of oxygen of skin the of h color lack caused by
DO NOT PANIC. NOT DO Fatigu Shortn Excess Swallo Frequent coughing,Frequent wheezing, rapid breathing, and bluis Chest p wit Cough Stop th Stop Mainta head degrees. bed the of least 45 at
f f f f f f f f f f f f f f f f f f f f This isthe highest risk for patients with tube feedings. The tube feeding the and be been lungs. the misplaced, has may inhaled into There are common problems that can occur with any feeding any with can occur problemsThere that common are quickly out help for you will watch tube. Knowing to what team. care health thesemanage problems your with
Call 911 for professional medical assistance, as this this as medical for assistance, professional 911 Call emergency. threatening becan life a Problem Solving WHAT YOU CAN DO YOU WHAT THE SIGNS AND SYMPTOMS INCLUDE THE FOLLOWING: THE THE SIGNS INCLUDE AND FOLLOWING: SYMPTOMS Aspiration 30 G-Tube or J-Tube Moves from Its Original Placement The tube has moved from its marked position.
WHAT YOU CAN DO
ff Shut off any feedings that are in progress.
ff Check the marker or tape to verify if the tube has moved and how much.
ff Check the placement. Try to withdraw fluid from the tube with the catheter-tip syringe. A tight sucking feeling with little or no fluid returned may indicate that the tube is in the small intestine.
ff A large amount of fluids may indicate that a tube that should be in the small intestine has moved back up into the stomach.
ff Check the color and pH of the contents returned. A pH of less than 5 with clear to light green contents should indicate that a gastrostomy tube is correctly placed in the stomach. A pH greater than 6 can indicate that the tube may be in the small intestine if secretions are yellow.
ff Call your provider for directions on how to proceed.
G-Tube or J-Tube Pulled Out Tube is obviously not inserted in its site.
WHAT YOU CAN DO
ff DO NOT PANIC.
ff Shut off any feedings that are in progress.
ff For a G-tube: Cover the stoma with a small, clean dressing and tape. The G-tube needs to be replaced as soon as possible (within 1 to 3 hours) so that the tract will not close.
ff Replace a gastrostomy tube if you have a backup tube and have been properly trained by your health care provider.
J-tube: Do not attempt to reinsert. Notify your doctor’s office if the J-tube is out of place or removed.
American College of Surgeons • Division of Education Problem Solving and Emergencies 31 SAMPLE Surgical Patient Education Patient Surgical kin gently with soap and water. Use a Q-tips Use kin soap with gently water. and
rrect position. There be not should leakage much in barrier powder if available and a dry and barrier in powder if if available necessary. sterile dressing he bolster a G-tube of skin breakdown. prevent to daily n e’s stoma site e’s Apply sk t Rotate Infectio it is Check feeding the sure or tape tube make marker to co the in 3 days. healed has 2 to in stoma the site once s the Wash swab dry and cotton swab around to or gauze site. the Irritated or red skin around tub the Soreness Bad odor f f f f f f f f f f f f f f f f Call the doctor’s office if your skin does not improve or worsens. or your doctor’s the if skin Call improve office not does WHAT YOU CAN DO YOU WHAT SIGN AND SYMPTOMS: Irritation of Skin at the Site Stoma 32 Nausea or Vomiting Caused by Certain Medications, the Tube Moving in the Stomach or Blocking the Stomach Outlet, or Tube Feeding Intolerance
WHAT YOU CAN DO
ff Stop the feedings if continuous.
ff Check the feeding tube for residual volume with the feeding syringe.
ff Check the placement of the tube and readjust if necessary.
ff Check to see if the abdomen is firm or painful to the touch.
ff Watch for signs of dehydration such as dry mouth, thirst, or decreased urine.
Call the doctor’s office if there is a large residual volume after 2 feedings, if the abdomen is firm or swollen, or if there are signs of dehydration.
Diarrhea Caused by Feeding Intolerance, Too Much Water, Medication, a Virus, or Infection
WHAT YOU CAN DO
ff Watch for signs of dehydration such as dry mouth, thirst, or decreased urine output.
ff Continue to feed, watching and recording the amounts closely.
If diarrhea lasts more than 2 days, call your doctor’s office.
Constipation: Infrequent and/or Hard Stools, Bloating, Gas, Cramping, or Pain
THIS MAY BE CAUSED BY:
ff Inadequate fluid intake or fiber
ff Certain medications
ff A bowel obstruction
ff Inactivity
American College of Surgeons • Division of Education Problem Solving and Emergencies 33 SAMPLE Surgical Patient Education Patient Surgical ecured tube can also increase granulation tissue and lead and tissue ecured granulation tube increase can also
he tube gently. he tube gently. t the stomat the site profile devices, have the length stoma have profile devices, se activities walking. like Practice good hygiene to the site. site. the Practice to good hygiene Handle t A poorly s low- For to infection,to bleeding, or an increase in drainage and odor. Pink to red overgrown tissue tissue red overgrown to Pink or skin a Bleeding Increase fluids. Increa remeasured your by physician. f f f f f f f f f f f f f f f f Call your doctor if you have not had a bowel movement in 2 days, you you 2 days, in had a bowel not movement doctor your Call have if you Your begin vomiting. you or cramping, or swelling abdominal have a stooldoctor you softener medications, need give your review may to fluids. daily your your orfeedings,of addtheamount fiberto change or be necessary may blocked are or obstructed. bowels if your Tests Contact the doctor’s office to provide local care to the site. Contactprovidethe to to doctor’slocal the care office WHAT YOU CAN DO: YOU WHAT SIGNS AND SYMPTOMS: WHAT YOU CAN DO CAN DO YOU WHAT Granulation Tissue Due to Friction, Granulation Tissue Dueto Friction, Chafing, or Dragging Downwards 34 Clogged Feeding Tube The feeding tube can be clogged due to feeding sediment in the tube, causing slow delivery rates of feeding or inability to flush the tube or deliver medications.
WHAT YOU CAN DO
ff Try to slowly flush the tube with warm water using a 10 mL syringe and repeat every 10–15 minutes until the clog is cleared.
Do NOT attempt to clear blockage by inserting an object. This could result in damage to the tube or injury to the GI tract. Do NOT use cranberry juice, meat tenderizer, or carbonated beverages (for example, cola) to unclog tube. These products can make the clog worse. Notify the doctor’s office if the tube remains clogged.
Tube Leakage Your feeding tube can have leakage due to the amount of feeding, weight gain or loss, enlarged stoma, underinflated balloon or loose bumper, incorrect tube position, feeding intolerance, or constipation. Incorrect button length for the stoma can also be a cause.
SIGNS AND SYMPTOMS:
ff Fluid, feeding, or blood noted at the tubing insertion site
ff Need for a dressing more than 2 days after tube insertion
WHAT CAN YOU DO
ff Most leakage is due to intolerance of the rate and the amount of feeding. Do not overinflate the balloon if there is leaking. Call the doctor’s office to determine if the feeding should be slowed down or the amount adjusted.
If there is another cause: ff Determine the reason for weight change and treat.
ff Deflate the balloon and reinflate using the correct amount of water.
ff Treat constipation by increasing activity and providing adequate feedings and fluids.
ff Adjust medications if necessary.
ff For low-profile buttons, have the stoma length remeasured and confirmed by your physician.
American College of Surgeons • Division of Education Problem Solving and Emergencies 35 SAMPLE Surgical Patient Education Patient Surgical ing tube has come out and you have have out you and come tubeing has or difficulty breathing g or diarrhea that continues for more than 2 days for more than continues g or that diarrhea ature of 101°F or 38.3°C 3 days 2 to for more than 101°F of ature l weakness, fever, chills or symptoms other chills l weakness, fever, s, pain, or from drainage tube the insertion site ng, tears, or change in color around the G-tube the around color in ng, or tears, change stoma resistance feeding to n Vomitin Unusua Rednes Temper not beennot it trained or replace cannot Choking The feed Bleedi f f f f f f f Bleeding Infectio withPain Ulceration Leakage f f f f f f f f f f f f Contact surgeon the or nurse or go your immediately to nearest emergency issues: following the room have if you f f f f f Call the doctor’s office to confirm the condition and condition obtain the confirm to doctor’s the Call office medical possibly be or to advice remeasured. Buried bumper bumper holding syndrome the internal the to due can occur or loss. gain weight as well abdominal the as wall against tube tightly too WHAT YOU CAN DO YOU WHAT SIGNS AND SYMPTOMS: SIGNS AND SYMPTOMS: Medical Emergencies Buried Bumper Syndrome Buried Bumper Syndrome 36
American College of Surgeons • Division of Education Home Management and Other Resources 37 SAMPLE Surgical Patient Education Patient Surgical
Daily care of the feeding tube includes flushingthe feeding tube after feedingeach the clear used or afterto is The given. are medications flush 10 of mL orto formula of medicine. Recommendedtubing 5 mL are flushes adults. and for children mL water of 30 mL to for infants 15 and water Look feeding the at tube for leakage, daily site bleeding, problems. skin or be should The kept site soap with water and clean and the skin around the gently. dried opening After the initial insertion opening the tube, the of be around healed should is there so tubing the that little leaking no and need If there for a dressing. leakageis that requires a daily dressing or any problemsother skin the with report healing, and doctor the them to feedings regular with skin and care. do improve not if they Try to live your life as normally as you can. You or your family member or your should can. You you normally as as life your live to Try a positive maintain try help you will active Socializing possible. as as remain to outlook. feel unique who a need may has a child overprotect Parents or treat to Your to them become cause dependent.may which needs differently, physical will happierchild be Your shehe or feels.the in way only “different” is child if rules same the stay carries life and same the on before. much as Family and good and receiving tube feedings. to normal friends adjust help you is can It all Family feelto receiving of tired tube The affects feedings time. from process to time every contactand feelings a everyone’s through to talk but it helps way, family a different in booklet back the this of in who There can help resources if necessary. are professional common someare to Below help. and professionals information can where find you about when think someone to areas receiving tube is feedings home. the in
Other Resources Home and Management DAILY CARE Keeping Things Normal ThingsKeeping Normal Overview 38
BATHING AND DRESSING
ff Until the stoma site has healed, it should be cleaned with soap and water and a dry sterile dressing applied. After the site has healed, you may shower and bathe as normal.
ff Clamp the G-tube before bathing.
ff In low-profile devices, make sure the port covers are securely closed.
ff Avoid overly warm water that can irritate tender skin at the tube site.
ff Use only mild soaps and soft washcloths.
ff Dry completely around the stoma, as any dampness can breed bacteria and develop into an infection.
ff Children may chew the tubing or play with it. If a child is allowed to pull or tug at the tubing, they may be able to pull it out. You can prevent this by:
zz Dressing the child in a one-piece undershirt with the tube tucked inside. zz Wrapping a piece of tape or rubber band around the tubing and pinning the tape/rubber band to your child’s diaper or undershirt. zz Placing the end of the tubing under the tabs of a disposable diaper. zz Dressing your child in a tube top or wrapping an elastic bandage around the waist, securing the tubing underneath.
AC TIV IT Y
The health care provider will tell you when you or your family member can resume your normal activities. You will usually be told to avoid lifting for 6 weeks after an open procedure, but there are fewer restrictions after PEG tube placement.
There should be no restrictions for a child with a gastrostomy tube. A young child should be able to crawl and should be able to sleep on his or her stomach. Taking a bath or swimming in a pool is also permitted. Be sure to dry the skin around the tubing or the button after swimming or bathing. If you are unsure of a planned activity, ask your doctor or nurse.
SCHOOL AND WORK
Discuss the type of work you do with your doctor and ask how long you will need to be away from your job depending on your procedure. Your child should be able to return to school as normal. Your community team, social worker, or the special-needs coordinator at the school will be able to advise you further about this. The staff at the school can be taught G-tube maintenance for emergency situations and possibly assist with feedings. If you or your child particularly enjoys contact sports, ask the medical team for advice.
American College of Surgeons • Division of Education Home Management and Other Resources 39 SAMPLE Surgical Patient Education Patient Surgical ringe phone numbers a rechargeable battery r rubber band oves oves yringe sure sure wels er for tap water water tap for er eding tube g bag or set Rubber gl Paper to Contain o C-clamp mea Tape Emergency Extra fe with Pump Feedin Feeding s mL sy 10 5 mL to f f f f f f f f f f f f f f f f f f f f f f Keep your supplies with you in a carry-on in you with supplies your Keep bag extra remember and take to breakage, end case loss, staying of in or up if you longersupplies you than kit emergency of a travel take planned. including: you, Always with supplies When traveling out of town, call your home care company ahead of time to arrange to ahead time of home company your care call out town, of When traveling phone numbers and service portablefor addresses customer keep and equipment, carry also should a letter consultant from You your away. are you while you with explaining that you are carrying medical equipment because of you or your family member’s feeding needs. special request Contact to ahead time any of airline the security need know you that to and supplies the all on board. allow assistance will There should be no restrictions for travel; however, if you or your family member has member has family your or you if however, travel; for be restrictions no There should doctor the with a letter write or plans her him to ask and complex travel needs, discuss need help if will you This seek medicalexplaining to your medical history. locally. advice Try to keep family mealtimes as normal as possible normal for family socialization keep as as mealtimes purposes. to TheTry family member a feeding with tube be should rest the join encouraged the of to During tube eating. not feedings if he or is she for and even mealtime, family at after minutes family feeding the or your you completed, 45 is to 30 approximately A if necessary. side ormember lying right upright seated on your remain should or him to tube help a pacifier use while being fed may gastrostomy by a child young a normal of feeding. sucking full the pleasurable with and sensations her associate VACATION AND TRAVELING VACATION MEALTIMES 40
For road trips, check the location of your seat belt to avoid pressure on the tubing and insertion site.
If you are planning a beach holiday, cover the gastrostomy with a large dressing to stop sand from getting into it. Sand can irritate the skin near the stoma site, cause an infection, or damage the device itself.
It is important to stay well hydrated and to flush small amounts of water through the tube whenever possible.
EMOTIONS
You or your family member may feel self-conscious or have anxiety about your feeding tube. Talking to other people may help. You can try contacting the support groups listed in the back of this booklet or contact local resources through your health care provider.
Children may become more demanding, clingy, or revert to earlier behavior such as bed-wetting if they have been hospitalized or away from you for a while. Reentry into the family life and acceptance and participation in the care of a child with a feeding tube should help the child settle back into a normal routine.
BODY IMAGE
You and the rest of your family may feel that much has changed and that everything has to revolve around the feedings for a while. Keeping to your normal routine as much as possible and maintaining the usual mealtimes, rituals and bedtimes may help. Staying as active as possible and allowing good friends to know what you have experienced will help you gain acceptance of this change. There are support groups, references, and websites at the back of this book that will offer the advice of others who are willing to share their experience and answers to some of the questions you and your family may have.
American College of Surgeons • Division of Education Home Management and Other Resources 41 /
/ mber SAMPLE
Feeding pump Phone nu Phone Phone number Phone /
/
Surgical Patient Education Patient Surgical
Bolus syringe feeding
alth nurseis alth f formula feeding at
Gravity drip eding formula
Vent or burp G-tube feeding? Vent each prior to feeding? each prior to Check residuals Notes: Supplies may be ordered a local may through Supplies medical equipment or store insurance Check your with pharmacy order company. internet or a national need may a prescription preferred providers. see to have You if they company be may they home care, feeding health for your tube have supplies. If you planner hospital discharge supplies. your Check with order your to assigned you need.supplies the of coverage specificfor your the for details Have your supplies ordered before you leave the hospital. It may take 1 to 2 days for 2 days 1 to take hospital. the may It ordered supplies before your leave you Have a delay. case is there in supplies of days hospital the several with Leave arrive. them to Feeding tube type model and # My feeding tube care supplies are of feeding:Type My surgeon is surgeon My Tube fe Tube My homeMy he Amount of flush after flush of Amount feedingand medication Feeding schedule Feeding Number of daily feedings Amount o Your Discharge Plan Your 42 Feeding Tube Resources for Nutrition and Home Care
FOUNDATION ORGANIZATION
American College of Surgeons www.surgicalpatienteducation.org 800 - 621- 4111 Surgical Patient Education Program
COLLABORATIVE ORGANIZATIONS
American Head and Neck Society (AHNS) www.ahns.info
American Laryngological Association (ALA) www.alahns.org
American Pediatric Surgical Nurses Association (APSNA) www.apsna.org 855-984-1609
American Pediatric Surgical Association (APSA) [email protected] 847-480-9576
American Society of Parenteral and Enteral Nutrition (ASPEN) www.nutritioncare.org 800-727-4567 Guidelines for enteral nutrition therapy and home nutrition support
Association of Gastrointestinal Motility Disorders, Inc. (AGMD) www.agmd-gimotility.org 781-275-1300 Focuses on education, advocacy, outreach, research, and support
Commission on Cancer (CoC) www.facs.org/cancer
Feeding Tube Awareness Foundation www.feedingtubeawareness.com
Wound, Ostomy and Continence Nurses Society (WOCN®) www.wocn.org 888-224-9626
American College of Surgeons • Division of Education Home Management and Other Resources 43
on 3 – C
Questi Question 4 – C
SAMPLE Question 1 – B Question 2 – A Answers: Answers: Surgical Patient Education Patient Surgical
feeding tube or extension set with the recommended amount of water. breast milk can be hung for 4 hours. Feeding solution from a container can hang for 8 hours. Feeding or solution powder, mixed that is with water, None of the above containers or prepared feeding solutions. When the feeding is finished, disconnect the feeding set and wash in the dishwasher. When the feeding finished, is disconnect the feeding set and wash in the dishwasher. When the feeding finished, is just clamp the tube theand feedingleave When the feeding finished, is always pour the water into syringe or flush the set in place. You should or microwave boil a feedingYou solution before given. it is You need and refrigerate cover to You all unused open A gastric button lies flat on thesurface of the abdomen. A percutaneous gastrostomy tube can be reinserted if necessary home. at A gastrostomy tube feeds nutrition directly the into small intestine. A jejunostomy tube feeds nutrition directly the into stomach. An infant, child, or adult needs remain to upright for minutes 10 after the feeding. A 30 or 60 mL syringe A 5 mL syringe mLA 10 syringe
D. B. B. D. D. B. B. D. C. C. C. C. A. A. A. A. through the tube? the through What type of syringe should use you when flushing and feeding Which of these statements aboutfeeding enteral tubes TRUE? is Which of these statements about feedings enteral TRUE? is Which of these statements is NOT TRUE when are you giving tube feedings? QUESTION 4 QUESTION 3 QUESTION 2
QUESTION 1 Check Your Knowledge Check Your 44
Frederick L. Greene, MD, FACS ACS SURGICAL PATIENT Clinical Professor of Surgery, UNC School of Medicine, Medical Director of Cancer Data EDUCATION PROGRAM Registry, Levine Cancer Institute, Charlotte, NC
Director: Ajit K. Sachdeva, MD, FACS, FRCSC Anne Marie Herlehy, DNP, RN, CNOR Assistant Director: Kathleen Heneghan, RN, MSN, Administrative Director, Perioperative PN-C and Cardiovascular Services, Alexian Manager: Nancy Strand, RN, MPH Brothers Medical Center, Elk Grove, IL Program Coordinator: Mandy Bruggeman Sue Kozik Mother of pediatric feeding tube patient PATIENT EDUCATION Dennis H. Kraus, MD, FACS Director, Center for Head & Neck Oncology COMMITTEE New York Head & Neck Institute, North Shore-LIJ Cancer Institute Ajit K. Sachdeva, MD, FACS, FRCSC, Co-Chair John M. Daly, MD FACS, Co-Chair Arlet G. Kurkchubasche, MD, FACS Eileen M. Duggan, MD Associate Professor of Surgery and Pediatrics David V. Feliciano, MD, FACS Alpert School of Medicine, Brown Frederick L. Greene, MD, FACS University, Providence, RI B. J. Hancock, MD, FACS, FRCSC Dennis H. Kraus, MD, FACS Daniel Teitelbaum, MD, FACS, ASPEN Michael F. McGee, MD, FACS Professor of Surgery, C.S. Mott Children’s Beth H. Sutton, MD, FACS Hospital, University of Michigan Michael J. Zinner, MD, FACS
DISCLAIMER: FEEDING TUBE TASK FORCE The information contained in the patient education Debra Arnow, DNP, RN, NE-BC section of the American College of Surgeons (ACS) Vice President, Patient Care Services & CNO website does not constitute medical advice. This Children’s Hospital & Medical Center, Omaha, NE information is published as a communications vehicle to inform and to educate the public about specific surgical Clint Bowers procedures. It is not intended to take the place of a Feeding tube patient discussion with a qualified surgeon who is familiar with your situation. It is important to remember that each individual is different, and the reasons and outcomes Jan Cannon-Bowers, PhD of any operation depend upon the patient’s specific Director of Research, USF Center for Advanced diagnosis, disease state, or other medical condition. Medical Learning and Simulation, Orlando, FL The ACS is a scientific and educational organization that is dedicated to the ethical and competent practice Teri Coha, APN, CWOCN of surgery; it was founded to raise the standards of Pediatric Surgery, Ann & Robert H. Lurie surgical practice and to improve the quality of care Children’s Hospital, Chicago, IL for the surgical patient. The ACS has endeavored to present information for prospective surgical patients Janice C. Colwell, MS, RN, FAAN based on current scientific information; there is no Ostomy Care Services, University of warranty on the timeliness, accuracy, or usefulness Chicago Hospital, Chicago, IL of this content. Under no circumstances will the ACS be liable for direct, indirect, incidental, special or Maureen Emlund, RN, MSN, CPN punitive, or consequential damages that result in Clinical Simulation Manager any way from your use of this electronic resource. Dominican University, River Forest, IL © American College of Surgeons 2015 Lisa A. Gorski, MS, APRN, BC, CRNI, FAAN Clinical Nurse Specialist Wheaton Franciscan Home Health, Milwaukee, WI The Feeding Tube Home Skills Kit, developed by the American College of Surgeons Division of Education, is made possible in part by the generous support of an education grant from: Applied Medical Technology, Inc.
American College of Surgeons • Division of Education