www.healthinfo.org.nz Tube feeding with a gastrostomy tube

This factsheet tells you how to care for your feeding tube and stoma (the artificial opening into your stomach) and how to take your feed and medications via your tube. Gastrostomy A gastrostomy is an artificial opening through your abdomen into your stomach. A feeding tube is inserted through the opening so that special liquid food (feed), medications and fluids can go directly into your stomach. Some feeding tubes go down into your jejunum, a part of your small intestine. There are two types of gastrostomy tube, a PEG (percutaneous endoscopic gastrostomy) and a RIG (radiologically Inserted gastrostomy). These terms describe how the tube is fitted. PEG and RIG tubes both have centimetre (cm) markings.

A – Feeding port. B – Flange (bumper). C – Clamp. D – Balloon inflation-deflation port. PEG tube The PEG tube has a flange (bumper) inside your stomach to keep your tube in the right position. The tube can remain in place for 18 months or longer. The feeding port on the end of the tube can be replaced as shown on the diagram. RIG tube The RIG tube has a water filled balloon that holds the tube in your stomach. The nurse will show you how to check the balloon. The tube will need to be replaced approximately every six months. This is a very simple procedure and the PEG nursing service will contact you to arrange a clinic appointment. If the flange (bumper) is at the same cm marking but further away from your skin than normal, the balloon may have deflated. If this happens, try to push the tube back into its original position and tape it down. Contact the PEG Nursing Service urgently (see the contact details below).

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Tube feeding with a gastrostomy tube www.healthinfo.org.nz Feeding Flush your feeding tube with warm water before and after you tube feed, and before and after you take medications down your tube. If you have safe drinking water, you can use tap water to flush your tube. Otherwise, use boiled, cooled water. If you have a jejunal tube, always use boiled, cooled water to flush your tube.

Important Only put the following down your feeding tube: ▪ the feed prescribed by your dietitian or doctor ▪ water ▪ prescribed medications (see below for how to put medications down your feeding tube). Don't put puréed food down your feeding tube.

Feeding methods There are two methods of tube feeding, bolus feeding using a syringe and pump feeding. Your dietitian will decide which type of feeding is best for you. Bolus feeding via a syringe – This is when you have a set amount of feed at specified times during the day. This is similar to having meals at mealtimes. Pump feeding – This is when a pump is used to continuously deliver a set amount of feed through your feeding tube over a set amount of time. Your dietitian will discuss both options with you in more detail and provide you with a plan and instructions when needed. Medications The hospital pharmacist will review your medications before you go home to make sure you can take them through your feeding tube. There are some important points to note. ▪ Use the main port of your feeding tube for medications. ▪ Use the bolus feeding method (see above) to put medications down your feeding tube unless your dietitian or nurse advises otherwise. ▪ Flush your tube with 20 mL warm water before and after giving medications. This helps to prevent your feeding tube from blocking. ▪ If you have more than one medication, take each one separately. Flush your feeding tube with 10 to 15 mL of warm water between each medication. ▪ Finely crush each solid medication separately (a mortar and pestle is best for this) and mix it with 10 to 15 mL of water before putting it down your feeding tube. ▪ You can take liquid medications down your feeding tube without diluting them.

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Tube feeding with a gastrostomy tube www.healthinfo.org.nz Caring for your equipment and feed ▪ After feeding, wash the syringe with mild dishwashing detergent, rinse thoroughly and leave it to air dry. ▪ Place the syringe in a clean zip lock bag or a clean container with a lid. Store it in the fridge to prevent it being contaminated by bacteria. ▪ You can use each syringe for about two weeks. ▪ Giving sets (only used for pump feeding) can only be used once. Discard them after you've used them for 24 hours and don't reuse them. ▪ Cover open cans or bottles of feed and store them in the fridge. Throw away any open, unused feed after 24 hours. ▪ You can use ready-to-hang bottles of feed for 24 hours. Throw away any unused feed after 24 hours. ▪ Your feed should be at room temperature when you use it. If it has been in the fridge, leave it for 30 minutes before using it. Caring for your feeding tube and stoma Your stoma ▪ For the first one to two weeks after your tube is inserted, you can expect a small amount of discharge from your stoma as it heals. ▪ Clean your stoma daily with warm soapy water. ▪ If the discharge carries on, clean your stoma more regularly using the saline solution provided by the PEG nurse. ▪ After six weeks, you can swim or have a bath. Your feeding tube

Important If your feeding tube comes out, your stoma will begin to close within two to three hours. Contact the PEG Nursing Service immediately (see below). You may need to go to the hospital to have it put back in.

▪ Turn your feeding tube 360 degrees and move it slightly in and out of your stoma daily. This stops the tube from sticking. ▪ Attach your feeding tube to your stomach using the tube fastener supplied by the PEG Nursing Service. This will stop it moving in your stoma.

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Tube feeding with a gastrostomy tube www.healthinfo.org.nz ▪ If you gain or lose weight, you can reposition the flange (bumper) on the tube by sliding it up or down the feeding tube. It should always sit 1 to 2 mm away from your skin. ▪ Before starting your feed, always check that the flange (bumper) is in the same position. ▪ If you aren't using your feeding tube for feeding, flush it with warm water at least twice a day. Troubleshooting Problem Possible cause Recommended action Your skin around the tube is You may have an infection. See your GP who may prescribe very red and painful and there First check that the flange isn't antibiotics. is pus. too firm on your skin. Your skin is “raw” around the You may have what's called This is common and easily tube insertion site. overgranulation tissue. treated. Contact the PEG nursing service within normal working hours. See the contact details below. The feeding tube is blocked Try to unblock it using a 60 If you can't clear the blockage, mL syringe half filled with contact the PEG nursing warm water. Use a gentle push service. If after hours, contact pull method to dislodge the the on-call service. See the blockage. contact details below. Feed is leaking during feeding. Your tube may have come out Contact the PEG nursing of your stomach but still be service. If after hours, contact sitting under your skin. the on-call service. See the contact details below. Supplies, syringes and giving sets Contact the Canterbury DHB Supply Department (see below). Give as much notice as possible. Let them know if you can't collect the giving sets as they can courier them to you. There's no charge for giving sets, syringes or delivery. If you're under the care of the Ashburton Hospital dietitians, phone the Ashburton Supply Department (see below). You'll need to collect your giving sets from the Supply Department. Your hospital dietitian will organise your feed when you first go home. After this, your community dietitian will organise it. If you need to contact your feed supplier because your feed hasn't arrived, use the contact details below.

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Tube feeding with a gastrostomy tube www.healthinfo.org.nz Contact details PEG Nursing Service Phone: 027-351-2474, or (03) 364-0640 ext. 88945 Hours: Monday to Friday, 7.30 am to 6 pm For urgent help after hours (only after hours), for example, if your tube falls out, phone Christchurch Hospital on (03) 364-0640 and ask to speak with the Gastro Nurse on call. Canterbury DHB Supply Department Phone: (03) 364-0082 or (03) 364-0080 Address: 4 Rapide Way, Yaldhurst (near the airport) Hours: Monday to Friday, 7.30 am to 4.30 pm. Ashburton Hospital Supply Department Phone: (03) 307-8462 Address: Ashburton Hospital, Entrance D, 12 Elizabeth St, Ashburton Open for collection: Monday to Friday, 10.30 am to 2.30 pm. Feeding pump suppliers For any issues with your pump, use the following contact details: ▪ FreeGo pump (Abbott). Phone 0800-738-090. ▪ Flocare Infinity pump (Nutricia). Phone 0800-222-430. ▪ Kangaroo Joey pump (Cardinal Health). Phone 0800-522-400. Feed suppliers ▪ Abbott and Nestle feed (via Health Works Pharmacy). Phone (03) 351-8633. ▪ Nutricia feed. Phone 0800-688-747.

Written by Nutrition & Dietetics and PEG Nursing Service, Canterbury DHB. Adapted by HealthInfo clinical advisers. Last reviewed September 2021.

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