Problem Solving and Emergencies Surgical Patient Education Patient Surgical

aintain an upright sitting upright the an position or elevate aintain hest pain ough foul-smelling with pus, or sputum, blood xcessive sweating hortness of breath wallowing difficulty top the feeding immediately. atigue or feelingatigue sleepiness of D F S E S F oxygen of skin the of color lack caused by bluish C C S M head degrees. bed the of least 45 at

f PANIC. NOT O f f f f f requent coughing, wheezing, rapid breathing, and f f f f f f f f f f f f f f Call 911 for professional medical assistance, as this this as medical for assistance, professional 911 Call emergency. threatening becan life a 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 Problem Solving WHAT YOU CAN DO YOU WHAT THE INCLUDE THE FOLLOWING: THE THE SIGNS INCLUDE AND FOLLOWING: SYMPTOMS Aspiration 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 .

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 Surgical Patient Education Patient Surgical

ash the skin gently with soap and water. Use a Q-tips Use skin the soap with gently water. and ash pply skin a dry and barrier powder if if available necessary. sterile dressing ad odorad otate the bolster the a G-tube of skinotate breakdown. prevent to daily oreness nfection A R cotton swab or gauze to swab dry and cotton swab around to or gauze site. the I C correct the in position. There be not should leakage much 3 days. healed has 2 to in stoma the site once W I stoma site tube’s the S B f f f itis heck feeding the sure or tape tube make marker to f f f rritated or red skin around 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 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 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 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

ff Inactivity

American College of Surgeons • Division of Education Problem Solving and Emergencies Surgical Patient Education Patient Surgical

oorly secured tube can also increase granulation tissue and lead and oorly tissue secured granulation tube increase can also andle the tube gently. andle the tube gently. leeding or low-profile devices, have the length stoma or low-profilehave devices, ncrease activities walking.ncrease like P H A p F remeasured your by physician. to infection,to bleeding, or an increase in drainage and odor. P or skin stoma site the at B I I f f f f ractice site. the to good hygiene f tissue red overgrown to ink f f f ncrease fluids. f f f f f f f f Contact the doctor’s office to provide local care to the site. Contactprovidethe to to doctor’slocal the care office 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 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 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 . 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 Surgical Patient Education Patient Surgical nusual weakness, fever, chills or symptoms other chills weakness, fever, nusual hoking or difficulty breathing leeding, G-tube the around color in or tears, change stoma edness, pain, or from drainage tube the insertion site omiting or diarrhea that continues for more than 2 days for more than continues or that diarrhea omiting he feeding tube has come out and you have he feedinghave out you and come tube has emperature of 101°F or 38.3°C 3 days 2 to for more than emperature 101°F of V U R T not beennot it trained or replace cannot C T B akage f f f f f f f leeding ain with resistance feeding to nfection B I P U Le f f f f f f f f f f f lceration 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