Your Feeding Tubes 8/21/15 9:25 AM Stoma tract Stoma Surgical Patient Education Patient Surgical Gastrostomy feeding tube Lie flat against your body against flat Lie Are round in shape mouth) your of inside the to redAre and moist (similar feeling no Have f f f f f f f f Enteral refers to within the digestive system or intestine. system digestive the refers or within intestine. to Enteral feedingEnteral tubes liquid allow food your enter to The a tube. 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 the depends of abdomen. your of shape the and operation specific your on Feeding Tube? Most stomas: Most What Is an Enteral 112830_BODY.indd 1 3
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
112830_BODY.indd 2 8/21/15 9:25 AM Your Feeding Tubes 8/21/15 9:25 AM Oral Cavity Esophagus Throat/Pharynx Trachea Stomach Large Intestine/Colon Large Nasal Cavity Sigmoid Colon Sigmoid Rectum Lung Sphincter Surgical Patient Education Patient Surgical Anus Stomach Ileum Esophagus Small IntestineSmall 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 stomach. Whenthe food esophagus, the into moves of openingthe top the at the esophagus (sphincter) stop to thetightens upward food. the of movement The pharynx acts a doorway. as When food the passing, is opening the to airway closes. When food the reaches down broken it is stomach, very pieces. into small the into thenIt moves small intestine, where enzymes down break This liquid. thick food into further passes liquid thick where nutrients, vitamins, and water intestine, small the through absorbed.are intestine large the The through then passes liquid absorbed is from stool the colon. the becomes It in Water (colon). rectum. the out through moves more solid eventually and Understanding Your Digestive System Digestive Understanding Your 112830_BODY.indd 3 2 5 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 ff 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.
ff Low-profile gastric tubes or gastric buttons lay flat 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.
ff Gastro-jejunostomy tubes (GJ-tubes or low-profile 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.
ff 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
112830_BODY.indd 4 8/21/15 9:25 AM Your Feeding Tubes 8/21/15 9:25 AM bolster PEG Tube External Port Clamp Surgical Patient Education Patient Surgical Percutaneous radiologic gastrostomy (PRG) is the name of name of the is (PRG) radiologicPercutaneous gastrostomy where procedure another a G-tube stomach. the placed in is done is This under procedure local sedation. with anesthesia The on image X-ray continuous a fluoroscopy, by viewed abdomen is puncture A needle made a large with is the through a monitor. so that opening stomach. A larger the then created is skin over tube can be inserted gastrostomy the stomach. The the tube into balloon and a bumper internal held an with on is stomach the in outside.the These can be either long tubes or low-profiletubes. Percutaneous endoscopic gastrostomy (PEG) is the name of a a name of the is (PEG) gastrostomy endoscopic Percutaneous Placement where procedure a G-tube endoscopy. placedby 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 stomach. A puncture the into down mouth the and moved in needle made stomach, the large with is skin the through over and a heavy endoscope. The the string pulled it by is through string out mouth the and attaches comes a long which tube, to and out A skin the of stomach the incision. then pulledis into bumper and stomach, the on end the tube it inside the of keeps from outside. the a bolster place it in These keeps initially are canlong be low-profilelater. tubes changed that to devices The long tube a also have may Y-port allows that to side one for connect directly theto feeding opening an and for medications The water. and often is “PEG” term used describe to G-tubes.all PERCUTANEOUS RADIOLOGIC RADIOLOGIC PERCUTANEOUS TUBES (PRG) GASTROSTOMY PERCUTANEOUS ENDOSCOPIC ENDOSCOPIC PERCUTANEOUS TUBES GASTROSTOMY (PEG) 112830_BODY.indd 5 Port body) (outside G-tube here ends GJ-tube here ends 4 7
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-profile/button device. Long tubes may be changed to low-profile tubes once the tract has healed—usually 6 weeks to 3 months later, depending on the technique. Balloon port
Low-profile button
Feeding extension set
Balloon port G-button Safety cap Skin level
Abdominal wall
Low-profile button Stomach wall
American College of Surgeons • Division of Education
112830_BODY.indd 6 8/21/15 9:25 AM Your Feeding Tubes 8/21/15 9:25 AM Gastrojejunal tube (GJ) Surgical Patient Education Patient Surgical A jejunostomy (J) tube is also used also tube when is (J) feedings needA jejunostomy to a of time the at placed stomach. They the usually bypass are The operation related but be can also placed radiologically. J-tube The inserted tube is is intestine. the of wall the through secured on outside the abdomen, the of balloon and a small intestine). (small jejunum the inside place help it in keep may either by intestine small the When feedings delivered into are feedings,GJ-tube continuous or J-tube, must be they slow, does. stomach the food store cannot like intestine the since Gastrojejunal or GJ-tubes are used when feedings need the bypass to mouth, esophagus, and stomach. 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 operation. These are occasionally of first the placed as any by tube the methods described above. The GJ-tube two has ports: gastric and jejunal. The gastric port used access is to “G”) (marked used usually and is stomach the for medication. The jejunal port used is for feeding. “J”) (marked JEJUNOSTOMY (J) TUBESJEJUNOSTOMY (J) GASTRO-JEJUNAL (GJ) TUBES GASTRO-JEJUNAL TUBES (GJ) 112830_BODY.indd 7 Balloon port Stomach wall Stomach Abdominal wall G-button 6 9 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
112830_BODY.indd 8 8/21/15 9:25 AM Your Feeding Tubes 8/21/15 9:25 AM
tube connector ENFit feeding set to feeding to set feeding ENFit
safety features will have ENFit twistwill have connector Surgical Patient Education Patient Surgical all feeding tube syringes and feeding sets When the connector transition is complete, complete, is transition connector the When For more information, go to www.stayconnected.org to go information, more For to feedingto tube 2015 transition connector connector transition 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 and syringes onlyother fit feeding to other and suppliestube not adapters will 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 usedfeeding with tubes. You When the seen below. syringes, connectors, adapters or various connectors feeding syringes tube and all complete, is conversion twist secure connection. will the that ENFit™ an tip have will FEEDING TUBE CONNECTORS 112830_BODY.indd 9 8 11
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
112830_BODY.indd 10 8/21/15 9:25 AM Your Feeding Tubes 8/21/15 9:25 AM Surgical Patient Education Patient Surgical If there is a blockageIf is there the in the of feedingflow a kinkIf is feeding the there in tube If feeding the bag empty is 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 stomadays the site few inserted.thetubeis they But be used to not are routinely feeding the of care for everyday tube. An enteral feeding The enteral An feedings can pump deliver a steady at rate. electrical is pump or battery operated, and it can be or purchased rented from The a medical medicalsupply supply will company. company instructions you sethelp and give pump the you for up its use. a variety in Feeding come pumps of some and sizes, portable are for travel. The can pump be attached a pole to on wheels a backpack. or placed in on battery running If is pump the it alarms has alert that power, you problems: following the about GAUZE DRESSINGSGAUZE PUMPS AND POLES ANDPUMPS POLES 112830_BODY.indd 11 10