Wednesday, January 9, 2008

Feeding Tubes

For Lia and younger and older Alex

Caretaking & Feeding Tubage

Important excerpts from the above article

Ø When not in use, they can simple be taped to the patients stomach to prevent them from moving around under clothing.

Ø About three inches of tubing will protrude from the incision area. Initially, there may be some discomfort while getting used to using the system, from gas or air, or from adjusting to the liquid foods themselves.

Ø Greater care is required during the first week the tube is in place, as the surgery has just been performed. The area around the wound must be kept thoroughly clean and covered with clean, gauze. During this period of time the tube may occasionally pull away from the abdominal wall, resulting in leakage around the insertion site. Leakage may also occur if the stoma site becomes enlarged. Excessive tension may cause the tube to be pulled out prematurely.

Ø The tube is very narrow, and commercial tube feeding formulas such as Ensure, are designed so that they will not clog the tube; they are not too thick and do not leave a residue. Most formulas are designed to have water added to them to ensure that the patient is receiving enough dietary water, and to further thin the formula for ease of use. To maintain patency, the patient should flush the tube with clear water before and after feedings, or after medications have been administered through the tube. The placement of noncommercial formulas or foods into the tube is highly discouraged, as there is a greater likelihood that they will contribute to clogging. After the tube is placed, a registered dietitian or a nurse who specializes in nutrition should assess the patient to determine their nutritional needs, the amount of calories, protein, and fluids that will be necessary, as well as the most appropriate nutritional formula and how much of that formula will be needed each day. Nutritional products designed for tube feeding are formulated to provide all the nutrients the patient will need including proteins, carbohydrates, vitamins, and minerals. Some even contain dietary fiber and other non-nutritional elements.

Ø When feeding the patient, it is imperative that the caregiver or patient thoroughly washes their hands with soap and water before preparing formula or having contact with the PEG system. The patient should be upright, no less than thirty degrees, to minimize the risk of regurgitation and aspiration, and they should be kept upright for thirty to sixty minutes after feeding. To prevent complications (abdominal cramping, nausea and vomiting, gastric distension, diarrhea, aspiration), food should be infused slowly. It may take more than an hour to administer one feeding session, as the drip mechanism is kept at very slow settings.

Ø Using an attached bag system to contain the liquid diet for feeding is a secondary method by which food is allowed to drip slowly into the tube though “gravity feeding.” With this technique, there is greater freedom in that feedings can be done anywhere, at any interval, and medications may be administered through the PEG tube utilizing this method.

Ø Scrupulous oral care is imperative in preventing problems, and must be attended to frequently, especially in patients who are provided with total nutritional support through the PEG tube. Daily brushing of the patient's teeth, gums and tongue must be performed. The patient's lips should be routinely moistened, and if necessary, lubricated with petroleum jelly to prevent cracking. The incision area must be observed daily for redness, swelling, necrosis or purulent drainage, and the skin must also be cleaned daily. It helps to routinely apply an antibacterial ointment to the insertion site after cleaning to prevent infections such as Neosporin.

Ø The lifespan of the feeding tube is about six months. [BRETT note: This varies. Other resources put tube life as two-three years without replacement. Keep in mind.] When the tubing begins to wear, it may pull away from the stomach wall and cause leakage near the insertion point. The replacement process is relatively simple, and usually does not involve another endoscopic procedure. Typically, the tubing is merely pulled out through the stomach site and then replaced with a new catheter.

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