Enteral Feeding

Symptom and Description

When weight loss or lack of appetite become severe, nutrition supplements can be given. These supplements provide protein, vitamins, and other nutrients your body needs for energy. If you are unable to take these supplements by mouth, special tubes can be placed that allow you to receive the necessary nutrients without eating or drinking. The types of special tubes are:

  • Nasogastric tube: A tube that goes from the nose down the esophagus to the stomach.

  • Gastrostomy tube: A tube that is placed by the surgeon into the stomach through a small hole outside the stomach wall. (Called a PEG tube--a percutaneous endoscopic gastrostomy tube.)

  • Jejunostomy tube: A tube that is placed into the upper part of the intestine (jejunum), just beyond the stomach. The tube is placed by the surgeon through a small hole in the abdomen.

Learning Needs

You will need to learn to care for the nutrition tube and learn to give yourself the nutrients. You will also need to learn about some of the problems that can occur with tube feedings and what to report to your doctor.

Preventing Problems

Tube feeding is important in giving you the nutrients you need. When care is taken to give the tube feeding safely, many problems can be avoided.

1. Aspiration:

  • Sit up to take feeding and for one hour after feeding.

  • If feeding is continuous, keep your head elevated on two or three pillows.

  • Check for residual food before giving feeding. If more than 50 mL or 2 ounces of residual food, do not take a feeding at that time. Try again in one hour. (Your nurse will teach you how to do this.)

  • Check placement of tube before beginning. (Your nurse will teach you how to do this and instructions are below.)

  • Do not begin feeding if you feel full or bloated.

2. Diarrhea:

  • Allow feeding solution to warm to room temperature before giving.

  • Do not use feeding solution that has been opened and out for more than six to eight hours.

  • Do not use feeding solution left open in refrigerator longer than 24 hours.

  • Wash hands before handling tube or feeding solution.

  • Keep feeding container clean.

3. Constipation:

  • Take additional water.

  • Ask about adding fiber to diet.

  • Consider a stool softener/laxative.

  • Increase your physical activity as allowed.

4. Skin irritation:

  • Keep skin around tube clean and dry.

  • Check for leakage around tube and report this immediately to your doctor .

  • Tape tube securely to prevent pulling.

  • Change dressing daily.

  • Apply skin protectant as needed.

5. Dehydration (loss of body fluids):

  • Increase amount of water given in the tube between feedings.

  • Observe for increased urination.

  • Observe for signs of thirst, fever.

  • Check with your doctor about changing formula.

6. Tube clogging:

  • Make sure there are no kinks in tube.

  • Flush tube with 3 to 4 ounces water after meals.

  • Dissolve all medications placed in the tube in at least 1 ounce water.

  • Rinse your tube with water before and after medications.

  • Rinse tube with cola or 1 part hydrogen peroxide in 3 parts water, if tube becomes sluggish. (Only if your doctor or nurse tells you to do this.)

Management

Your tube feeding will be given on a schedule that best fits your needs for care and amount of calories required. The doctor, dietitian, or nurse will explain the schedule that is best for you. The choices of schedules are as follows:

  • Intermittent or bolus: The amount of tube feeding for the day will be divided up into smaller portions to be given at set times during the day over short periods. May be done by gravity or syringe.

  • Continuous tube feeding: The amount of tube feeding for the day will be given slowly over the 24-hour period. It is usually given by a pump to keep the rate steady.

It is important to make sure the tube is in the right place before starting each feeding.

1. Nasogastric tube:

  • Wash your hands.

  • Draw up 10 to 20 cc air into a syringe.

  • Insert the tip of the syringe into the end of the feeding tube.

  • Unclamp the tube.

  • Put stethoscope into ears and place bell over abdominal area.

  • Quickly push air into feeding tube. You should hear a "whoosh,'' a bubbling, or a quick high-pitched gurgling sound.

  • Do not give your feeding if you cannot hear this sound. Contact the doctor, nurse, or dietitian.

2. Gastrostomy or jejunostomy tube:

  • Wash your hands.

  • Measure the number of inches from the stomach wall to the end of the tube.

  • Contact the doctor, nurse, or dietitian.

Report any of the following symptoms to your doctor:

  • Tube feeding into lungs (aspiration): Coughing or gagging, especially associated with fever.

  • Diarrhea: Loose, watery stools can occur alone or associated with other symptoms such as cramping, upset stomach, or dizziness.

  • Constipation: Hard, infrequent stools.

  • Skin irritation: Pain, redness, or bleeding around the tube.

  • Dehydration: Thirst, weight loss, dry mouth, lack of energy, extreme tiredness.

  • Tube clogging: Difficulty flushing tube with water or air.

Follow-up

Should any of these problems happen, call your doctor:

1. If you feel your feedings are not working well for you, check with your doctor or dietitian about changing rate of feeding or method of feeding.

2. If the tube becomes dislodged or falls out, apply a dressing over the opening if the tube is in your stomach, and call your doctor immediately.

3. Notify your caregiver if you have any of the following:

  • temperature of 100.5 F (38 C) or more

  • diarrhea

  • nausea or vomiting

  • constipation

  • abdominal distention

  • tube dislodgement

  • clogging of the tube

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