Tube Feeding at Home

You will be given 7 day’s supply of feed and equipment when you go home from hospital. Your hospital dietitian or community dietitian will register you with a feed company to organise regular deliveries of your feeds and equipment. The dietitian will request a prescription for your feeds from the GP and this will either be sent to the feed company or given to your local pharmacy if you would prefer to receive your feeds that way.

Feeds can be given by the following methods:

• Pump – using a pump connected to your feeding tube.

• Bolus – using a syringe to administer feeds. Once it is decided how you are to receive your feed, training will be provided to ensure you understand the procedure.

Your feeding tube needs to be flushed regularly with cooled, boiled water to prevent it from blocking:

• Before starting / restarting/ or after stopping a feed.

• After each bottle has finished.

• If the tube appears blocked.

• Before and after administration of medications.

• There may be other times you have been advised to flush your tube.

1. Check the label of the feed, making sure it is correct and within date.

2. Shake the feed gently to ensure it is well mixed.

3. Flush your tube with the correct amount of water.

4. Attach the giving set to the pump and prime the set (this will have been shown during your training).

5. Attach your tube to the giving set and check the rate you are to be feeding at is correct on the pump.

6. Clear any feed from a previous session before starting a new feed.

1. Check the feed you are to be receiving is correct and within date.

2. Flush your tube with the correct amount of water.

3. Remove the plunger from the syringe and attach it to the tube (the clamp on the tube should be closed).

4. Pour feed into the barrel of the syringe and release the clamp fully, allowing the feed to flow into the tube.

5. Continue topping the syringe with feed until the agreed volume has been administered.

6. If your feed does not flow into the tube with gravity then you can use the plunger to slowly and gently push the feed into the tube.

The method recommended for caring for your tube will depend upon the type of tube in place. If your tube is a nasogastric or nasojejunal tube, the care will be keeping the nose clean and the tube where it leaves the nose. If your tube is a device inserted into your body then caring for your stoma site and flushing your tube will be important.

The tube site (also called the stoma site) is the point at which the feeding tube enters the body. A dressing is not required once your stoma site has healed. Wash your hands with soap and water and dry well before touching the stoma site. Move the external fixation plate (if present) very slightly along your tube away from the skin to allow access for cleaning. If you are unable to move the fixation plate, please contact the feed company nutrition nurse or dietitian who can arrange for someone to show you. Gently clean the skin around the tube with mild soap and warm water. Dry the area thoroughly.

• Try to avoid using powders or creams on the skin area unless advised by a healthcare professional.

• Try to avoid using a dressing around the site unless advised to do so by a healthcare professional.

• Contact your feed company nutrition nurse, GP or community dietitian for advice if there is a problem, for example:

- The tube site is red and sore

- There is leaking from around the tube

- The tube is loose or tight

Some people may be prone to the skin inside the stomach growing over the internal plate. Rotating your tube may help to prevent this from happening.

• Always check with your feed company nutrition nurse or dietitian if and when to start rotating your tube and how to rotate it.

• To rotate it, once a day loosen the external fixation plate.

• Gently push the tube into the stomach by 2-3cm, and then rotate the tube 360 degrees. Finally pull back the tube gently to feel resistance and replace the fixation plate approximately 1cm from the skin. • Do not rotate your tube if there is discharge, if the stoma site has not healed or looks infected.

• Do not rotate your tube if you have stitches in place.

• Do not rotate the feeding tube if it is a jejunostomy or has a jejunal extension tube.

• If you are unsure of the type of tube you have in place, contact a relevant health professional for clarity before attempting to rotate the tube.

If the end of your tube breaks (this is called the Y adapter or luer lock adaptor), contact your community dietitian immediately as it may be replaced at home. It is useful to always keep a spare end. These can be provided through your dietitian.

• Prepare new cool boiled water in a new syringe.

• Hold the tube gently near the stoma site.

• Move the fixation plate about a centimetre away from the stoma site.

• Gently push tube into the stomach until the fixation plate rests on the abdomen and hold the tube in place, this prevents the tube from slipping out.

• Remove all the water from the balloon via the balloon port using a 10ml syringe.

• Discard water from the syringe. Repeat the procedure to ensure the balloon is completely empty.

• Replace the water in the balloon with the expected volume (depends on type of tube).

• If the water in your balloon is regularly less than the expected volume, then contact the company nutrition nurse as the balloon may be damaged and the tube may need to be changed.

• If the water removed from the balloon is less than that agreed as acceptable or if no water is able to be removed you MUST contact your HEF dietitian or feed company nurse urgently.

If the tube falls out within normal working hours, contact your feed company nurse, nutrition nurse or specialist dietitian. If you have been trained please put one of your emergency tubes or Enplug in the stoma site to keep it open. Out of hours you will need to go to A & E as soon as possible (take your emergency equipment / spare tube).

• Check to ensure all clamps are opened and there is nothing blocking the end of the tube.

• Check for any kinks or bends in the giving set or tube.

• Flush the tube with 30ml lukewarm water. You can use a gentle push/pull motion on the plunger of the syringe to aid unblocking the tube.

• Massaging the tube with the fingertips may help.

• Avoid using fruit juice or sugary fizzy drinks. Soda water may be of use to aid unblocking.

• Unblocking a tube may take several attempts. If the blockage persists, consult your specialist dietitian or feed company nurse.

• If you are currently taking antibiotics, it is likely these may be causing the diarrhoea. It is important not to stop antibiotics without discussion with your GP.

• If you are new to tube feeding you may need a review of the feed, the rate at which you are feeding or your medications in order to check if any of these may be contributing to this.

• If you are suffering diarrhoea you must ensure you are receiving sufficient fluid, as this could lead to dehydration.

• If diarrhoea persists it is essential you discuss this with your GP or health professional

• If you become constipated on a feed, consider whether you are taking enough water to help with your bowel function.

• Some medications can cause constipation, particularly strong pain relief.

• Your feed may require a review if the problem persists. You may need to contact your dietitian for a review.

• Consider if your bowel movements are normal.

• If the symptoms are present when the feed is not running, it is unlikely that the feed is causing this.

• Ensure you are positioned correctly during feeding.

• Consider reducing the rate of the feed temporarily.

• If you are vomiting, consider swapping the feeding for administration of water (to ensure you remain hydrated) for 24 hrs.

• If these symptoms persist contact your GP immediately.

• Check that you are feeding at the correct rate.

• If necessary, temporarily reduce the rate of the feed.

• Consider if you are opening your bowels regularly.

• Consider the volume of water/feed/medications taken together at any particular time.

• Contact your dietitian if the problem persists.

• If you feel thirsty, have a dry mouth or are passing less urine than usual you may be a bit dehydrated.

• Ensure that you are getting the fluid intake advised by your dietitian.

• If the weather is hot, you have a temperature or if you have diarrhoea, you may need to give extra water to flush to prevent dehydration.