Tube feeding education

There are several different locations, or routes, through which a feeding tube is placed to deliver the formula. Each of these routes allows the nutrients in the formula to be used by your body just as if you were eating a regular meal.

• Nasogastric or (NG-Tube). The feeding tube passes through the nose, down the throat and esophagus, and ends in the stomach.
• Nasointestinal (may be referred to as nasoduodenal or nasojejunal). The feeding tube passes through the nose, throat and esophagus, continues through the stomach, and ends in the first section of the small intestine.
• Gastrostomy (G-Tube). The feeding tube is inserted through the skin directly into the stomach.
• Jejunostomy (J-Tube). The feeding tube is surgically inserted into the jejunum — the middle section of the small intestine.
• Gastrojejunostomy (GJ-Tube). The feeding tube is surgically inserted into the stomach but will feed into the jejunum. The “G” portion can be used to vent, drain, or suction the stomach and the “J” portion can be used for feeding.

Your healthcare team has chosen the tube they believe will work best for you at home to make sure you receive the nutrition you need.

There are different ways to provide a tube feeding

Tube feedings may be:

• Bolus or Intermittent: formula is given at mealtimes or spread out during the day at specific times For example, feed at 8 am, noon, 6 pm or every four to 6 hours.
• Continuous: formula is delivered all day or for many hours throughout the day and/or night typically delivered by a feeding pump.
• A mix of these two methods

Syringe Feeding Supplies:

• Formula
• Clean measuring cup with pour spout (optional)
• 60 mL syringe*
• Water (lukewarm)

Setting Up Syringe Feeding:

1. Wash your hands thoroughly with soap and water.
2. Wipe the top of the formula container with clean, wet paper towel.
3. Mix the formula well by shaking or mixing as directed.
4. Pour formula into a clean measuring cup (or directly into the syringe once attached to your feeding tube or feeding tube extension).

Starting the Syringe Feeding:

1. To administer the feeding, sit or lie with your head elevated at least 30 degrees. (about the height of two pillows) and remain in this position for 30 to 60 minutes after each feeding.
2. Open (uncap) your feeding tube or feeding tube extension and attach syringe and gently flush with 30 mL of lukewarm water or the amount directed by your healthcare professional and close (recap) feeding tube or feeding tube extension.
3. Remove plunger from the syringe.
4. Pinch, clamp, or fold over your feeding tube or feeding tube extension to stop the flow of any fluid. Open (uncap) feeding tube or feeding tube extension and reattach the syringe.
5. Fill syringe with the prescribed amount of formula and release (unpinch/unclamp/unfold) feeding tube or feeding tube extension to allow formula to flow by gravity into your stomach.
6. Raise or lower the height of the syringe to increase or decrease the feeding rate. If you prefer to control the flow of your formula you can leave the plunger in the syringe, draw up your formula, and slowly push on the top of the plunger to force formula into your feeding tube.
7. If indicated, add more formula to the syringe until you have received your full prescribed amount and close (recap) your feeding tube or feeding tube extension.
8. After feeding is complete, replace the plunger into the syringe and draw up 30 mL of lukewarm water or the amount directed by your healthcare professional. Open (uncap) the feeding tube or feeding tube extension and reattach the syringe and flush feeding tube.
9. Detach the syringe from the feeding tube or feeding tube extension and close (recap) the feeding tube.
10. Clean, rinse, and dry your equipment after each feeding.
11. Replace your syringes as directed by your home care supplier.

Pump Feeding Supplies:

• Pump
• Formula
• 60 mL syringe*
• Feeding container and tubing (pump set)
• Pole or feeding pump backpack
• Water (lukewarm)

Setting Up Pump Feeding:

1. Wash your hands thoroughly with soap and water.
2. Wipe the top of the formula container with clean, wet paper towel.
3. Mix the formula well by shaking or mixing as directed.
4. Pour formula into feeding container and close cap. To reduce the risk of bacterial contamination, fill your feeding container with just enough formula for up to 8 hours. If you are using powdered formula, fill your feeding container with enough formula for up to 4 hours.
5. Hang the feeding container on the pole above the feeding pump or place securely inside the backpack.
6. If you are using a pre-filled feeding bag, shake the bag and connect to the pump set as directed and continue from this step.
7. Since every pump is different, follow the instructions provided by your healthcare professional to set up and operate your pump.

Starting the Pump Feeding:

1. To administer the feeding, sit or lie with your head elevated at least 30 degrees (about the height of two pillows) and remain in this position for 30 to 60 minutes after the feeding.
2. Prime your feeding pump and set flow rate on pump as directed to the recommended mL per hour.
3. Open (uncap) your feeding tube or feeding tube extension.
4. Before starting the feeding, use the syringe to flush your feeding tube with 30 mL of lukewarm water or the amount directed by your healthcare professional.
5. Connect the end of the pump set tubing to your feeding tube or feeding tube extension.
6. If applicable, open the clamp or roller clamp on the pump set tubing.
7. Start your pump to begin infusing the formula.
8. If additional formula is needed for hang times >8 hours, rinse out the feeding bag and tubing with lukewarm water before adding fresh formula. Refill your feeding bag again with just enough formula for up to 8 hours, 4 hours if using a powdered formula.
9. After the feeding, disconnect the pump set tubing from your feeding tube or feeding tube extension. Recap the end of the tubing with the plastic cap.
10. Using the syringe, flush your feeding tube again with 30 mL of lukewarm water or the amount directed by your healthcare professional.
11. Close (recap) your feeding tube or feeding tube extension.
12. Don’t forget to rinse before refilling your feeding container with formula (at least every 8 hours).
13. If using a pre-filled bag of formula, throw it away when empty or no later than 48 hours after starting the feeding.
14. Replace your feeding bag, tubing and syringes as directed by your home care supplier.

Gravity Feeding Supplies:

• Feeding bag/container
• Formula
• 60 mL syringe*
• Tubing (gravity set)
• Pole
• Water (lukewarm)

Setting Up Gravity Feeding:

1. Wash your hands thoroughly with soap and water.
2. Wipe the top of the formula container with clean, wet paper towel.
3. Mix the formula well by shaking or mixing as directed.
4. Fill the feeding container with the number of mL or containers of formula, and close as instructed.
5. Hang the feeding container on the pole so it is at least 18 inches above the level of your stomach.
6. If using a pre-filled feeding bag, shake the bag and connect to the gravity set as directed and continue from this step.
7. Open the clamp on the flow regulator until the formula flows towards the end of the tubing to approximately ¼ to ½ inch above the connector to avoid spilling formula into the moat of the ENFit® connector.
8. Close the clamp on the flow regulator.
9. Make sure the drip chamber is approximately half full.

Your Mouth

Regardless of the type and location of your feeding tube, it’s important to maintain good oral health. The following steps are recommended to keep your mouth as clean as possible. Follow any other special instructions from your healthcare professionals.

• Brush your teeth, gums and tongue at least two times a day using a soft toothbrush and toothpaste.
• To moisten your mouth, use oral swabs, ice chips or sugar-free chewing gum.
• Freshen your mouth and breath by using mouthwash. For children, check with your healthcare professional.
• To moisten your lips, use lip balm or a lanolin-based moisturizing cream. To prevent chapping, avoid licking your lips.
• Report bleeding or anything unusual in your mouth to your healthcare professional.

Your Tube Site

If you have a gastrostomy or jejunostomy tube, care of the skin surrounding the feeding site is very important.

Follow these steps:

• Wash your hands thoroughly with soap and water.
• Remove the old dressing and tape, being careful not to disturb the tube.
• Cleanse the skin around the tube daily with soap and water as directed by your healthcare professional.
• To remove any crusting around the tube site, use cotton swabs moistened with warm water.
• Check the tube site every day for signs of redness, soreness, swelling or unusual drainage. Report anything unusual to your healthcare professional.
• Dry the skin around the feeding tube site thoroughly. Healed gastrostomy or jejunostomy sites usually do not need a special dressing. If you have been told to apply a dressing, follow the instructions from your healthcare professional.

Water is part of your formula, but extra water and sometimes medications are needed to keep your body healthy and your feeding tube working properly.

Your healthcare professional will tell you how much water or medication to take.

Crush medications into fine particles or use liquid medications when available. Check with your nurse, doctor or pharmacist to get specific instructions on:

• How to crush medications
• How much water to mix with your medication
• Which medications should not be crushed
• Medications that need special considerations when given through a feeding tube