Enteral feeding delivers nutrition, fluids, and medications directly into the gastrointestinal tract when a person cannot safely consume enough by mouth. This process uses a specialized liquid formula containing all necessary nutrients, delivered through a tube placed in the stomach or small intestine. Safe administration at home requires careful adherence to training and medical advice. This article provides practical guidance for the safe administration and maintenance of a feeding tube system in a home setting.
Different Types of Feeding Tubes
The choice of feeding tube depends on the anticipated length of time feeding is needed and the patient’s digestive function. Tubes inserted through the nose or mouth, such as the Nasogastric (NG) tube into the stomach or the Nasojejunal (NJ) tube into the small intestine, are used for short-term feeding, typically less than four to six weeks. These long, flexible tubes can often be placed at the bedside but require careful placement checks before each use to ensure they have not moved.
For long-term nutritional support, tubes are surgically placed directly through the abdominal wall, creating a stoma. These include the Gastrostomy tube (G-tube), which ends in the stomach, and the Jejunostomy tube (J-tube), which bypasses the stomach to deliver feed into the small intestine. A G-tube or J-tube is secured internally with a balloon or bolster and externally with a small disc, offering a stable and permanent access route.
Step-by-Step Feeding Administration
Proper feeding administration begins with meticulous preparation to maintain a hygienic environment. Hand washing with soap and water for at least 20 seconds is required before handling any equipment or formula. The prescribed liquid formula should be checked to ensure it is at room temperature; opened formula must be refrigerated and discarded if unused after 24 hours. Before starting the feed, the patient should be positioned with their head and shoulders elevated to at least a 30 to 45-degree angle to prevent aspiration.
Following preparation, the tube must be flushed with water to ensure patency and clear residual material. A syringe, typically 60 mL, is used to gently push 30 mL of lukewarm water through the tube before administering the feed. If the initial flush meets resistance, gentle suction can be attempted. Forcing the water is not permitted, as it could damage the tube or cause discomfort.
Feeding is administered either through the bolus method or a continuous infusion. Bolus feeding involves delivering a measured volume of formula using a syringe or gravity drip multiple times a day, mimicking meal patterns. Continuous feeding administers the formula slowly over several hours, often overnight, using an electronic pump that controls the flow rate. The continuous method is preferred for jejunal tubes because the small intestine requires a controlled delivery of nutrients.
After the formula is administered, the tube must be flushed again to prevent clogging from residue. A final flush of 30 to 60 mL of lukewarm water is pushed through the tube, followed by clamping the tube and capping the port. The patient must remain elevated for 30 to 60 minutes after a bolus feed to ensure gastric emptying and reduce the risk of reflux or aspiration.
Maintaining Tube Site and Equipment Hygiene
Routine care of the stoma site is necessary to prevent infection and skin irritation. The area around the tube should be cleaned daily using mild soap and warm water, gently wiping around the insertion site and the external portion of the tube. The skin must then be patted completely dry with a clean towel, as moisture promotes bacterial growth and skin breakdown.
Regular inspection of the site is part of the daily cleaning ritual, looking for signs of redness, swelling, or unusual discharge. If a dressing is used, it should be changed whenever it becomes wet or soiled, and the skin should be kept dry. Minimizing movement of the tube is important, as constant friction can lead to irritation and the formation of granulation tissue, which is an overgrowth of healing skin.
Equipment, including feeding bags, pump tubing, and syringes, must be kept clean to avoid bacterial contamination. Non-disposable components should be rinsed thoroughly with warm, soapy water after each use and allowed to air dry completely on a clean surface. Feeding bags and tubing sets should be replaced every 24 to 48 hours, even with proper cleaning, to reduce the risk of infection.
Handling Common Problems and Emergencies
Tube clogs are a frequent issue, often caused by formula or crushed medication residue. The safest step to clear a blockage is to attempt a gentle push-and-pull motion with a syringe filled with warm water, applying moderate pressure without forcing the plunger. If the clog does not resolve after several attempts, a specialized commercial clog remover can be used, but solid objects, such as guide wires, should never be inserted.
Leakage around the stoma site can cause skin irritation and pain. This may be due to the tube moving excessively, an underfilled or defective balloon, or a feeding rate that is too fast. Temporary measures include ensuring the tube is secure and adjusting the feeding rate after consulting with a healthcare provider.
Signs of infection at the stoma site, such as increasing redness, warmth, pain, or thick, foul-smelling discharge, require professional attention. The development of granulation tissue, which looks like raised, pink or red tissue, should also be evaluated by a nurse or doctor for appropriate treatment.
An emergency situation requires immediate action and medical contact. If the tube becomes fully dislodged, especially a J-tube, the healthcare provider must be called immediately, as the stoma tract can begin to close rapidly. Choking, difficulty breathing, or severe, spreading abdominal pain after a feed are causes for emergency intervention, signaling aspiration or a serious complication.