Enteral nutrition, commonly known as tube feeding, delivers specialized liquid formula directly into the stomach or small intestine when an individual cannot safely consume enough food or liquids orally. The process uses a soft, flexible tube placed either through the nose (nasogastric or NG-tube) or directly into the abdomen (gastrostomy or G-tube, and jejunostomy or J-tube). This delivery of nutrients requires specific, personalized instructions from a multidisciplinary healthcare team, including dietitians and physicians. This guide provides general best practices for safe home use, but it must always supplement, not replace, the specific training provided by your clinical professionals.
Essential Preparation and Equipment Setup
Maintaining a high standard of hygiene is the initial step for every feeding and site-care procedure to prevent contamination. Before handling any supplies or the tube itself, thoroughly wash your hands with soap and water for at least 20 seconds. A clean, designated workspace should be prepared, free from clutter and potential sources of germs.
Gathering all necessary supplies streamlines the feeding and minimizes error. This typically includes the prescribed enteral formula, a syringe (often a 60-milliliter catheter tip or ENFit syringe), lukewarm water for flushing, and the feeding bag and pump if continuous feeding is planned. Always check the formula’s expiration date and inspect the container for damage or spoilage.
The formula should be at room temperature before administration to minimize gastrointestinal discomfort like cramping or nausea. If refrigerated, allow it to sit out for about an hour to warm naturally. Never use a microwave, which can create hot spots that damage the formula or cause injury. Gently shake the formula container before opening to ensure all nutrients are evenly mixed.
When using a feeding bag, prime the tubing before connecting it to the patient. Priming involves allowing the formula to run through the entire length of the tubing until all air bubbles are expelled at the tip. This prevents air from being introduced into the gastrointestinal tract, which can cause bloating and discomfort. If using a pump, load the tubing into the device according to the manufacturer’s instructions after priming.
Administering the Formula: Procedures for Feeding
Proper patient positioning is required to reduce the risk of aspiration (formula entering the lungs). The individual should be sitting upright or have their head elevated to at least a 30- to 45-degree angle during the entire feeding session. This elevated position must be maintained for 30 to 60 minutes after feeding is complete, allowing the stomach time to empty.
Before connecting the formula delivery system, flush the feeding tube with lukewarm water to ensure patency. The standard flush volume is typically 30 to 60 milliliters, specified by your healthcare provider. This initial flush clears any residue and confirms the tube is open before the nutritional feed begins.
For bolus feeding, a syringe is attached to the feeding port to deliver a measured amount of formula over a short period. If using the gravity method, remove the syringe plunger and pour the formula into the barrel, allowing it to flow naturally. The flow rate is controlled by the height at which the syringe is held; holding it higher increases the speed, while holding it lower slows the infusion.
If you are using the syringe-push method, apply gentle pressure to the plunger, ensuring the feeding takes at least 15 to 20 minutes to complete to prevent stomach upset. Rapid administration of formula can overwhelm the stomach and lead to cramping, nausea, or vomiting. Continuous feeding, administered slowly over many hours via a pump, requires setting the prescribed rate in milliliters per hour.
When administering continuous feeding, the formula is poured into a feeding bag, and the tubing is connected to the pump. Formula should not hang in the bag at room temperature for longer than eight hours to minimize the risk of bacterial growth.
After the entire feeding or medication administration is complete, the tube must be flushed again with the prescribed amount of water to prevent clogging. To disconnect, clamp the tube, remove the syringe or tubing, and cap the feeding port securely. All reusable equipment, such as syringes, should be rinsed immediately with warm water and allowed to air dry completely.
Daily Care and Maintenance of the Tube Site
Routine care of the tube insertion site, or stoma, is required to prevent skin breakdown and infection. The skin around the tube should be cleaned daily with mild soap and water, using a clean gauze or washcloth in a gentle circular motion. This cleaning helps remove any dried formula, drainage, or crusting that can accumulate near the tube.
After cleaning, the stoma area must be thoroughly dried, as moisture creates an ideal environment for yeast and bacteria to grow. Avoid using creams, powders, or petroleum-based ointments near the stoma unless instructed by your clinical team, as these can trap moisture or damage the tube material. Daily inspection of the skin is required to check for any signs of irritation, such as redness, swelling, or excessive discharge.
The external portion of the tube needs to be secured properly to prevent movement at the stoma site, which can enlarge the opening and cause leakage or pain. Anchoring devices or simple medical tape may be used to hold the tube in place and prevent tension or pulling. For gastrostomy tubes, gently rotating the tube a full turn daily, if advised, can prevent the internal bumper from becoming adhered to the stomach lining.
If a dressing is required, it should be changed whenever it becomes wet, soiled, or at least daily. A healthy, well-established stoma often does not require a dressing, but a gauze pad may be placed under the external bumper to absorb any minor drainage and reduce friction. Ensuring the tube is anchored and the skin is clean and dry are the primary actions for maintaining a healthy insertion site.
Troubleshooting Common Issues and Safety Concerns
Tube clogs are a frequent complication, often caused by inadequate flushing or administering thick medications. To attempt to clear a clog, fill a syringe with 5 to 10 milliliters of warm (not hot) water, connect it to the tube, and gently push and pull the syringe plunger in a pulsing motion. This stop-and-start pressure can help dislodge the blockage, but never use excessive force, which could rupture the tube.
If the clog does not clear easily with warm water and gentle pressure, contact your healthcare provider for further instructions. Avoid inserting sharp objects, such as wires or pins, into the tube, as this can puncture the tube wall and cause significant internal damage. Similarly, while some older advice suggested using soda, its frequent use can erode the tube material over time.
Leakage around the stoma site can indicate that the tube is not fitting correctly, the balloon is under-filled, or the stomach is distended from a rapid feeding rate. If you observe leakage, first check the external securing device and ensure the formula is not being administered too quickly. Persistent leakage can lead to skin erosion, so it requires prompt attention from your clinical team.
Gastrointestinal issues like nausea, vomiting, or diarrhea are often related to the formula, the rate of administration, or the temperature of the feed. If these symptoms occur, try slowing the infusion rate and ensuring the formula is at room temperature. Do not change the type or concentration of the formula without consulting your dietitian, as this can disrupt the balance of nutrients.
Accidental removal of the tube is an emergency, especially for newer stomas, which can close rapidly. If a gastrostomy (G-tube) is pulled out, cover the site with a clean dressing and contact your healthcare provider immediately. The tube often needs to be reinserted within a few hours to prevent the stoma tract from closing. If a jejunostomy (J-tube) is dislodged, do not attempt to reinsert it yourself, as correct placement by a professional is required.
Immediate medical attention is required if you observe specific red flags that signal a serious infection or complication. These symptoms indicate a need for urgent professional assessment:
- A temperature above 101.5 degrees Fahrenheit.
- Severe abdominal pain.
- Excessive bleeding or foul-smelling discharge from the stoma site.
- An inability to flush the tube after multiple attempts.