A feeding tube is a medical device designed to deliver nutrition, hydration, and medication directly into the gastrointestinal tract when consuming these orally is not possible or sufficient. Its use is always under the guidance of healthcare professionals, ensuring appropriate care and administration. This guide provides practical steps for managing daily tube care and administering feeds, supporting both patients and caregivers.
Types of Feeding Tubes
Feeding tubes vary based on their insertion site and intended duration of use. Nasogastric (NG) tubes are thin, flexible tubes inserted through the nose, down the esophagus, and into the stomach. These are used for short-term feeding, often for less than a month.
For longer-term nutritional support, tubes are placed directly into the abdomen. Gastrostomy (G) tubes are inserted through a small incision in the abdomen directly into the stomach. Jejunostomy (J) tubes are placed through an abdominal incision into the jejunum, a part of the small intestine. Both G-tubes and J-tubes are considered more permanent solutions, with J-tubes preferred when the stomach cannot tolerate feeds, such as with severe reflux or impaired gastric motility.
Administering Feeds and Medications
Proper preparation is essential before administering feeds or medications through a feeding tube. Begin by washing hands thoroughly with soap and water. If using formula from a can, wipe the top of the container with a clean cloth before opening.
For bolus feeds, which involve administering a larger volume over a shorter period, a syringe is used. After preparing the formula, attach the syringe to the feeding tube and slowly push the plunger to deliver the feed. Gravity can also assist with bolus feeds; the feeding bag is hung above the patient, allowing the formula to flow down the tube. For continuous feeds, a feeding pump delivers formula at a steady rate over many hours. To set up a continuous feed, fill the feeding bag with the prescribed amount of formula, hang it on an IV pole or hook, and connect the tubing to the pump and then to the feeding tube. Prime the tubing to remove air before connecting it to the tube, which helps prevent gas buildup.
Flushing the feeding tube is a routine step that helps prevent clogging and ensures patency. Before and after each feeding, and between different medications, flush the tube with a specified amount of warm water, 30 to 60 mL, using a clean syringe. This practice clears any residual formula or medication that might otherwise lead to blockages. When administering medications, use liquid forms whenever possible. If a pill must be given, consult a healthcare provider or pharmacist, as some medications should not be crushed. For crushable pills, grind them into a fine powder and mix thoroughly with water before administering, flushing the tube between each medication to prevent interactions and blockages.
Daily Tube Care and Maintenance
Maintaining the feeding tube and the surrounding skin is important for preventing complications. The skin around the tube should be kept clean and dry, which involves gently washing the area daily with mild soap and warm water. After washing, thoroughly pat the skin dry.
Regularly inspect the tube site for any changes such as redness, swelling, or unusual drainage. A small amount of clear or tan drainage can be normal, but any increase or change in color (e.g., yellow-green) should be noted. If dressings are used around the tube site, they should be changed as instructed by the healthcare team, ensuring the area remains clean and protected. Securing the tube properly helps to limit movement and reduce irritation to the skin. Even when not actively feeding, tubes require daily flushing with 30-60 mL of water to prevent internal blockages from forming.
Recognizing Problems and Seeking Help
While feeding tubes are safe, various issues can arise, necessitating prompt attention. Tube clogging is a common problem, often caused by inadequate flushing or medication residue. The initial approach to unclogging involves attaching a 30 or 60 mL syringe and attempting to flush with warm water, using a gentle push-pull motion. If water alone is insufficient, healthcare providers may recommend specific enzyme solutions designed to break down clogs.
Accidental dislodgement of the tube can occur, which requires immediate medical attention for reinsertion to prevent complications and ensure continuous nutritional support. Leakage around the tube site can lead to skin irritation from digestive fluids. This may indicate an improper tube size, an under-inflated balloon, or a stretched stoma, and should be reported to a healthcare provider. Cleaning the affected skin with warm water and mild soap, then drying thoroughly, helps manage irritation.
Signs of infection at the tube site include increased redness, swelling, pain, warmth, or the presence of thick, foul-smelling, green, or white discharge. Fever in conjunction with these symptoms suggests a more widespread infection. Aspiration pneumonia, where formula enters the lungs, can manifest with respiratory distress, coughing, or gagging. Any of these symptoms, especially fever, severe pain, or difficulty breathing, warrant immediate medical evaluation.