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Enteral Feeding

Symptom and description

When weight loss or lack of appetite become severe, nutrition supplements can be given. These supplements provide protein, vitamins, and other nutrients your body needs for energy. If you are unable to take these supplements by mouth, special tubes can be placed that allow you to receive the necessary nutrients without eating or drinking. The types of special tubes are:

  • Nasogastric tube. A tube that goes from the nose down the esophagus to the stomach.

  • Gastrostomy tube. A tube that is placed by the surgeon into the stomach through a small hole outside the stomach wall. (Called a PEG tube ? a percutaneous endoscopic gastrostomy tube.)

  • Jejunostomy tube. A tube that is placed into the upper part of the intestine (jejunum), just beyond the stomach. The tube is placed by the surgeon through a small hole in the abdomen.

Learning needs

You will need to learn to care for the nutrition tube and learn to give yourself the nutrients. You will also need to learn about some of the problems that can occur with tube feedings and what to report to your doctor.

Your home health nurse will make certain you and your caregiver understand how to store and prepare the nutritional feedings, how to start and stop the infusions, and what to do if problems occur.�It is best to practice the feeding procedure while the nurse is with you. You will also have resources to call in case you have problems or think of additional questions. Always ask questions if you do not understand the information.�

Preventing problems

Tube feeding is important in giving you the nutrients you need. When care is taken to give the tube feeding safely, many problems can be avoided. Here are some of the more common problems and what you can do to try to prevent them:

Aspiration (this is when the tube feeding is inhaled into the lungs)

  • Sit up to take feeding and for�1 hour after feeding.

  • If feeding is continuous, keep your head elevated on�2 or�3 pillows.

  • Check for residual food before giving feeding. (Your nurse will teach you how to do this.)

  • Check placement of tube before beginning. (Your nurse will teach you how to do this.)

  • Do not begin feeding if you feel full or bloated.

Diarrhea

  • Do not use feeding solution that has been opened and at room temperature for more than�6 hours.

  • Do not use feeding solution left open in refrigerator longer than 24 hours.

  • Wash your hands before handling tube or feeding solution.

  • Keep the feeding container and tubing or syringes clean.

Constipation

  • Ask about adding fiber to your diet.

  • Talk to your doctor about using a stool softener or laxative.

  • Increase your physical activity as allowed.

Skin irritation

  • Keep skin around the tube clean and dry.

  • Check for leakage around the tube and report this to your doctor right away.

  • Tape tube securely to prevent pulling.

  • Change dressing daily.

  • Apply skin protectant as needed.

Dehydration (loss of body fluids)

  • Ask your nurse about increasing the amount of water given in the tube between feedings.

  • Observe for increased urination.

  • Observe for signs of thirst or fever.

  • Check with your doctor about changing the feeding formula.

Tube clogging

  • Make sure there are no kinks in the tube.

  • Flush tube after meals.

  • Rinse your tube before and after giving medications.

Management

Your tube feeding will be given on a schedule that best fits your needs for care and the amount of calories required. The doctor, dietitian, or nurse will explain the schedule that is best for you. The choices of schedules are as follows:

  • Intermittent or bolus. The amount of tube feeding for the day will be divided up into smaller portions to be given at set times during the day over short periods. This may be done by gravity or syringe.

  • Continuous tube feeding. The amount of tube feeding for the day will be given slowly over the 24-hour period. It is usually given by a pump to keep the rate steady.

It is important to make sure the tube is in the right place before starting each feeding. Your nurse or other team member will tell you how to do this. Make sure you do it every time you use the tube.

Follow-up

If you feel your feedings are not working well for you, check with your doctor or dietitian about changing the rate of feeding or method of feeding.

If the tube becomes dislodged or falls out, apply a dressing over the opening if the tube is in your stomach, and call your doctor immediately.

Notify your�doctor right away if you have any of the following:

  • Temperature of 100.5�F�(38.1�C) or higher

  • Diarrhea for more than�1 day

  • Nausea or vomiting

  • Constipation

  • Abdominal distention (swelling)

  • Tube dislodgement

  • Clogging of the tube

  • Shortness of breath

  • Coughing

  • Unusual sleepiness, disorientation, or confusion