Feeding Tube Types and Care Guidelines

In this video, we are going to talk about gastrostomy, jejunostomy, and gastrojejunostomy tubes, commonly known as feeding tubes. First, we will review the types of feeding tubes. Then, we will discuss the daily care and maintenance of your tube, common issues or complications that may arise, and finally, look at some frequently asked questions. Moffitt Cancer Center places in-fit feeding tubes. No matter what tube is placed, care and maintenance are the same. The first tube we are going to discuss is a gastrostomy tube or G-tube. This tube is placed directly into the stomach, has one main port, and is mostly used for feedings. The second tube is a jejunostomy tube. This tube is placed into the jejunum or small intestine right below the stomach. It also has one main port and is used for feedings. The third tube is a gastrojejunostomy tube or a GJ tube. This tube is placed in the stomach and extends into the jejunum or the small intestine. The GJ tube has two ports. The gastrostomy port is used for medication administration and the jejunostomy port is used for feedings. When a tube is inserted, special placeholders are used to keep it from falling out. Inside your body is a balloon that is inflated during the procedure. The white port on all of the tubes is used to inflate the balloon when the tube is placed. You should never put anything in the white port. Outside of your body is a round disc called a bumper that sits directly against your skin and holds the tube securely in place. You'll also notice two to four round buttons around the outside of the bumper. These buttons are stitched in place. When the stitch is dissolved, the buttons may fall off on their own. This can take four to six weeks. The entire insertion site is typically covered by a gauze dressing for 24 hours after the tube is placed. You may not eat or drink anything for 12 hours. If your doctor allows it, You may take medications by mouth with small sips of water only. Alternatively, you can crush your medications and then flush it through the tube with water. Speak to your dietician or pharmacist about which medications you can crush and how to crush them. Also, if your doctor allows it, you may have clear liquids or feedings beginning 12 hours after the procedure. The important thing to remember is to follow your doctor's orders. Now we'll talk about daily care and maintenance that are required in order to keep your feeding tube in good working order. Every day you will need to clean and check the area around the tube, clean the tube connections, secure the tube, and flush the tube. We will start by showing you how to remove the dressing 24 hours after the procedure and how to clean around the tube set. Begin by washing your hands well with soap and water. If a gauze dressing is covering the insertion site, remove it and throw it away. 24 hours after the procedure, you can shower and use a soft cloth to wash the skin around the tube insertion site with mild soap and warm water. As you shower, gently clean around the bumper and the buttons. Carefully remove any drainage or dried fluids under the bumper with a cotton swab. Dry your skin well. It is important to keep the area around the tube insertion site clean and dry to prevent skin irritation and infections. Always check the area around the tube insertion site for signs of infection. Such signs could be drainage with an odor, redness that is warm to touch. Look for swelling, drainage or excess skin growing around the tube. A small amount of redness is normal. You can expect pain and soreness for the first 2-3 days after the tube is inserted. You will need to clean and check the tube and skin every day. Do not use creams or ointments around the tube insertion site unless directed to do so by your doctor. If there is no drainage or leaking around the tube, a dressing is not needed. However, if there is drainage or leakage around the tube, a dressing should be applied. To apply a dressing, have your dressing supplies ready. Put a split drain gauze on top of the bumper and secure with tape. Remember, do not put dressing under the bumper. This increases the risk of skin irritation and infection. Cleaning the tube connection. With a soft toothbrush or equivalent, gently clean the inside of the end of the tube where the syringe connects with water. Securing the tube. It is important to secure the feeding tube in an upright position to prevent pulling and tension. Tension on the tube can cause injury to the insertion site, making the opening wider, which can lead to leakage or dislodgement. Flushing your tube. It is important to flush the tube every day, even if you aren't using the tube for feeding or medication. If you are using the tube for feeding or medication, flush the tube both before and after you put feedings or medication in the tube. To flush the tube you will need an in-fit syringe and 60 ml or 2 oz of room temperature water. Start by removing the plunger and the cap from the syringe. Fold over or pinch the end of the tube with your fingers to prevent leaking. Remove the cap from the tube. Attach the syringe to the end of the tube. Push in and turn clockwise or to the right to secure syringe to the feeding tube. Pour the water into the syringe. The higher you hold the syringe, the faster it flushes. The lower you hold the syringe, the slower it flushes. Pinch the end of the tube again with your fingers and remove the syringe. Turn the syringe counterclockwise or to the left to remove it. Recap the end of the feeding tube. Clean, rinse, and dry your supplies after each use. Taking medications through the feeding tube. If possible, take liquid medications through the feeding tube instead of pills or capsules. Some medications only come in pill form and can be crushed and mixed with water so you can take them through the tube. There are other medications that only come in pill form that are not effective if they are crushed. It is important to speak with your doctor or pharmacist before crushing and placing any medications in the feeding tube. Troubleshooting common feeding tube issues. It is important to know when to call your doctor and how to troubleshoot common issues that may arise. Leaking or drainage around the tube. Some drainage is normal, especially right after the tube has been placed. Your body position is very important. Place your body at a 45 degree angle, slightly reclined. when using the tube feeding or taking medications. This will decrease pressure inside your abdomen which can contribute to leaking or drainage. Check that the bumper is close to the skin, at least one finger's width from the skin, to help keep the tube in place. Blocked and clogged tubes. A blockage can be caused by a buildup of food or medicine in the tube or by body fluids drying around the opening of the tube. To clear a blockage, flush the tube with 30 milliliters or 1 ounce of warm water. Do not use meat tenderizer, juice or soda to unplug your tube. These fluids can make the blockage worse for a short period of time. You should only flush the tube with water. The most important thing you can do to prevent blockage is to flush your tube before and after feedings. Excessive gas and overfeeding can cause bloating of the stomach, nausea, and vomiting. You can try opening the cap of the tube to allow air to escape. This may relieve the problem. You'll want to have a towel handy because gastric juices or drainage will come out of the tube. Leave it open for approximately 15 to 20 minutes. If you get no relief, cap it and give your doctor a call. Tube breaks. Most feeding tubes last 3 to 6 months with normal use. Eventually the tube will break down, become more difficult to use, or the tip of the tube may split. These are signs that the tube will need to be replaced. Tube cap breaks off. Due to the frequency of use, the tube cap may break off completely. Do not worry if this happens. The tube can still be used for a short time with the emergency infit cap that has been provided to you. This is a temporary fix. Your tube will need to be replaced, so you need to call your doctor to schedule a replacement. When to call your doctor? You have chills or a fever of 100.4 or greater. You have severe pain or redness around the tube insertion site. You have foul-smelling yellow or green drainage pus or any drainage that concerns you. Or you are vomiting. Your tube is leaking, falls out, or you are unable to use it. If your tube falls out, you may wash it and place it back in the opening it fell out of on your stomach and call immediately for a replacement appointment. Do not use the tube. Frequently asked questions. Can I put food in the blender and put it in my tube? Check with your dietitian and or physician to see if there is any alternatives. Can I swim with my tube? After four weeks, check with your doctor before swimming in the ocean or pool. Remember, never swim in a lake, pond, or river while you have a feeding tube. What is the white port? The white port is used to inflate the balloon that holds the tube in place. Never attach anything to that port and never put anything in this port. How long will I need this tube? The amount of time you need the tube depends on you, your treatment plan, and your doctor.

The first tube we are going to discuss is a gastrostomy tube or G-tube. This tube is placed directly into the stomach, has one main port, and is mostly used for feedings. The second tube is a jejunostomy tube.

This tube is placed into the jejunum or small intestine right below the stomach. It also has one main port and is used for feedings. The third tube is a gastrojejunostomy tube or a GJ tube.

This tube is placed in the stomach and extends into the jejunum or the small intestine. The GJ tube has two ports. The gastrostomy port is used for medication administration and the jejunostomy port is used for feedings.

When a tube is inserted, special placeholders are used to keep it from falling out. Inside your body is a balloon that is inflated during the procedure. The white port on all of the tubes is used to inflate the balloon when the tube is placed. You should never put anything in the white port. Outside of your body is a round disc called a bumper that sits directly against your skin and holds the tube securely in place.

You'll also notice two to four round buttons around the outside of the bumper. These buttons are stitched in place. When the stitch is dissolved, the buttons may fall off on their own. This can take four to six weeks. The entire insertion site is typically covered by a gauze dressing for 24 hours after the tube is placed.

You may not eat or drink anything for 12 hours. If your doctor allows it, You may take medications by mouth with small sips of water only. Alternatively, you can crush your medications and then flush it through the tube with water.

Speak to your dietician or pharmacist about which medications you can crush and how to crush them. Also, if your doctor allows it, you may have clear liquids or feedings beginning 12 hours after the procedure. The important thing to remember is to follow your doctor's orders. Now we'll talk about daily care and maintenance that are required in order to keep your feeding tube in good working order.

Every day you will need to clean and check the area around the tube, clean the tube connections, secure the tube, and flush the tube. We will start by showing you how to remove the dressing 24 hours after the procedure and how to clean around the tube set. Begin by washing your hands well with soap and water.

If a gauze dressing is covering the insertion site, remove it and throw it away. 24 hours after the procedure, you can shower and use a soft cloth to wash the skin around the tube insertion site with mild soap and warm water. As you shower, gently clean around the bumper and the buttons.

Carefully remove any drainage or dried fluids under the bumper with a cotton swab. Dry your skin well. It is important to keep the area around the tube insertion site clean and dry to prevent skin irritation and infections. Always check the area around the tube insertion site for signs of infection.

Such signs could be drainage with an odor, redness that is warm to touch. Look for swelling, drainage or excess skin growing around the tube. A small amount of redness is normal.

You can expect pain and soreness for the first 2-3 days after the tube is inserted. You will need to clean and check the tube and skin every day. Do not use creams or ointments around the tube insertion site unless directed to do so by your doctor. If there is no drainage or leaking around the tube, a dressing is not needed.

However, if there is drainage or leakage around the tube, a dressing should be applied. To apply a dressing, have your dressing supplies ready. Put a split drain gauze on top of the bumper and secure with tape. Remember, do not put dressing under the bumper. This increases the risk of skin irritation and infection.

Cleaning the tube connection. With a soft toothbrush or equivalent, gently clean the inside of the end of the tube where the syringe connects with water. Securing the tube. It is important to secure the feeding tube in an upright position to prevent pulling and tension. Tension on the tube can cause injury to the insertion site, making the opening wider, which can lead to leakage or dislodgement.

Flushing your tube. It is important to flush the tube every day, even if you aren't using the tube for feeding or medication. If you are using the tube for feeding or medication, flush the tube both before and after you put feedings or medication in the tube. To flush the tube you will need an in-fit syringe and 60 ml or 2 oz of room temperature water.

Start by removing the plunger and the cap from the syringe. Fold over or pinch the end of the tube with your fingers to prevent leaking. Remove the cap from the tube.

Attach the syringe to the end of the tube. Push in and turn clockwise or to the right to secure syringe to the feeding tube. Pour the water into the syringe.

The higher you hold the syringe, the faster it flushes. The lower you hold the syringe, the slower it flushes. Pinch the end of the tube again with your fingers and remove the syringe.

Turn the syringe counterclockwise or to the left to remove it. Recap the end of the feeding tube. Clean, rinse, and dry your supplies after each use. Taking medications through the feeding tube. If possible, take liquid medications through the feeding tube instead of pills or capsules.

Some medications only come in pill form and can be crushed and mixed with water so you can take them through the tube. There are other medications that only come in pill form that are not effective if they are crushed. It is important to speak with your doctor or pharmacist before crushing and placing any medications in the feeding tube.

Troubleshooting common feeding tube issues. It is important to know when to call your doctor and how to troubleshoot common issues that may arise. Leaking or drainage around the tube. Some drainage is normal, especially right after the tube has been placed.

Your body position is very important. Place your body at a 45 degree angle, slightly reclined. when using the tube feeding or taking medications. This will decrease pressure inside your abdomen which can contribute to leaking or drainage.

Check that the bumper is close to the skin, at least one finger's width from the skin, to help keep the tube in place. Blocked and clogged tubes. A blockage can be caused by a buildup of food or medicine in the tube or by body fluids drying around the opening of the tube. To clear a blockage, flush the tube with 30 milliliters or 1 ounce of warm water. Do not use meat tenderizer, juice or soda to unplug your tube.

These fluids can make the blockage worse for a short period of time. You should only flush the tube with water. The most important thing you can do to prevent blockage is to flush your tube before and after feedings. Excessive gas and overfeeding can cause bloating of the stomach, nausea, and vomiting. You can try opening the cap of the tube to allow air to escape.

This may relieve the problem. You'll want to have a towel handy because gastric juices or drainage will come out of the tube. Leave it open for approximately 15 to 20 minutes.

If you get no relief, cap it and give your doctor a call. Tube breaks. Most feeding tubes last 3 to 6 months with normal use.

Eventually the tube will break down, become more difficult to use, or the tip of the tube may split. These are signs that the tube will need to be replaced. Tube cap breaks off. Due to the frequency of use, the tube cap may break off completely. Do not worry if this happens.

The tube can still be used for a short time with the emergency infit cap that has been provided to you. This is a temporary fix. Your tube will need to be replaced, so you need to call your doctor to schedule a replacement.

When to call your doctor? You have chills or a fever of 100.4 or greater. You have severe pain or redness around the tube insertion site.

You have foul-smelling yellow or green drainage pus or any drainage that concerns you. Or you are vomiting. Your tube is leaking, falls out, or you are unable to use it.

If your tube falls out, you may wash it and place it back in the opening it fell out of on your stomach and call immediately for a replacement appointment. Do not use the tube. Frequently asked questions. Can I put food in the blender and put it in my tube? Check with your dietitian and or physician to see if there is any alternatives.

Can I swim with my tube? After four weeks, check with your doctor before swimming in the ocean or pool. Remember, never swim in a lake, pond, or river while you have a feeding tube.

What is the white port? The white port is used to inflate the balloon that holds the tube in place. Never attach anything to that port and never put anything in this port.

How long will I need this tube? The amount of time you need the tube depends on you, your treatment plan, and your doctor.

Transcript for:Feeding Tube Types and Care Guidelines

Transcript for:
Feeding Tube Types and Care Guidelines