1 Nasogastric Tube Feedings Why do I need a feeding tube? A nasogastric feeding tube is used to give fluids, tube feeds, and medicine to people who cannot take them by mouth. The tube is placed through your nose into your stomach. An x-ray is taken to make sure that the tube is in your stomach. The feeding tube is often used up to a few weeks. My Tube Feed and Hydration Plan Formula name: ______________________________________________________________ Amount of formula needed per day: ______________________________________________ Give ____ cans or ____ ounces or ____ milliliters (mL) ____ times per day Amount of water needed per day in addition to goal tube feeds: ______________________ Flush tube with _______ milliliters (mL) of tap water after each feeding How do I give tube feedings? Gravity tube feedings are given multiple times per day, several hours apart and are delivered by a feeding bag over 30 minutes or less. The feeding bag hangs above the head and the formula drips in. Bolus (syringe) tube feeds may be given multiple times per day, several hours apart and are given through a syringe over 15-30 minutes. Gravity Tube Feedings 1. Wash your hands with soap and water. Dry them with a clean towel. 2. Use room temperature formula. Very cold formula may cause stomach discomfort. 3. Preparing the feeding: You will either use a ready-made formula or one that requires at home preparation from powder. A. Ready-made: • If using a ready-made formula, wash the lid of the can and dry the lid with a clean towel. • Only open containers of formula that you will need for the feeding. • Shake the can(s) before opening. • Only place 8 hours’ worth of formula into the bag. • Leftover formula that is open can be stored in the refrigerator with a cover. • Discard formula that has been open for more than 24 hours. B. Prepared formulas from powder: • Follow the mixing instructions given to you by your healthcare provider. • Only place 4 hours’ worth of formula into the bag. 2 • Leftover formula can be stored in the refrigerator with a cover. • Discard formula that has been prepared more than 24 hours ago. 4. Prepare water flushes for before and/or after feedings as instructed by your healthcare provider. 5. Check the roller clamp to ensure that the tubing is pinched closed. 6. Pour the formula into the feeding bag. Generally, no more than 2 cans or 480 mL of formula will be put into the feeding bag at a time. Close the lid on the feeding bag and hang the bag on a pole/hook that is at least 12 inches higher than your stomach. 7. Open the cap on the feeding tube and using a syringe, insert water into your tube as instructed by your healthcare provider. 8. Connect the tubing from the feeding bag to the feeding tube. 9. During feedings, sit upright so that your shoulders are higher than your stomach. Sit in a chair or prop yourself up in a bed or on the couch. Never lay flat on your back during feedings unless otherwise instructed by your healthcare provider. 10. Unclamp the tubing coming from the feeding bag. Control the flow rate by using the roller clamp. A good rate to start at is generally 1-2 drips per second. You may control the speed of flow per your comfort. 11. Once your feeding is finished, clamp the tube, remove the tubing from the feeding bag and unhook the feeding from your feeding tube. 12. Flush your g-tube with at least 30 mL of warm water or as instructed by your healthcare provider. Depending on fluid needs, you may need to put more water into the feeding bag and allow it to flow into your feeding tube using the roller clamp to control speed. 13. Close the cap on your feeding tube. 14. Rinse the feeding bag and tubing with cool water and then swish with warm water and a small amount of liquid dishwashing detergent. Rinse well and hang to dry. Use a new feeding bag set every 3 days. Bolus (Syringe) Feedings If you have been tolerating tube feeds by the gravity drip method, you may try the syringe method if you prefer. 1. Complete the steps 1-3 listed above. 2. Pull the plunger from the syringe. Open the cap on the feeding tube and place the tip of the syringe into the feeding tube. 3. Flush the feeding tube with 30 mL of warm water or as instructed by your healthcare provider. 4. Fill the syringe with formula and allow the formula to flow slowly. You may adjust the flow by gently pinching the feeding tube. It is not recommended to use the plunger of the syringe to force formula into the tube. This can cause bloating and discomfort. Repeat this step as many times as necessary to complete your goal for this individual feed. It will take about 4 full 60 mL syringes to complete 1 can of formula. It should take about 15 minutes to complete 1 can of formula. 5. After the feeding is complete, flush tube with 30 mL of warm water or as instructed by your healthcare provider. 6. After all the water has gone through the tube, place cap on the feeding tube. 7. Clean syringe with warm, soapy water and allow to air dry completely between feedings. Change the syringe each week. 3 Water Flushes Your body needs enough fluid each day to stay hydrated. Your tube feeding formula will provide some fluids. The rest of your fluid will be met by oral intake (if safe) and/or by doing water flushes through your feeding tube. Avoid a lot of force when flushing your feeding tube. If you are not feeling well and cannot tolerate your goal tube feeds, you will need more water through your tube to stay hydrated. You may not be getting enough fluid if you have: dizziness, dry mouth, dry lips, dark urine, or less urine than normal. Giving Medicines You can give medicine through the feeding tube if you are unable to swallow them. Follow these instructions: 1. Do not add medicine directly to the formula 2. Give each medicine one at a time; do not mix together. 3. Flush the tube with 30 mL water before giving a medicine or as instructed by your healthcare provider. If giving more than one medicine at one time, flush in between each dose with 10 mL water. 4. Crush and dissolve pills in at least 30 mL water prior to flushing them through the tube. Never crush enteric-coated or time-release capsules. Sterilized water is the preferred method for diluting medicine. 5. Flush the tube again with 30 mL water after administering the medicine, or as instructed by your healthcare provider. Call Your Doctor If… • Occasionally your tube may clog. Medicines may cause clogs or it may clog if you are not flushing your tube with water frequently. This is not an emergency situation. First try to flush the tube with 30 mL of warm water. Never force fluid into the tube. If this does not unclog the tube, call your doctor. If your tube clogs at night you can wait until morning to call. • If your tube falls out, it is important that you call your doctor immediately. Although this is not harmful to you, replacing the tube becomes more difficult or impossible the longer the tube is out. • For adults: Weigh yourself 3 times a week at the same time of day on the same scale. Early morning is best, after urinating. Keep a record of your weight. If you notice weight gain or loss of more than 2-3 pounds per week contact your doctor, nurse or registered dietitian. • Nausea or upset stomach that continues for more than 24 hours. • Diarrhea (3 or more loose, watery bowel movements) for more than 2 days. • Constipation (lack of bowel movement) that continues more than 5 days. • Anything that causes you to stop giving tube feedings for more than one day. 4 Teach Back What is the most important thing you learned from this handout? What changes will you make in your diet/lifestyle, based on what you learned today? If you are a UW Health patient and have more questions please contact UW Health at one of the phone numbers listed below. You can also visit our website at www.uwhealth.org/nutrition. Nutrition clinics for UW Hospital and Clinics (UWHC) and American Family Children’s Hospital (AFCH) can be reached at: (608) 890-5500. Nutrition clinics for UW Medical Foundation (UWMF) can be reached at: (608) 287-2770. The Spanish version of this Health Facts for You is #603s Your health care team may have given you this information as part of your care. If so, please use it and call if you have any questions. If this information was not given to you as part of your care, please check with your doctor. This is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person’s health needs are different, you should talk with your doctor or others on your health care team when using this information. If you have an emergency, please call 911. Copyright © 9/2017 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Clinical Nutrition Services Department and the Department of Nursing. HF#603