Dietetics - Home Enteral Tube Feeding

 

Patient's name: _______________________________________________________________

Introduction

You are to be discharged from hospital with a feeding tube. Your feeding tube will ensure that your body has enough nutrition and fluids.

This leaflet provides information to help you care for your feed and feeding tube, including:

• Your feeding plan
• Types of feeding
• Some possible problems
• Useful contact details

Tube information

Type of tube ____________________________________________________________    

Manufacturer ___________________________________________________________     

Size of tube _____________________________________________________________     

Date placed _____________     

Approximate date your tube needs changing ______________________________     

If your tube falls out:

• If within office hours, contact your community dietitian or nutrition nurse immediately
• If they are not available or if outside of hours, contact your district nurse or go to A&E
• If you have a spare tube, please bring to A&E

Your Feeding Plan 

Your Fluid Plan

Before and after feed or bolus (ml) ______________________    

Before and after medication (ml) ________________________     

Between each medication (ml) __________________________     

Additional water flushes ________________________________     

Total water flushes _____________________________________     

In warm weather you may need extra water flushes. If you have any queries, please discuss with your dietitian.

What type of water shall I use once home?

☐    Freshly drawn tap water
☐    Cool boiled water (change every 24 hours)

Syringes

You need to use a new purple oral/enteral 60ml syringe every:

Feed

• Store unopened feed at room temperature, not in direct sunlight and away from radiators or other heat sources
• Check you have the correct feed before use
• Check the expiry date of feed before use
• If the feed is to be stopped for longer than 4 hours, it must be stored in the fridge and used within 24 hours
• Do not leave your feed connected for more than 24 hours

Hygiene

• Always wash your hands with soap and water before touching the tube, feed or syringe
• Try to handle the tube and giving sets as little as possible to reduce the risk of infection
• Try not to stop and start the feed for long periods as this may increase the risk of infection
• Use a new giving set (connecting tube) every 24 hours
• Clean up any spillages

How to flush your tube

• Step 1: Using a purple 60ml syringe draw up the volume of water from your fluid plan
• Step 2: Attach the syringe to the end of your tube. If your tube has a clamp, ensure your clamp is open. Press down the plunger slowly. This should take approximately 30 seconds
• Step 3: Repeat steps 1 and 2 until the full volume of water is given as per your fluid plan
• Step 4: Close the end connector. If your tube has a clamp, make sure your clamp is open when the tube is not in use and the end is closed. This will increase the life of the tube and reduce the risk of blockages

Medications

Before going home, check the following with your ward nurse or pharmacist:

• Times your medication need to be given
• If you need to leave a break between your feed and medications
• If your medication comes in dissolvable or liquid form
• Take medications individually as they can interact with each other and increase the risk of blocking your tube
• If you can swallow your medication you should continue to do so
• If you are unable to swallow, your medications will go down your tube. Always follow your fluid plan to make sure your medications are flushed through properly and reduce the risk of your tube blocking

Skincare

• Clean the tube entry site (stoma) every day to reduce risk of infection with warm soapy water
• Dry thoroughly with a clean disposable paper towel

Methods of feeding

Your feed can be given in different ways:

1.    Pump feeding
Pump feeding gives the feed at a controlled hourly rate. The home delivery company will provide training on how to use the pump.

2.    Bolus feeding
Bolus feeding is when you deliver your feed through a syringe to your tube.

3.    Combination feeding (pump and bolus)
Combination feeding allows you to give your feeding using the pump and the syringe.

How to set up your pump feed

Use your training manual provided by the home delivery company to set up your pump, as outlined in your feed and fluid plan.

How to bolus your feed

• Step 1: Ensure your feed is at room temperature. If you store your feed in the fridge, take it out at least 1 hour before it is given
• Step 2: Using a purple 60ml syringe, draw up the outlined volume of feed from your feeding plan
• Step 3: Attach the syringe to the end of your tube. If your tube has a clamp, make sure your clamp is open. Press down the plunger gently and slowly
• Step 4: Repeat step 2 and 3 until the full volume of feed is given as outlined in your feeding plan. Bolus feeds should not be rushed and should take approximately 20 minutes per bolus

Syringe cleaning instructions

• Clean the syringe after each feed and medication
• Use a bowl of fresh warm soapy water to clean the syringe. Draw the plunger of the syringe in and out several times to make sure all the feed and medications have been removed
• Separate the plunger from the syringe, and rinse. Shake off excess water and dry with a paper towel
• Once dry, store in a clean dry place

Mouth care

• It is important to keep your mouth, teeth and gums clean to help prevent infections
• If you are unable to take any fluids orally, dip a soft toothbrush in a small amount of a gentle mouth wash. Shake off the excess and clean mouth, teeth and gums twice a day
• If you wear dentures, ensure that they are cleaned twice a day

Other information

• Always flush your feeding tube with water before and after feeding, to reduce the chance of blocking and infection
• If you are feeding in bed, your head and shoulders must be raised with 3 pillows whilst feeding and for 2 hours after your feed has finished. This will help to prevent regurgitation of the feed
• If your tube has a clamp, please only use the clamp when the end of your tube is open. Using the clamp as little as possible will increase the life of your tube
• If you run out of your feed or syringes, please contact your home delivery company or community dietitian (see contact details)

Troubleshooting

Nausea, vomiting or regurgitation

• When did you last open your bowels?
• If you are feeding in bed, make sure that you have at least 3 pillows to keep you upright
• If bolus feeding, take more time to give your bolus
• Check feed is in date and stored correctly
• If pump feeding, try reducing the rate – discuss with dietitian prior to changing rate
• Contact your community dietitian or GP

Bloating

• Make sure you have opened your bowels
• If bolus feeding, take more time to give your bolus
• If pump feeding, try to reduce the rate
• Contact your community dietitian or GP

Diarrhoea

• Check the feeding rate is correct
• Ask district nurses to take a stool sample
• Diarrhoea maybe caused by antibiotics. Do not stop taking the antibiotics. Contact your GP
• If pump feeding, try reducing the rate – discuss with dietitian prior to changing rate
• Check feed is in date and stored correctly
• Make sure feed is at room temperature
• If bolus feeding, take more time to give your bolus
• Contact your community dietitian or GP

Constipation

• Check your feeding and fluid plan to ensure you are having the right amount of fluid
• In warm weather, give yourself an extra 500ml of water through the day
• Contact your community dietitian or GP

Thirsty

• Check your feeding and fluid plan to ensure you are having the right amount of fluid
• Make sure you are having regular mouth care
• In warm weather, give yourself an extra 500ml of water through the day
• Contact your community dietitian or GP

Blocked Tube

• Check clamp is off
• Check tube is not kinked
• Check the fixation plate is positioned correctly and not causing a blockage
• Check the tube to see any signs of blockage
• Where you see a blockage, try massaging the tube to loosen any blockage
• Milk the tube by squeezing towards the end of the tube to remove any blockage
• Try to flush the tube with water. Push the plunger in and out several times. Do not use too much force

If these don’t work:

• Try filling the tube with warm boiled water (not hot) and leave it for 30 mins
• Try using a warm flannel around the tube to help the tube expand
• Try soda water or sodium bicarbonate (1/2 teaspoon in 50mls)
• Do not use acidic drinks, such as coke or orange juice to unblock the tube
• Contact your community dietitian or district nurses

Tube has fallen out

• If in office hours, contact your community dietitian or nutrition nurse immediately
• If they are unavailable or if out of hours, contact your district nurse or go to A&E
• If you have a spare tube, please bring to A&E

Pump problems

• Make sure your pump is plugged in or battery is fully charged
• Check your pump manual
• Contact your home delivery company

Low stock of feed/giving sets/syringes

• Try not to let your stocks run below 7 day supply
• Contact your home delivery company
• Contact community dietitian

Redness/oozing/bleeding around the entry site (stoma)

• Make sure the fixation plate is in the correct position
• Make sure skin is clean and dry
• Contact your community dietitian or district nurses

Contact numbers

Community dietitian
Name     
Telephone     

Home Delivery company
Name     
Telephone     

Home delivery nurse
Name     
Telephone     

Salford Royal dietitian
Name     
Telephone     

Salford Royal nutrition nurse
Name     
Telephone     

District nurses
Name     
Telephone     

Where do I get supplies from?

Feed __________________________________________________________________________________________________     

Plastic giving sets (connecting tubes) _____________________________________________________________________     

Syringes ________________________________________________________________________________________________