Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the...
Transcript of Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the...
![Page 1: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/1.jpg)
Home Tube Feeding: How to Troubleshoot and Manage Common Complications
Amy Long Carrera MS, RD, CNSC, CWCMSCorporate Registered DietitianShield HealthCare
Coming soon!
![Page 2: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/2.jpg)
Introduction
Amy Long Carrera MS, RD, CNSC, CWCMSCorporate Registered DietitianCertified Nutrition Support Clinician
This information is intended for educational purposes. Contact your healthcare professional about your treatment plan.
2
![Page 3: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/3.jpg)
Objectives
Solutions
Troubleshooting
Common Complications
Tube Feeding Basics Review
3
![Page 4: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/4.jpg)
Feeding Routes
Nasal
Gastric
Jejunal
4
![Page 5: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/5.jpg)
Feeding Tubes
Nasogastric (NG tube)
Regular Gastrostomy
(G-tube)
Low Profile Gastrostomy
(G-tube Button)
Balloon Internal bumperNon-balloon button
5
![Page 6: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/6.jpg)
Feeding Methods
Bolus Gravity Pump
6
![Page 7: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/7.jpg)
Common Tube Feeding Complications
Nausea and Vomiting
Diarrhea
Constipation
Skin Issues
Clogged Feeding Tube
7
![Page 8: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/8.jpg)
Why Prevent Complications?
Reduce Hospital Readmissions, ER Visits
Prevent Malnutrition
Improve Quality of Life
Kurien M et al. Eur J Clin Nutr 2012Silver HJ et al. J Parenter Enteral Nutr 2004 8
![Page 9: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/9.jpg)
Nausea and VomitingIs the formula too fast?
9
![Page 10: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/10.jpg)
Nausea and Vomiting
– Check the external length of the tube OR– Check the amount of water in the balloon
Is the tube in the right place?
10
![Page 11: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/11.jpg)
Nausea and Vomiting
– Check for last bowel movement– Check the abdomen for hardness/distension
Is it constipation?
11
![Page 12: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/12.jpg)
Nausea and Vomiting
• Sit upright or keep the head of the bed at 30 degrees – During and for at least 30 minutes after the feeding
• Use room-temperature formula
• Separate water flushes from thefeeding
More tips for nausea and vomiting
12
![Page 13: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/13.jpg)
Diarrhea
• Too much too fast?– Slow it down
• Too concentrated?– Consider 1 or 1.2 kcal/mL
• Poor absorption?– If malabsorption is suspected:
• Consider a hydrolyzed or “pre-digested” formula
Is it the tube feeding?
13
![Page 14: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/14.jpg)
Diarrhea
• Ask your doctor if you need a stool test– This is especially important if:
• You have taken antibiotics in the last few months• You have had gastrointestinal infections in the past
Is it infection?
14
![Page 15: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/15.jpg)
Diarrhea
• Some medications can cause loose stools– Antibiotics– Laxatives – Pro-motility agents – Liquid medications containing sorbitol
Is it medication?
15
![Page 16: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/16.jpg)
Diarrhea
• Hydration
• Probiotic supplements– Prevention of antibiotic-associated diarrhea
• Lactobacillus rhamnosus GG (Culturelle)• Lactobacillus casei and acidophilus (Bio-K+)• Saccharomyces boulardii (Florastor)
• Fiber– Try a formula that contains fiber
More tips for diarrhea
16
![Page 17: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/17.jpg)
Constipation
• Your formula contains water but you may need to add extra water through your tube to meet your fluid needs
Are you getting enough water?
17
![Page 18: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/18.jpg)
Constipation
• Ask your doctor or dietitian how much additional water you should take every day
Are you getting enough water?
18
![Page 19: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/19.jpg)
Constipation
• Draws water into colon to prevent hard stools• Pectin • Guar gum• Oat fiber
Soluble fiber
• Adds bulk to speed transit time• Soy fiber
Insoluble fiber
Are you getting enough fiber?
19
![Page 20: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/20.jpg)
Skin IssuesHealthy Stoma Site
20
![Page 21: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/21.jpg)
Leakage Around the Tube
• Check the external bolster or balloon volume • Apply a skin protectant or moisture barrier• Use a short-term dressing to absorb drainage
Is the tube too loose?
21
![Page 22: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/22.jpg)
Pressure Necrosis
• Check the external bolster or balloon volume
Is the tube too tight?
External Bolster
22
![Page 23: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/23.jpg)
Checking the External Bolster
• Note the markings on the tube where the external bolster is sitting
• Slide the external bolster up or down to adjust
External Bolster
23
![Page 24: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/24.jpg)
Checking Balloon Volume
1. Determine the amount the balloon should hold 2. Use a 10 mL syringe to deflate the balloon and note the
amount.
3. Re-inflate with the correct amount of sterile water– Air can seep out and deflate balloon
– Saline can clog the access port
Balloon port
Balloon
24
![Page 25: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/25.jpg)
Hypergranulation Tissue
• Use only mild soap and water for daily cleaning• Stabilize the tube to restrict movement
Is something irritating your skin?
25
![Page 26: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/26.jpg)
Bacterial or Yeast Infection
• Wash your hands before touching the skin• Clean the site daily and keep it dry
Is the skin too moist?
26
![Page 27: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/27.jpg)
Daily Skin Care Tips
Wash your
hands
Rotate the tube ¼
turn (except for
J-tubes)
Check external bolster height
Secure the tube
Keep it clean
and dry
27
![Page 28: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/28.jpg)
Clogged Feeding Tube
• Flush the tube regularly with water– Every time you use it– Every few hours when not in use
Preventing a Clogged Tube
28
![Page 29: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/29.jpg)
Clogged Feeding Tube
• Give medications separately from formula1. Stop the feeding and flush the tube with water2. Give each medication separately3. Flush your tube with water after each medication
Preventing a Clogged Tube
29
![Page 30: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/30.jpg)
Clogged Feeding Tube
Push warm water into your tube with a 60 mL syringe
Gently push and pull the plunger to loosen the clog
NOTE: Avoid pulling back on the plunger if you have a J-tube
Clamp your tube and let the water “soak” for 15 minutes
Try gently massaging the tubing with your fingertips
To Clear the Clog at Home
30
![Page 31: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/31.jpg)
ReferenceBankhead R, et al. Enteral nutrition practice recommendations. Journal of Parenteral and Enteral Nutrition. 2009;33(2):149-58.
Hickson H. Probiotics in the prevention of antibiotic-associated diarrhea and clostridium difficile infection. Therap Adv Gastroenterol. 2011;4(3):185-197.
Kurien M et al. Managing patients with gastrostomy tubes in the community: can a dedicated enteral feed dietetic service reduce hospital readmissions? Eur J Clin Nutr 2012;66(6):757-60.
Silver HJ et al. Older adults receiving home enteral nutrition: enteral regimen, provider involvement, and health care outcomes. J Parenter Enteral Nutr. 2004;28(2):92-98.
31
![Page 32: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/32.jpg)
32
![Page 33: Home Tube Feeding - Shield HealthCare · 2. Use a 10 mL syringe to deflate the balloon and note the amount. 3. Re-inflate with the correct amount of sterile water – Air can seep](https://reader030.fdocuments.in/reader030/viewer/2022040216/5f225a8b53464b3ecc3ade0d/html5/thumbnails/33.jpg)
33Shield HealthCare
For more information on tube feeding and nutrition:• shieldhealthcare.com/community/nutrition
• youtube.com/shieldhealthcare
Contact Amy: [email protected]
This concludes our presentation. Thank you for joining us.