This guide will help you with the additional tube feedings you need to boost your nutrition. The feedings can help you by providing more nutrients and calories.

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. This tube is usually used for short-term(a few days to weeks) nutrition support.

Gastrostomy tube: A tube that is placed by the surgeon into the stomach through a small hole outside the stomach wall.

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. Both the gastrostomy and jejunostomy tubes are used to provide nutritional support for longer-term feeding (usually several weeks).

Insertion of the tubes is relatively simple and can be done in the outpatient setting.

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.1.
To prevent regurgitation of the feeding:
•
Sit up to take feeding and for 1 hour following feeding.
• If your feeding is continuous, keep your head elevated on two or three pillows.
•

Before starting your feeding, check for residual food in your stomach. If you get back more than 50 ml or 2 ounces of residual food, do not take a feeding at that time. Try again in 1 hour.
• Check placement of tube before beginning your feedings.
• Do not begin feeding if you feel full or bloated.
2. To prevent diarrhea:
• Allow feeding solution to warm to room temperature before giving.
• Do not use feeding solution that has been opened and out for more than 6 to 8 hours.
• Do not use feeding solution left open in refrigerator longer than 24 hours.
• Wash your hands before handling tube or feeding solution.
• Keep feeding container clean and all of your feeding equipment clean.
3. Preventing constipation:
• Make sure you drink enough water.
• Ask about adding fiber to diet.
• Consider a stool softener/laxative if you are prone to constipation.
• Increase your physical activity as tolerated.
4. Preventung skin irritation:
• It is important to keep skin around tube clean and dry.
• Check for leakage around tube and report this immediately to your caregiver.
• Tape tube securely to prevent pulling.
• Change dressing daily.
• Apply skin protectant as needed.
5. Dehydration (loss of body fluids):
• Increase amount of water given in the tube between feedings.
• Observe for increased urination.
• Observe for signs of thirst, fever.
• Check with physician about changing formula.
6.
Prevent clogging of your feeding tube:
• Make sure there are no kinks in tube.
• Flush tube with 3 to 4 ounces warm water after meals.
• Dissolve all medications placed in the tube in at least 1 ounce water.
• Rinse your tube with water before and after medications.
• Rinse tube with cola or 1 part hydrogen peroxide in 3 parts water, if tube becomes sluggish.

Management Your tube feeding will be given on a schedule that best fits your needs for care and 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. 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.1.
Nasogastric tube:
• Wash your hands.
• Draw up 10 to 20 cc air into a syringe.
• Insert the tip of the syringe into the end of the feeding tube.
• Unclamp the tube.
• Put stethoscope into ears and place bell over abdominal area.
• Quickly push air into feeding tube. You should hear a ‘‘whoosh,’’ a bubbling, or a quick high-pitched gurgling sound.
• Do not give your feeding if you cannot hear this sound. Contact the doctor, nurse, or dietitian.
2. Gastrostomy or jejunostomy tube:
• Wash your hands.
• Measure the number of inches from the stomach wall to the end of the tube.
• If more than _____ inches, do not give feeding.
• Contact the doctor, nurse, or dietitian.

Report any of the following symptoms to your doctor:
Tube feeding into lungs (aspiration): Coughing or gagging, especially associated with fever.
Diarrhea: Loose, watery stools can occur alone or associated with other symptoms such as cramping, upset stomach, or dizziness.
Constipation: Hard, infrequent stools.
Skin irritation: Pain, redness, or bleeding around the tube.
Dehydration: Thirst, weight loss, dry mouth, lack of energy, extreme tiredness.
Tube clogging: Difficulty flushing tube with water or air.

Follow-up Should any of these problems happen, call your doctor:1.
If you feel your feedings are not working well for you, check with your doctor or dietitian about changing rate of feeding or method of feeding.
2. If the tube becomes dislodged or falls out, apply a dressing over the opening if the tube is in your stomach, and call your caregiver immediately.
3. Notify your caregiver if you have any of the following:
• temperature of 100.4°F (38°C) or more
• diarrhea
• nausea or vomiting
• constipation
• abdominal distention
• tube dislodgement
• clogging of the tube