All of our publications are available in different languages, larger print, braille (English only), audio tape or another format of your choice. Tha gach sgrìobhainn againn rim faotainn ann an diofar chànanan, clò nas motha, Braille (Beurla a-mhàin), teip claistinn no riochd eile a tha sibh airson a thaghadh. Gastrostomy tube care Patient held record and information booklet You must bring this booklet with you to all clinic appointments or hospital admissions. Patient details Compiled by Nutrition and Diet Therapy Last reviewed: November 2017 Leaflet reference XND03-002-CC/PIL17-0391 0800 169 1441 Tell us what you think... If you would like to comment on any issues raised by this document, please complete this form and return it to: Communications Department, 28 Lister Street, Crosshouse Hospital, Crosshouse KA2 0BE. You can also email us at: comms@aaaht.scot.nhs.uk or comms@aapct.scot.nhs.uk. If you provide your contact details, we will acknowledge your comments and pass them to the appropriate departments for a response. Name Address Comment GREEN PAPER XND03-002-CC Follow us on Twitter @NHSaaa Find us on Facebook at www.facebook.com/nhsaaa Visit our website: www.nhsaaa.net All our publications are available in other formats
Contents Notes Page 2. Your feeding equipment 3. Aims of training 4. Care of your gastrostomy tube and site 5. Use of syringes 6. Prepare the feed for administration 7. Instructions for gravity feeding 7. Best position for tube feeding 7. Instructions for pump feeding 8. Instructions for bolus feeding 9. Drug administration 10. Mouth care 11. Troubleshooting 12. Contact numbers 13. Pump feeding details 14. Your feeding tube Your feeding equipment Item Gastrostomy tube - make - order number - size - date inserted - approximate life of tube Extension set - make - order number Bolus adaptor - make - order number Pump Syringes - single use - size Comments/supplied by: 2 15
Details of your replacement gastrostomy tube Aims of training Before discharge, the patient and / or main carer will be able to: Make and Size Length Date Approx life Name and order number exposed inserted of tube signature of feeding tube Care for stoma site Prepare the feed for administration Connect the feed to the gastrostomy tube Programme the feeding pump Administer a bolus feed through the gastrostomy tube Administer medication through the gastrostomy tube (if applicable) Disconnect the feed and flush water down the gastrostomy tube Have solutions for troubleshooting I have received training in the above steps. Name Signature (patient / main carer) Date Staff signature 14 3
Care of your gastrostomy tube and site Pump feeding details Daily After the first four weeks rotate the tube in a complete circle during daily cleaning. For the first 14 days after your initial insertion, clean tube site daily with sterile saline and dry. After 14 days, clean around the tube site daily with mild soap and water, rinse and dry thoroughly. Check your fixation plate daily in relation to markings on the tube. Clean your feed/medication port daily by using warm water. Flush tube with fresh cold tap water before and after feed/medication, as directed by your dietitian. Weekly - only if balloon retained tube The sterile water in your balloon has to be changed every seven to ten days. Discuss this with your district nurse. Additional care Do not overtighten luer caps - it may cause damage. Dressings are not needed around your gastrostomy site. If the tube site leaks contact your district nurse. You may have a shower for the first two weeks after the insertion of your gastrostomy tube. After this time you can have a bath if preferred. Avoid using talc or cream at the gastrostomy site as this increases the risk of bacterial contamination around the stoma site. Nothing should go through the tube except food, water and prescribed medication. Date Name of feed amount Rate Comments 4 13
Digestive problems If you feel uncomfortable and full after your feed, decrease the rate of your feed by either 25ml or 30ml an hour (if pump feeding). If this feeling continues and you feel sick, stop the feed and contact your district nurse or dietitian for advice. You should also contact your district nurse or dietitian if you experience any of the following: Nausea Vomiting Diarrhoea Constipation Coughing and retching Useful contact numbers Community dietitian: District nurse: Specialist nurse: Family doctor (GP): Homecare nurse advisor: Company helpline: Hospital dietitian: Use of syringes There are two types of syringes: Single use syringes - usually used in hospitals. - use once only then discard. Single patient use syringes - have a purple coloured plunger. - can be re-used for a specific patient only and washed following the manufacturer s instructions. Care of single patient use syringe: 1. Clean immediately after each use with fresh, warm, soapy water (domestic washing up liquid). It is essential to draw the plunger in and out several times, until all traces of feed/medicine are removed from the inside tip. 3. Rinse under the cold tap and shake off excess water. Wipe dry with clean paper towel. 4. Store in a clean dry container. Reassemble when required. The syringe can also be: Put in a dishwasher (50ml size only) stack with the tip pointing up. Immersed in boiling water. Immersed in cold sterilising solution (see manufacturer s instructions). However, the syringe should not be permanently immersed between uses. Processed in a microwave steam steriliser (see microwave instructions). Support group: 2. Separate the barrel and plunger and wash both thoroughly in warm, soapy water. 12 5
Single patient use syringes can be used up to 30 times. Replace syringe sooner if: There is any visible damage to the barrel or tip. The dose markings are no longer clear. Thorough cleaning before any of these processes is essential. Store your feed in a cool, dry place, out of direct sunlight. If you notice any damage to the feed container, or a change to the texture of the feed, do not use, keep the container and contact your pharmacist or home care company. Before you open your feed containers, check the expiry date. There are two types of feed: - ready to hang - can be hung for 24 hours - modified - can be hung for four hours The plunger seal is damaged. It becomes difficult to use. Prepare the feed for administration 6 Your dietitian can confirm what type you use. Opened bottles or containers with any remaining ready-to-hang feed should be carefully covered and kept in the fridge for a maximum of 24 hours. Preparing your feed Make sure the area and all equipment used is kept clean. Hand hygiene is the single most important procedure in the prevention of infection. Wash your hands thoroughly in warm running water using liquid soap. Rinse and dry thoroughly. Troubleshooting Leakage from insertion site If your feed/medication leaks out from around your tube and your tube looks shorter, this may be due to inward movement of the tube. If possible gently pull on the tube until it is the length it should be and push the skin disc down onto your stomach (not too tightly). If you are unable to reposition the tube or if it persists in moving inwards, contact your district nurse for advice. Accidental removal of the tube Replacement tubes are more easily dislodged than your original tube. If your tube accidentally comes out, contact your district nurse immediately to ensure a new tube is put in within an hour or two. If you are unable to contact the nurse, contact the Accident and Emergency department at your local hospital. 11 Infection around insertion site Any redness, pain, swelling or yellow discharge from your site may suggest an infection and may need treatment. Contact your district nurse for advice. Tube blockage Remember regular flushing before and after feeding or taking medication should help prevent your tube from blocking. However, if your tube should block, try to clear it by taking a new syringe and plunging the tube with warm water. If this is unsuccessful, try 30ml of sparkling water. Wait for 30 minutes and try again. If you are unable to clear the blockage contact your district nurse for advice.
Mouth care Whether you receive all or some of your nutrition through your gastrostomy tube, it is vital that you follow a good daily mouth care routine. Teeth and dentures Continue to clean your teeth or dentures morning and evening with a toothbrush and a fluoride toothpaste. Rinse with tap water. Dentures should be removed overnight and soaked in a solution advised by your dentist. Continue to have regular dental check ups. Mouthwashes If you wish to use a mouthwash as well as brushing you should use an alcohol free solution to prevent your mouth getting dry. Infection If you develop an infection in your mouth, continue to follow your daily mouth care routine and seek medical advice. Dry mouth There are several causes of a persistent dry mouth. It may be worthwhile having your medications reviewed. Make sure that you are taking adequate fluids - if you have a raised temperature, episode of diarrhoea or experience warm weather, you may need additional fluids. Your dietitian can review this. If your lips become cracked or sore apply a lip balm. If you are unable to drink fluids, lubricant gum or gel may be available - check with your family doctor (GP). Alternatively, try misting your mouth with a hand held water spray. Connect the feed to the feeding tube Giving sets and feed containers need to be changed every 24 hours. Feeding tubes should be used for the administration of tube feed, medication and water only. Flush tube with water before connecting the feed. Programme the feeding pump You will be trained on using your feeding pump by a representative of the home care company. You will also be given an instruction booklet for using your pump. Pump feeding For your pump feeding details see page 14. What to do if your pump breaks down Contact your home care company 24 hour helpline listed on page 13. Best position for feeding When feeding in bed, it is best to use one or two pillows to prop up your head and shoulders. When feeding at other times, it is best to have your head and shoulders supported. Do not lie flat for at least one hour after feeding. 10 7
Instructions for bolus feeding 1. Wash your hands thoroughly and dry on a clean towel. 2. Shake the bottle of feed and open. 3. Remove the cap from the end of your feeding tube. 4. Using a syringe remove the plunger and insert the tip of the syringe into the end of the tube. 5. Flush your tube with... ml water. 6. Pour the required amount of feed into the syringe (see bolus feeding details, page 9). 7. Hold the syringe above your tube to allow the feed to run in. Never attempt to rush bolus feeding. 8. If the feed is running in too slowly, put the plunger back into the syringe and push the feed down gently and slowly. 9. When the feed is finished, flush the tube with... ml fresh cold tap water. 8 10. Put the cap back on your feeding tube. 11. Cover, label and store any remaining opened feed in the fridge. Label and store for up to a maximum of 24 hours. Bring feed out of the fridge half an hour before next bolus feed. 12. Discard syringe or wash as the manufacturer s instructions. Use of bolus adaptors Bolus adaptors may be used as a means of decanting feed from the container to a suitable bowl and as a means of resealing an open container. Catheter tipped syringes must not be used to obtain feed directly through the bolus adaptor. Where bolus adaptors are being used, the enteral feed bag must be considered nonsterile. So it must be used within four hours of opening if stored at room temperature or 24 hours if stored in the fridge. Bolus adaptors must be used on one bag of enteral feed only and discarded when the bag is emptied. Bolus feeding details Number of feeds Volume of each Suggested a day feed (ml) times Drug administration through your gastrostomy tube Always check with your local pharmacist before taking any medication. If you are unable to take medication by mouth, your gastrostomy tube can be used. For all medicines administered through your gastrostomy tube, follow these steps: Tell your pharmacist the medications are to be given through a feeding tube. All medications, if possible, should be in liquid form or dispersible. 9 Do not add any medication to your feeds. Always flush through your gastrostomy tube with 60ml, or as indicated, of water before and after administering your medication. If you are taking any medication for indigestion (antacids) separate them from all drugs and enteral feeds. The antacid should be given one hour before or two hours after feeds or other medication.