Home enteral tube feeding a guide for patients and carers

Contents Feeding and fluid plan 1 Tube information Type of tube NHS Number: Hygiene 3 Manufacturer Hospital Number: How to flush your tube Medications 3 4 Size of tube Introduction How to set up your feed (pump/bolus) 5 Date placed You are to be discharged from hospital with a feeding tube. Your feeding tube will ensure that your body has enough nutrition and fluids. Mouth care Troubleshooting 6 7 Approximate date your tube needs changing This booklet provides information to help you care for your feed and feeding tube, including: l Your feeding plan l Types of feeding l Some possible problems l Useful contact details If your tube falls out: l If within office hours contact your Community Dietitian or nutrition nurse immediately l If they are not available or if outside of hours, contact your district nurse or go to A&E l If you have a spare tube please bring to A&E 1 2

Your feeding plan Name of feed Your fluid plan Before and after feed or bolus (ml) Before and after medications (ml) Between each medications (ml) Additional water flushes Total water flushes (ml) Feed volume (ml) 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) Rate (ml/hr) or bolus volume (ml) Syringes Start time Finish time You need to use a new purple oral/enteral 60ml syringe every:... Feed l Store unopened feed at room temperature, not in direct sunlight and away from radiators or other heat sources l Check you have the correct feed before use l Check the expiry date of feed before use l If the feed is to be stopped for longer than 4 hours it must be stored in the fridge and used within 24 hours l Do not leave your feed connected for more than 24 hours Hygiene l Always wash your hands with soap and water before touching the tube, feed or syringe l Try to handle the tube and giving sets as little as possible to reduce the risk of infection l Try not to stop and start the feed for long periods as this may increase the risk of infection l Use a new giving set (connecting tube) every 24 hours l Clean up any spillages How to flush your tube l Step 1 Using a purple 60ml syringe draw up the volume of water from your fluid plan l 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 l Step 3 Repeat steps 1 and 2 until the full volume of water is given as per your fluid plan l 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 3 4

Medications l Before going home check the following with your ward nurse or pharmacist: n Times your medication need to be given n If you need to leave a break between your feed and medications n If your medication comes in dissolvable or liquid form n Take medications individually as they can interact with each other and increase the risk of blocking your tube l If you can swallow your medication you should continue to do so l 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 l Clean the tube entry site (stoma) every day to reduce risk of infection with warm soapy water l Dry thoroughly with a clean disposable paper towel Methods of feeding Your feed can be given in different ways: 1. Pump feeding l 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 l Bolus feeding is when you deliver your feed through a syringe to your tube 3. Combination feeding (pump and bolus) l 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 with your feed and fluid plan. How to bolus your feed l 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 l Step 2. Using a purple 60ml syringe draw up the outlined volume of feed from your feeding plan l 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 l Step 4. Repeat step 2 & 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 l Clean the syringe after each feed and medication l 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 has been removed l Separate the plunger from the syringe, and rinse. Shake off excess water and dry with a paper towel l Once dry, store in a clean dry place 5 6

Mouth care l It is important to keep your mouth, teeth and gums clean to help prevent infections l 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 l If you wear dentures ensure that they are cleaned twice a day Other information l Always flush your feeding tube with water before and after feeding, to reduce the chance of blocking and infection l 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 l 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 l 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 l When did you last open your bowels? l If you are feeding in bed make sure that you have at least 3 pillows to keep you upright l If bolus feeding take more time to give your bolus l Check feed is in date and stored correctly l If pump feeding try reducing the rate - discuss with dietitian prior to changing rate Bloating l Make sure your have opened your bowels l If bolus feeding take more time to give your bolus l If pump feeding try to reduce the rate Diarrhoea l Check the feeding rate is correct l Ask District Nurses to take a stool sample l Diarrhoea maybe caused by antibiotics. Do not stop taking the antibiotics. Contact your GP l If pump feeding try reducing the rate - discuss with dietitian prior to changing rate l Check feed is in date and stored correctly l Make sure feed is at room temperature l If bolus feeding take more time to give your bolus Constipation l Check your feeding and fluid plan to ensure you are having the right amount of fluid l In warm weather give yourself an extra 500ml of water through the day Thirsty l Check your feeding and fluid plan to ensure you are having the right amount of fluid l Make sure you are having regular mouth care l In warm weather give yourself an extra 500ml of water through day 7 8

Blocked tube l Check clamp is off l Check tube is not kinked l Check the fixation plate is positioned correctly and not causing a blockage l Check the tube to see any signs of blockage l Where you see a blockage try massaging the tube to loosen any blockage l Milk the tube by squeezing towards the end of the tube to remove any blockage l 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 l Try filling the tube with warm boiled water (not hot) and leave it for 30mins l Try using a warm flannel around the tube to help the tube expand l Try soda water or sodium bicarbonate (1/2 teaspoon in 50mls) l Do not use acidic drinks such as coke or orange juice to unblock the tube l Contact your community dietitian or district nurses Tube has fallen out l If in office hours contact your Community Dietitian or nutrition nurse immediately l If they are not available or if out of hours, contact your district nurse or go to A&E l If you have a spare tube please bring to A&E Pump problems l Make sure your pump is plugged in or battery is fully charged l Check your pump manual l Contact your home delivery company Low Stock of feed/ giving sets/ syringes l Try not to let your stocks run below 7 day supply l Contact your home delivery company l Contact community dietitian Redness/oozing/bleeding around the entry site (stoma) l Make sure the fixation plate is in the correct position l Make sure skin clean and dry l Contact your community dietitian or district nurses Contact numbers Community Dietitian Home Delivery Company Home Delivery Nurse Salford Royal Dietitian Salford Royal Nutrition Nurse District Nurses Where do I get supplies from? Feed Plastic Giving Sets (connecting tubes) Syringes 9 10

G17092704W. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2017 This document MUST NOT be photocopied Information Leaflet Control Policy: Unique Identifier: CS 66 (16) Review Date: September 2019 University Teaching Trust For further information on this leaflet, it s references and sources used, please contact 0161 206 4255. Copies of this information are available in other languages and formats upon request. If you need this interpreting please telephone In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities, to access this treatment / service. Email: InterpretationandTrans@srft.nhs.uk Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on 0161 206 1779 Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD Telephone 0161 789 7373 www.srft.nhs.uk If you would like to become a Foundation Trust Member please visit: www.srft.nhs.uk/ for-members If you have any suggestions as to how this document could be improved in the future then please visit: http://www.srft.nhs.uk/ for-patients