Tube feeding with a nasogastric or nasojejunal tube

Transcription

1 Tube feeding with a nasogastric or nasojejunal This factsheet tells you how to care for your feeding and how to take your feed and medications via your. Your dietitian needs to fill in parts of this factsheet. What is a nasogastric (NG) or nasojejunal (NJ)? This a that goes through your nose and into your stomach (NG) or jejunum, a part of your small intestine (NJ). The allows you to take special liquid food (feed), medications and fluids if you can't meet all of your nutritional needs by eating normally. You have a. If you have an NG, there are two types of feeding, bolus feeding using a syringe, and pump feeding. Both types of feeding are described in the following sections. Your dietitian will decide which type of feeding is best for you. If you have an NJ, you can only use pump feeding. Getting ready to feed Always wash your hands with warm soapy water before handling your feeding and feed. Check the expiry date of the feed before you use it. If it has expired, throw it away. Your feeding has centimetre (cm) markings. Always check that the same cm marking is nearest your nostril before starting to feed. Your marking is Sit so your back is at least 30 degrees above horizontal when you feed and for an hour after feeding. This helps the feed go into your stomach and not your lungs. Flush your feeding with warm water before and after you feed, and before and after you take medications down your. If you have safe drinking water, you can use tap water to flush your. Otherwise, use boiled, cooled water. If you have a jejunal, always use boiled, cooled water to flush your. Important Only put down your feeding : the feed prescribed by your dietitian or doctor water prescribed medications (see below for how to put medications down your feeding ). cm. HealthInfo reference: Issued: 9 April 2018 Page 1 of 5

2 Bolus feeding using a syringe This is when you have a set amount of feed at specified times during the day. This is similar to having meals at meal times. Your dietitian will give you a bolus feeding plan with the details filled in. 1) Collect all the equipment you'll need (a 60 ml syringe, a measuring and pouring jug, and your feed). Check the expiry date on the feed and shake it well before opening it. 2) Wash your hands with warm soapy water. 3) Remove the cap on your feeding. Remove the plunger from the syringe and connect the syringe to your feeding. 4) Hold the syringe upright and pour the prescribed amount of warm water into the syringe to flush the. 5) Pour the prescribed amount of feed into the syringe. Allow the feed to flow into the feeding until it has gone. 6) Pour the prescribed amount of warm water into the syringe to flush the. 7) Disconnect the syringe and close your feeding with the attached cap. Pump Feeding Pump feeding uses a feeding pump that continuously delivers a set amount of feed through your feeding over a set amount of time. Your dietitian will give you a pump feeding plan with the details filled in. Your nurse, dietitian or a nutrition company representative will teach you how to use your feeding pump. They'll also give you written instructions. Your dietitian will give you a feeding pump and giving sets when you're discharged from hospital. Feed for pump feeding comes in ready-to-hang bottles like the one shown in the picture. HealthInfo reference: Issued: 9 April 2018 Page 2 of 5

3 Medications The hospital pharmacist will review your medications before you go home to make sure you can take them through your feeding. Use the main port of your feeding for medications. Use the bolus feeding method (explained above) to put medications down your feeding unless your dietitian or nurse advises otherwise. Flush your with 20 ml warm water before and after giving medications. This helps to prevent your feeding from blocking. If you have more than one medication, take each one separately. Flush your feeding with 10 to 15 ml of warm water between each medication. Finely crush each solid medication and mix it with 10 to 15 ml of water before putting it down your feeding (a mortar and pestle is best for this). You can take liquid medications down your feeding without diluting them. Caring for your equipment and feed After feeding, wash the syringe with mild dishwashing detergent, rinse thoroughly and leave it to air dry. Place the syringe in a clean zip lock bag or a clean container with a lid. Store it in the fridge to prevent it being contaminated by bacteria. You can use each syringe for about two weeks. Giving sets can only be used once. Discard them after you've used them for 24 hours and don't reuse them. Cover open cans or bottles of feed and store them in the fridge. Throw away any open, unused feed after 24 hours. You can use ready-to-hang bottles of feed for 24 hours. Throw away any unused feed after 24 hours. Your feed should be at room temperature when you use it. If it has been in the fridge, leave it for 30 minutes before using it. Feeding blockage Your feeding may block if you don t flush it regularly or you don t take your medications correctly. You can stop your from blocking by flushing the with warm water before and after each feed, before and after giving medications, and every three to four hours during continuous pump feeding. HealthInfo reference: Issued: 9 April 2018 Page 3 of 5

4 If your blocks, try the following to try to clear the blockage: check for any kinks in the tubing massage the from the nose end, out towards the end of the insert a 60 ml syringe into the end of the pull back the plunger and withdraw as much fluid as possible from the take the syringe out of the and throw away the fluid you withdrew half-fill a 60 ml syringe with warm water and attach it to the end of the, move the plunger back and forth to try to dislodge the blockage massage the again and then use the back and forth action with the plunger to try to clear the if you've repeated this three or four times and you can't unblock the, contact your GP. Important If your feeding comes out, contact your GP. Caring for your mouth Taking good care of your mouth is important, especially if you can't eat or drink. brush all surfaces of your teeth, gums and tongue using a soft toothbrush and toothpaste at least twice a day rinse your mouth well with mouthwash and spit it out an alternative to commercial mouthwash is a salt and baking soda mouthwash. Mix half a teaspoon of salt and half a teaspoon of baking soda in a glass of warm water if you can't swallow safely or are at a high risk of aspiration (fluid going into your lungs), don't rinse your mouth. The hospital can provide you with green Toothette swabs to clean your mouth use lip balm to moisten your lips and prevent cracking regularly check your mouth and tongue. Redness, or yellow or white patches on your tongue may be a sign of infection or thrush. In this case, see your GP. Supplies and giving sets For syringes, contact your community dietitian who will arrange an ongoing supply from the Canterbury DHB Supply Department (see below). When you're discharged from hospital, the hospital dietitian will give you ten nose plasters. When you need more, you can order them from your local pharmacy. Nasofix is one of the brands you can use. You can also ask your community dietitian who may be able to organise an ongoing supply. HealthInfo reference: Issued: 9 April 2018 Page 4 of 5

5 Tube feeding with a nasogastric or nasojejunal For giving sets, contact your community dietitian or phone the Canterbury DHB Supply Department (see below). Give as much notice as possible. Let them know if you can't collect the giving sets as they can courier them to you. There's no charge for giving sets or delivery. If you're under the care of the Ashburton Hospital dietitians, phone the Ashburton Supply Department (see below). You'll need to collect your giving sets from the Supply Department. Your hospital dietitian will organise your feed when you first go home. After this, your community dietitian will organise it. If you need to contact your feed supplier because your feed hasn't arrived, use the contact details below. Contact details Canterbury DHB Supply Department Phone: (03) or (03) Address: 211 Blenheim Rd Hours: Monday to Friday, 8 am to 4 pm. Ashburton Hospital Supply Department Phone: (03) Address: Ashburton Hospital, Entrance D, 12 Elizabeth St, Ashburton Hours: Monday to Friday, am to 2.30 pm. Feeding pump suppliers For any concerns about your pump, use the following contact details: FreeGo pump (Abbott). Phone Flocare Infinity pump (Nutricia). Phone Kangaroo Joey pump (Cardinal Health). Phone Feed suppliers Abbott and Nestle feed (via Health Works Pharmacy). Phone (03) Nutricia feed. Phone Dietitians Hospital dietitian: Community dietitian: Phone: Phone: Written by Nutrition & Dietetics, Canterbury DHB. Adapted by HealthInfo clinical advisers. April HealthInfo reference: Issued: 9 April 2018 Page 5 of 5