YOUR HOME ENTERAL NUTRITION SURVIVAL GUIDE FOR JEJUNOSTOMY FEEDINGS

Transcription

1 YOUR HOME ENTERAL NUTRITION SURVIVAL GUIDE FOR JEJUNOSTOMY FEEDINGS INTRODUCTION: Your health care team may prescribe a program of home Enteral nutrition (or home tube feeding) designed to meet your nutritional needs if you are unable to take adequate nutrition by mouth. Enteral nutrition is a therapy which provides a liquid nutrition formula through a tube that is placed in the stomach or small intestine. Enteral formulas contain all of the essential nutrients needed to promote healing and maintain good health. These nutrients include calories, protein, carbohydrates, fat, vitamins and minerals. YOUR FEEDING TUBE: Feeding tubes can be placed at several different locations depending on your individual medical needs. Each feeding route is designed to deliver the tube feeding formula schedule recommended by your health care team. You have a Jejunostomy Tube (J-tube) - a feeding tube which is surgically placed into the jejunum, which is the second part of the small intestine. Care of your Feeding Tube: Jejunostomy Tube: Flush tube with warm water only. Use of other liquids such as juices or carbonated beverages is not recommended due to possibility of clogging the tube. Site Care- the jejunostomy tube is held in place by a suture. Clean the J-tube site with mild soap and rinse with water. You may shower however, submerging the site fully in water (such as a full bathtub) is not recommended. Dry the site thoroughly. Avoid using creams, lotions or ointments unless instructed to by your health care team. If there is a small amount of leakage around the site, cover it with a gauze dressing, otherwise the site can be left open to air. Report any increasing redness, pus-like drainage, pain or if the suture comes out. GETTING STARTED 1. Supplies: Washcloth Antibacterial soap Tape Alcohol Wipes to clean the top of formula cans (optional)

2 2. Your Work Area: Keep your work area neat and clean. Choose an area that has the following: No drafts, visible dirt, dust or clutter. Good light and space. A smooth, flat surface that can be easily cleaned. Storage space for supplies. Do not use the kitchen or bathroom. Before starting clean your work area with soap and water or rubbing alcohol. Dry it with a clean towel. DO NOT ALLOW CHILDREN OR PETS IN THE WORK AREA AND KEEP ALL SUPPLIES OUT OF REACH OF CHILDREN AND PETS. 3. Wash your hands: 4. Handling Supplies: Wet your hands and wrists. Lather your hands well with antibacterial soap. Clean under fingernails with soapy hands. Rub your hands together using friction. Make sure you thoroughly wash between all fingers and the back of both hands for at least one minute. Rinse your hands so that water flows from the tips of the fingers to the wrist. Dry your hands using a clean paper towel. Use a clean, dry towel to turn off the water so your clean hands do not touch the faucet. After washing hands, DO NOT touch anything but your infusion supplies. If called away, wash your hands before you begin again. All supplies should be kept in a clean dry area. Keep supplies in front of you and above waist level at all times. Put your supplies in the order in which you will use them. Have only supplies you need for each particular procedure on your work area. Check date on all Enteral products. DO NOT use any product that is past the date marked expired or if the can is dented/rusted or swollen. Look at the labels to make sure the product matches exactly to your prescribed enteral formula. Unopened cans of tube feeding can be stored at room temperature in a clean and dry area. Opened cans should be covered and placed in the refrigerator. If not used within 24 hours they should be thrown away.

3 YOUR TUBE FEEDING PLAN OF CARE: Enteral Formula Administration Schedule: Continuous Feeding: ounces/ml per hour Run Feeding from TO Optional: Protein Powder Requirement: grams of protein per day ***Important***Flush tube with 60ml water prior to administration. Each scoop of protein powder should be mixed with at least 60ml of water prior to administration. After administration, the tube should be flushed with 60ml water to clear residual protein from the tube and to prevent clogging. (NOTE: Protein powders may vary in amounts of protein refer to food label). HOW TO GIVE THE TUBE FEEDING 1. Preparing Tube Feeding: Wipe the top of each can to remove any dust. Shake each can before opening. Keep open cans in the refrigerator and discard unused portions after 24 hours (allow refrigerated can to warm up before administration). 2. Flushing your tube ALWAYS FLUSH YOUR FEEDING TUBE BEFORE AND AFTER YOUR FEEDINGS AND BEFORE AND AFTER MEDICATIONS. If you are not using your feeding tube every day, flush with 60 ml of warm tap water once a day to keep the tube open. A new syringe should be used every week. If you give feedings everyday, flush the tube with 60 ml warm tap water before and after feeding (do not put other liquids in the tube unless prescribed to avoid clogging the tube). Rinse the syringe after each use. Supplies: (1) 60 ml syringe (1) clean cup with warm tap water Procedure: Wash hands. Fill syringe with 60 ml of warm tap water. Clamp the feeding tube. Remove the cap or disconnect the feeding bag, if you have just finished a feeding. Attach the syringe to the tube and unclamp. Flush by slowly pushing water into the tube. Clamp the tube again. Put the cap back on the feeding tube and tape the connection.

4 3. Feeding by Pump Starting your feeding: Supplies: Formula Feeding bag Pump Procedure: Wash hands. Close roller clamp on feeding bag. Fill feeding bag with prescribed amount of formula (The feeding bag can hold about 1000ml of formula) and hang on pole. Set up pump by following the specific directions for the type of pump that is provided by your infusion supply company. When the infusion is complete flush and clamp the feeding tube (see section on flushing tube). Rinse your feeding bag well after each use. Store in refrigerator until next feeding. Use a new feeding bag every TWO days. 4. Giving medications through the feeding tube Your doctor may order medications to be given through your feeding tube. The following instructions help to give the medications. 1. A liquid form is best to give via a feeding tube. 2. If a medicine is not available in liquid, it should be crushed and dissolved completely in at least 30ml or 1 oz. of warm water. 3. Each medication should be crushed and dissolved separately, and then given through the tube one at a time. 4. Some medications are sustained release or enteric coated (a hard outer shell covering) and should not be crushed. Check with your nutrition support nurse before you leave the hospital about how to give these kinds of medications. 5. Flush the tube with 60ml warm tap water before and after giving each medication to prevent the tube from clogging. Your personal instructions are:

5 HELP SECTION PROBLEM POSSIBLE CAUSES WHAT TO DO Feeding will not run Tubing may be kinked Un-kink tubing. Diarrhea Various causes Call your doctor. Cramping or bloating Drainage around tube Nausea/Vomiting The stitches break The tube falls out Choking Feeding may be too cold Feedings administered too quickly. It can be normal to have about a quarter-size area of tan drainage on dressing. Feedings may be running too fast This can happen over time Tube not secured Lying flat during feeding Allow feedings to come to room temperature before infusing. If you have gravity flow feedings, they should infuse over at least minutes. If more than quarter-size amount, call your doctor. Keep area clean with soap and water. You may put a dressing around tube to absorb drainage. Stop feeding for 60 minutes and see if you feel better. I you do, restart feeding. Activity, such as getting out of bed or walking may help. Sit up at a 45-degree angle (or higher). If these don t help call your doctor. RELAX, if the stitches break, tape the tube down well and call your physician to make arrangement to have sutures replaced if needed. Clean tube off with soap and water and immediately put tube back in. Then come to the emergency room. If unable to do so call your doctor right away to make plans to replace tube. Always sit up 45 degrees during and one hour after feeding. If you choke or cough during your feeding, stop the feeding immediately. Call the doctor to report this incident.

6 Clogged feeding tube Dry mouth and lips Inadequate flushing Uncrushed medications Unable to take anything by mouth Flush feeding tube with 60 ml of warm water before and after all feedings or drugs. Check for a kink in the tube. If available, use medications in their liquid forms. Crush pills to a fine powder and mix with ml of warm water. Check with you doctor before crushing any medications. If you cannot unclog your feeding tube call your doctor or come to the emergency room. The following things may help prevent dryness: Lubricate dry lips with Chapstick or Vaseline. If allowed by your doctor: rinse your mouth with water or mouthwash, suck on hard candy or chew sugarless gum. Adapted from UPHS CNSS department 11/07 Copyright 2007 by the Trustees of the University of Pennsylvania. All rights reserved. No part of this publication may be reproduced without permission in writing from the Trustees of the University of Pennsylvania.