Patient Solutions CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS MIEKE HABECK

Transcription

1 Patient Solutions CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS MIEKE HABECK

2 CARE OF FEEDING TUBES - AGENDA Types of Tubes Tube Maintenance Stoma Care Complications - management and prevention Halyard Support

3 TYPES OF TUBES Nasal/Jejunal feeding tubes, via the Nares Gastric, via gastric stoma Jejunal feeding, via gastric stoma Jejunal feeding, via jejunal stoma Transgastric, feeding via a gastric stoma into the stomach and jejunum CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 5

4 TYPES OF TUBES INITIAL PLACEMENT PEG (PERCUTANEOUS ENDOSCOPIC GASTROSTOMY) ENFit Non Balloon Device Replace ENFit end Trimable tube length Ventilated SECURE LOK* Retention Ring Radiopaque Stripe Centimetre Markings Clearly Marked Ports Medical Grade Silicone Traction Removable 16, 20, 24 Fr. Sizes CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 6

5 TYPES OF TUBES (STANDARD BALLOON RETAINED GASTROSTOMY FEEDING TUBES) ENFIT Recessed balloon tip Ventilated Retention Ring Centimetre Markings Clearly Marked Ports Radiopaque Stripe Medical Grade Silicone Variety of Fr. Sizes Low Volume 3-5mls Balloon on & 16 Fr. Tubes CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 7

6 FEEDING TUBES RIG Gastrostomy RADIOLOGICALLY INSERTED GASTROSTOMY (RIG) AN ESTABLISHED ALTERNATIVE TO ENDOSCOPIC & LAPAROSCOPIC PLACEMENT RIG involves a single procedure that reduces patient exposure to Anaesthesia, operating room time and the potential for complications compared with an endoscopic pull PEG or surgical placement. Straight to a balloon retained tube CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 8

7 TYPES OF TUBES MIC-KEY* LOW PROFILE True COMPLETELY Recessed Balloon Tip Adjustable balloon volume 5-10mls on all Balloons except 12Fr 12Fr (neonatal) has a low volume balloon 3-5mls Proximal Rigid Anti-Reflux Valve no accidental leaking during tummy time ENFit* Extension Sets Radiopaque Stripe Medical Grade Silicone 12Fr-24Fr & 0.8-5cm Stoma Lengths CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 9

8 TYPES OF TUBES MIC-KEY* LOW PROFILE ENFit* Extension Sets CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 10

9 FEEDING TUBES- MEASURING DEVICE Single use Over the wire To measure length of stoma for correct size selection for low profile feeding tubes Read the cm markings at base of disc, take two measurements = Patient flat and at 30degrees Fill balloon with the minimum volume for the French size MIC- KEY button 14Fr = 5mls 12Fr = 3mls CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 11

10 FEEDING TUBES MIC-KEY buttons CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 12

11 FEEDING TUBES Transgastric Jejunal feeding Through a Gastric stoma you have Both Gastric and Jejunal access CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 13

12 FEEDING TUBES Surgical Jejunostomy MIC Surgical Jejunostomy ( ) for permanent Jejunal feeding via a Jejunal stoma The MIC Jejunostomy tube is the only tube specifically designed for surgical placement using the Witzel technique which allows for ambulatory nutritional support. The tube does not require dressings after 7-10 days and is not stiff. Allows for patient comfort, convenience and a more normal way of life. Dacron cuff secures tube into the subcutaneous tissues, reducing leaking and tube movement or dislodgement Surgeons have used Foley catheters and Robinson Red Rubber catheters with limited success Sites tend to leak and the catheters tend to migrate and fall out. CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 14

13 FEEDING TUBES - ACCESSORIES FARRELL ENTERAL GASTRIC PRESSURE RELIEF SYSTEM ( ) CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 15

14 FEEDING TUBES- ACCESSORIES CLOG ZAPPER TUBE UNBLOCKER ( ) CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 16

15 FEEDING TUBES - ACCESSORIES STOMA STOPPER DRESSING (CS-01) CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 17

16 FEEDING TUBES - ACCESSORIES UNIVERSAL GASTROSTOMY TUBE CLAMP ( ) CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 18

17 FEEDING TUBES- ACCESSORIES CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 19

18 FEEDING TUBES - ACCESSORIES CORTRAK 2 ENTERAL ACCESS SYSTEM CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 20

19 TUBE MAINTENANCE FLUSH FLUSH FLUSH CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 21

20 TUBE MAINTENANCE FLUSH Pre and Post Feeding FLUSH Pre and Post Medications FLUSH Every 4 hours (except during a night feed) Clean the Tube and Skin Daily with Warm Soapy Water, Rinse and DRY Gently Rotate Gastrostomy Tubes in Daily Weekly Balloon Checks & Balloon Water Exchange Use Water in Balloon to Achieve the Correct Fit before giving any feed Daily General Tube Check CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 22

21 COMPLICATIONS Tube occlusion Flush++, massage and/or solutions Use Clog Zapper as soon as tube starts to obstruct Tube migration/obstruction - Verify placement, discontinue feeding Accidental removal - Replace ASAP. If this happens in the first 6 weeks after the initial placement you must get x-ray verification of tube placement. Otherwise check ph. Tube Deterioration Change tube, verify new placement with ph Balloon burst change tube, verify new placement withph. Check fit, stoma track length and balloon volume Use the balloon volume to achieve correct fit CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 26

22 PREVENTING COMPLICATIONS FLUSH, FLUSH, FLUSH! Every 4/6hours and after every medication with 10mls of warm water! Daily wash and dry No dressings/creams on healthy skin Hydrocolloid dressing on excoriated skin Carry a spare feeding tube & ext set CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 27

23 STOMA SITE COMPLICATIONS- BACTERIAL INFECTION CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 28

24 STOMA SITE COMPLICATIONS- BACTERIAL INFECTION Possible Causes Excessive moisture due to leakage at the site Lack of prophylactic antibiotics at the time of tube insertion Characteristics Pain, inflammation, skin redness, warmth or drainage at the site Intervention Stoma Site Clean the site 2-3 times daily with warm water Consult physician or healthcare provider to prescribe antibiotics Swab to determine bacterial presence CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 29

25 STOMA SITE COMPLICATIONS- YEAST/ FUNGAL INFECTION CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 30

26 STOMA SITE COMPLICATIONS- YEAST/ FUNGAL INFECTION Possible Causes Warm, dark, moist environments, body perspiration, leakage and denuded skin Most common in humid and warmer months Characteristics Rash with an area of erythema with satellite lesions spreading away from the area of redness Papules or pustules may be present Intervention Stoma Site Correct excessive leakage Clean the site with warm water, dry and apply antifungal powder to the skin surrounding the tube Notify doctor - Prescription for systemic treatment Intervention Feeding Tube Tube appears milky, bubbly and sticky on the inside. Tends to collapse on itself and feeds may be difficult to deliver Tube may require treatment with liquid anti fungal preparation Tube needs to be replaced after successful treatment of the infection CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 31

27 STOMA SITE COMPLICATIONS- TUBE WITH FUNGAL INFECTION PEG Balloon CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 32

28 STOMA SITE COMPLICATIONS- TUBE WITH FUNGAL INFECTION Possible Cause Bolster held too tightly against the skin Characteristics Skin redness, irritation, ulcer and/or tissue necrosis Intervention Stoma Site Gently cleanse and dry the skin; avoid rubbing and picking at residual skin barriers Apply an alcohol-free skin powder For ulcerations, consider the use of hydrocolloid dressings Intervention Feeding Tube Verify proper placement of the external bolster is 2-3mm above the skin Verify proper fill volume of the balloon CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 33

29 STOMA SITE COMPLICATIONS- PRESSURE NECROSIS CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 34

30 STOMA SITE COMPLICATIONS- PRESSURE NECROSIS Possible Cause Bolster held too tightly against the skin Characteristics Skin redness, irritation, ulcer and/or tissue necrosis Intervention Stoma Site Gently cleanse and dry the skin; avoid rubbing and picking at residual skin barriers Apply an alcohol-free skin powder For ulcerations, consider the use of hydrocolloid dressing Intervention Feeding Tube Verify proper placement of the external bolster is 2-3mm above the skin Verify proper fill volume of the balloon CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 35

31 STOMA SITE COMPLICATIONS- SKIN BREAKDOWN CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 36

32 STOMA SITE COMPLICATIONS- SKIN BREAKDOWN Possible Causes Excessive moisture around the stoma site due to wet or soiled dressings or the leakage of jejunal contents due to tube displacement Inadequate tube stabilization, improperly sized tube and incorrect feeding practices. Characteristics Skin redness, irritation, inflammation or bleeding Intervention Stoma Site Ideally NO dressings Gently cleanse and dry the skin and apply skin barrier powder or hydrocolloid dressing that seals the skin, must be alcohol free. * refer to notes below for product information If gastric leakage present and the skin is intact, apply a skin protectant or moisture barrier such as zinc oxide. Notify doctor if redness extends more than 1cm from the tube or is accompanied by pain and/or swelling. Intervention Feeding Tube Verify proper tube placement and fill volume of balloon retained devices. Make sure the tube is properly sized and stabilised CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 37

33 STOMA SITE COMPLICATIONS- HYPERGRANULATION CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 38

34 STOMA SITE COMPLICATIONS- HYPERGRANULATION Possible Causes Excessive tube movement, trapped moisture, reaction to the tube material Constant exposure to drainage or a reaction to the use of hydrogen peroxide Characteristics Wart-like papules or nodules also called proud flesh as it sits higher that surrounding skin Reddish-brown or white grey skin discoloration Lesions at the mucocutaneous border. Can be highly vascular. Intervention Stoma Site Cleanse and gently dry the skin Area may need to be cauterized with silver nitrate or treated with prescribed cream Keep site free of moisture Intervention Feeding Tube Stabilize the tube to restrict movement, Use hydrocolloid dressing CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 39

35 FEEDING TUBE REVIEW - PEG Initial tube Secured by a dome May last 12 months, or more Traction removal or under vision of scope removal Usually replaced with a balloon device No balloon access CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 40

36 FEEDING TUBE REPLACEMENT G-TUBE Secured by a balloon May change with out sedation May last for months although dependant on patient condition CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 41

37 FEEDING TUBE REPLACEMENT MIC- KEY* Low Profile Feeding Tube Usually a balloon device Change is changed without sedation May stay in place for months although is dependent on patient condition CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 42

38 RIG Radiological placement KIT MIC*, MIC-KEY* Introducer kit designed to facilitate initial placement of balloon retained enteral feeding tubes. Procedure can be done by Surgeon, Gastroenterologist or Interventional Radiologist NEW CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 43

39 HALYARD PROVIDED SUPPORT In-service Education Provide Literature, Care Booklets come in all MIC-KEY kits Health Care Service Customer Care Internet Sites CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 44

40 CARE AND MAINTENANCE OF FEEDING TUBES CARE AND MAINTENANCE OF FEEDING TUBES AND COMPLICATIONS 45