Nasogastric Tube Patient Passport

Transcription

1 Nutrition and Dietetics Department Nasogastric Tube Patient Passport Please bring this booklet with you for all tube changes Patient Information If you need this information in another format or language Further information about the Trust is available on the following websites: KGH - NHS Choices - Ref: PI 984 March 2016 Next review: December 2017

2 Your feeding tube There are many different types of feeding tubes. Your tube is a nasogastric tube, which is designed for short term feeding and can be inserted and removed easily. This feeding tube is positioned from your nose to your stomach. Caring for the feeding tube Always wash your hands before and after caring for your tube. It is important to check the position of the tube by: a) measuring the ph value of stomach contents:- before feeding before administering water or medication after a coughing or vomiting episode if there are any concerns that the tube may have moved. b) Checking the cm marking / marker on the tube to ensure it hasn t moved. Please record your ph checks / cm markings within this document on the sheet provided. To check the position 1. Pull back into the syringe (aspirate) a small amount of liquid (this should be gastric juices) 2. Test the contents of the syringe on ph paper. Match the colour change to the colour code on the box / container. 3. A ph between 1-5 indicates the tube is in the correct place. 4. However, if you obtain a result of between 5-6 do not use the nasogastric tube. The acidity in your stomach can be affected by a recent feed or medications. Seek further advice. See Who to contact - 2 -

3 Never insert any water or feed into the tube and do not start feeding before confirmation of ph The feeding tube should be flushed using a 60ml purple syringe and fresh water before and after administering feed and medication or twice a day if feeding is not in progress. These flushes may be incorporated into your feeding regimen provided by the dietician. Flushing will help keep the feeding tube clean and prevent it from becoming blocked with enteral feed or medications. Check the feeding tube daily: o Is it clean? o Is it difficult to flush? o Are bits of the tube missing? o Has the tube split anywhere? o Is any liquid leaking from the feeding tube? Problems with your feeding tube Blocked Tube If the tube is blocked, you will be unable to aspirate a ph to confirm gastric placement. It is important that you check the cm markings to ensure the tube hasn t moved prior to attempting to unblock. Try warm water (previously boiled) syringed into the feeding tube using a push-pause technique. This may help to remove the blockage. You may need to keep some water in the tube for around 30 minutes to allow the blockage to dissolve before trying the push/pause technique again. Sore Nose If the tube stays in for longer than 6 weeks you may find you get a sore nose. If this occurs let your nurse/doctor know. Never insert objects into the tube Unable to Aspirate If you can t obtain aspirate from your stomach to check ph try the following:- Inject 10-20ml of air down the tube and try again. If you have assistance turn onto your left side and ask relative / carer to follow steps as described above. (To check the tube position) If you have not been told to remain nil by mouth, take a drink, wait a few minutes and try to aspirate the tube again. Orange cordial or Ribena are ideal to drink. After 2-3 minutes aspirate the tube again. Try cleaning your mouth to stimulate gastric juices and try again in minutes Check the tube length to see if it appears to have moved. If you are still unable to obtain contents from your stomach seek further advice from who to contact information - 3 -

4 The earlier a problem is identified the better. Please note: that whilst some people may experience one or two problems, many people do not experience any problems. Hygiene Hands should be washed thoroughly before touching the container of feed or any aspect of the feeding tube. Check the use by dates of the feed and equipment. Keep feed in a cool area Unopened feed should be stored in a cool dry place Once the feed has been opened, label the container with the date and time of opening and store in the refrigerator when not being used. (Remember to let the feed reach room temperature before it is put down the tube) Throw away any feed that has been opened for 24 hours or more Throw away any feed containers and feed administration sets after 24 hours. Use freshly drawn tap water to flush the feeding tube before and after feed/medication. ph paper should be kept clean and dry by storing it in a sealed container. Recommendations for giving Medicines through a feeding tube Always follow the Pharmacist s / Doctors instructions Always use enteral (purple) syringes to measure and administer medication. Wash hands before starting Flush the feeding tube with 30-50mls of freshly drawn or cooled boiled tap water before and after putting any medication down the tube. Give each drug separately and flush the feeding tube with at least 10mls of water between each drug, until tube is clear of medication. Medicines that come as syrups may need to be watered down to make them easier to put down the tube. (Check with your Pharmacist) For medicines that only come in tablet form, check with the Doctor / Pharmacist that they can be crushed. If they can, crush to a fine powder and mix with water. Syringe the mixture down the feeding tube. The feeding tube will need to be flushed with plenty of water to remove all traces of the drug from the tube. Cleaning a reusable Syringe Wash hands Immediately after use, clean the syringe with fresh warm soapy water, drawing the plunger in and out several times. For further information please follow Manufacturer s instructions provided at the time of your syringe delivery

5 Mouth care A clean healthy mouth is essential for good health, but often is forgotten when someone is unable to eat or drink easily. All people regardless of their ability to eat or drink should clean their mouth/teeth, dentures at least once a day. People who take no food or drink by mouth should have mouth care at least 4 times a day. Teeth should be cleaned as usual using a fluoride toothpaste. Dentures should be cleaned with denture cleaner. This should be done twice a day. Try to keep your mouth moist. Your GP can prescribe an oral gel which is wiped around your gums and tongue which helps to do this. The mouth and teeth should be wiped round with a dampened gauze swab or pink sponge stick with plain water. Special attention should be paid to the roof of the mouth and the area around the back of the teeth (top and bottom). Do not use lemon / glycerine sponges as these can dry out your mouth and the sugar content may help to build bacteria in the mouth. Care should be taken with the use of mouthwash and avoid those that contain alcohol for the following reasons: o They can cause significant damage to the lungs if they go the wrong way o They are very drying to the delicate skin in the mouth and can sting broken or ulcerated tissue. Check with your doctor / consultant before using a mouthwash. Lip balm can be put on the lips to stop them feeling dry or cracked. Petroleum based lip balms should be avoided in the presence of oxygen therapy. If you are having radiotherapy to the head and neck area please check with the radiotherapist first before using lip balms. Even if someone is not eating or drinking they should continue to see the dentist every 6 months to help prevent decay and gum disease. The dentist can also advise on the best way to clean and floss teeth. Dentures should be worn where possible if fitting correctly. After illness or loss of weight the mouth may change shape and dentures may no longer fit. Try denture fixative to see if this helps. Consider having dentures remade/re-fitted a minimum of 3 months after illness. If eating and drinking problems exist it is important to check underneath dentures/around teeth after each meal to make sure that all food is removed and clear any food debris using a pink mouth sponge or soft toothbrush. If it is not removed the food may mix with saliva and fall into the windpipe/trachea, or lungs, eventually causing a chest infection. Some people feel as if they have too much saliva in their mouth and dribble. If you feel you are having problems with either too much or too little saliva please discuss this with the Speech and Language therapist as there may be techniques or medication to help

6 Body positioning during enteral feeding Whilst having your feed or fluids and for an hour after it has finished, you must sit at a degree angle, to prevent reflux of the feeds/fluids. Most people find it useful to be propped up by pillows/cushions at this time Nasogastric Tube Daily Check Record Date Cm from nose to blue tip Daily ph Daily flush with 50ml water Before feed Number on tube at nose tip - 6 -

7 Nasogastric Tube Daily Check Record Date Cm from nose to blue tip Daily ph Daily flush with 50ml water Before feed Number on tube at nose tip - 7 -

8 Contact Information Problem Who to contact Notes Nasogastric feeding tube fallen out / moved. Homeward Phone as early as possible. If ph of gastric contents reads between 5-6. Homeward Have you tried tips given above (point no.4) Nasogastric feeding tube blocked Homeward Have you tried tips above (point no.4) The feeding pump or giving sets Homeward If you can t contact the Careline service contact the dietician / Hospital Nutrition Nurse Difficulties setting up / managing to give the feed. Homeward If you can t contact the Careline service contact the dietician / Hospital Nutrition Nurse Delivery of the feed, bolus syringes or giving sets. Homeward Mention it to your dietician. If you are short of feed or syringes / giving sets, phone your dietician as soon as possible Feeling bloated on a regular basis Dietician Vomiting or feeling sick. Dietician If severe or prolonged see your GP immediately or come to local A&E Experiencing a feeling of feed refluxing up from the Dietician Ensure you are not lying flat while feeding stomach A change of bowel habits (constipation or diarrhoea) Dietician If diarrhoea is severe contact your GP. Weight gain over the last 1-2 months or weight loss Dietician Feeling very hungry or thirsty on a regular basis Dietician Timings of the feed regimen Dietician Out of hours, please contact your GP If you need this information in another format or language Further information about the Trust is available on the following websites: KGH - NHS Choices - Ref: PI 984 March 2016 Next review: December 2017