Dietetics & Nutrition - Tube Feeding

Dietetics & Nutrition

Tube Feeding Optimising Your Nutrition

c Nasogastri Tube

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n Nasoduode Tube

y Gastrostom Tube

y Jejunostom Tube l Nasojejuna Tube

The Dietetics & Nutrition department offers comprehensive nutritional assessment, intervention and education to our patients and their family.

The Department provides evidence-based nutrition advice to patients with clinical conditions such as heart disease, diabetes, gastrointestinal disorders, obesity as well as those on special diets such as tube-feeding.

In addition to addressing the nutritional needs of clinical conditions, our dietitians also tailor nutrition plans for training athletes and general weight loss.

You may require a feeding tube if: • The muscles of your throat have become weaker gradually due to a stroke.

• You are at risk of choking when you swallow as your food goes down your windpipe, causing an infection known as aspiration pneumonia.

• You have undergone head and neck surgery.

• You have an obstruction in your throat.

With tube feeding, you will receive adequate nutrition and run a lower risk of developing aspiration pneumonia.

What are the different routes of feeding?

Nasogastric (NG) feeding This is the most commonly-used route and involves inserting the tube through your nose and into your stomach.

Nasojejunal (NJ) feeding If your stomach is not functioning well and you experience gastric reflux, your doctor may recommend a nasojejunal tube that is inserted through your nose and into your intestine.

Percutaneous endoscopic gastrostomy (PEG) feeding The tube is inserted through your stomach via a surgical or an endoscopic procedure. This route of feeding is chosen if you require long term tube feeding. It may also be used if you are at risk of gastric reflux or when there is an obstruction of the upper airway that makes inserting an NG tube difficult.

Care of PEG tube Please take note of the following: • Do not tug or pull on the tube.

• Use soap, water and a cotton swab to gently clean around the tube insertion site 1 or 2 times a day. (You may continue to take baths or showers) • Pat your skin dry, gently and carefully.

• Keep the PEG tube attached to the abdomen with a surgical tape. Alternate the site where you tape down your tube.

• Examine your skin around the site for redness or swelling.

• Check for fluid draining from the PEG site.

• If there are no stitches holding your PEG tube in place on your skin, rotate the gastrostomy tube daily.

What kinds of feeds are there?

Liquid • Feeds are packaged in cans or packets.

• Shake the container well and wipe the top before opening.

• They are ready to use and no dilution is needed.

• Unopened supplements should be stored away from heat, direct sunlight and moisture.

• Most supplements may be refrigerated up to 24 hours after opening. Check the label for storage instructions.

• Refrigerated feeds can be warmed up in a bath of hot water but not over direct heat or in the microwave.

Powdered • Feeds have to be prepared as instructed on the label or as per your dietitian’s recommendations.

• Use boiled water that is cooled to room temperture.

• Feeds that have been made up and left standing at room temperature for more than 12 hours should be discarded.

• Mix your formula well to prevent the formation of lumps which will clog your tube.

How can these feeds be provided?

Intermittently (bolus feeding) • A larger amount of feed (100300ml) is given five to eight times a day, every 2 to 3 hours.

• Gravity is used to administer the feeds over 15 to 20 minutes.

• This method is preferred for patients who are mobile because it allows them more freedom of movement than continuous feeding and mimics normal meal timings.

Continuously • This involves feeding at a slow rate of 30-100ml/hour over a period of 12 to 24 hours. This ensures better tolerance and absorption of the feeds.

• The feeds should be hung up for a maximum of 4 to 6 hours in a cool area away from direct sunlight.

How is tube feeding done?

• Wash your hands thoroughly before preparing the feed.

• Ensure that all equipment and accessories are clean.

• You should be in a sitting position or at an angle of at least 30 degrees while feeding and also for 30 minutes after feeding.

• Check for gastric residuals before each bolus feed or every 4 to 6 hours during continuous feeding.

• Flush your tube with water after each bolus feed or every 4 to 6 hours of continuous feeding to avoid tube blockage and to provide additional fluid intake.

Will there be any complications?

Excessive volume of aspirates If aspirates are less than 200ml: • Return aspirates.

• Top up with feeds to original feeding volume.

If aspirates are more than 200ml: • Return 200ml of aspirates and discard the remaining.

• Re-check for aspirates at the next feeding time. If it is less than 200ml, resume feeding.

Managing aspiration If 200ml of formula is fed at each bolus:

Constipation • Increase the amount of water flushes.

• Take laxatives to soften your stool. It may be prescribed by your doctor.

• Your dietitian may suggest the use of fibre containing feeds.

Dehydration • Your urine may appear dark-coloured. This is usually due to insufficient fluids.

• Increase the amount of water flushes or the frequency of water flushes if you do not have any fluid restrictions.

Diarrhoea • Reduce feeding rate or increase time intervals between feeds.

• Reduce strength or volume of formula if decreased feeding rate does not improve tolerance.

• Review the delivery methods such as wrong dilution of formula or poor hygiene practice.

• Your dietitian may suggest the use of fibre containing feeds.

Displacement of tube • If the feeding tube comes out or is incorrectly placed, please contact your doctor or nurse as soon as possible.

• Do not feed the patient.

• You may also contact the Home Nursing Foundation (HNF) at 6854 5500.

Indigestion, vomiting and stomach cramps • Lengthen the time interval between feeds.

• Dilute the formula for a short time.

• Do not feed in the presence of vomiting.

• If these problems are severe or persist for more than 24 hours, consult your doctor.

Blockage • Flush tube with warm water.

• When administering drugs through the feeding tubes, ensure that they are in a liquid form or very finely crushed. Flush tube before and after administration.

• Regular flushing will prevent blockage.

Tube feeding prescription for: The above patient is on: NGT

 NJT  PEG  PEJ 

Liquid formula:

Amount:

Powdered formula:

OR Amount:

Protein powder:

Amount:

Feeding regime: TIME

FORMULA

WATER FLUSHES

Remarks:

Please contact your dietitian if you have any queries.

Dietitian:

Date:

For more information Ng Teng Fong General Hospital and Jurong Community Hospital 1 Jurong East St 21, Singapore 609606 General enquiries: 6716 2000 Fax: 6716 5500 www.juronghealth.com.sg Clinical and appointment line hours (closed on Sundays and public holidays) For appointments, please call 6716 2222 Monday - Friday 8.00am - 5.30pm, Saturday 8.00am - 12.30pm For dental appointments, please call 6716 2233 Monday - Thursday 8.00am - 5.30pm, Friday 8.00am - 5.00pm Getting there

Jurong East MRT Station By bus From Jurong East Bus Interchange SBS 51, 52, 66, 78, 79, 97, 97e, 98, 98M, 105, 143, 143M, 160, 183, 197, 333, 334, 335, 506 Along Boon Lay Way SBS 99, Private bus service 625

Disclaimer: The information in this brochure is meant for educational purposes and should not be used as substitute for medical diagnosis or treatment. Please seek your doctor’s advice before starting any treatment or if you have any questions related to your health, physical fitness or medical condition.

Copyright Š JurongHealth B E 010-12 April 2012 Updated June 2015

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