Possible Problems

 

 

peg & feeding tubes

 

Feeding Tube Placement

If you are a candidate for receiving a feeding tube, you may want to review the following article from Web MD about preparations for getting a feeding tube. It tells you the exact procedure and what to expect.

"If a person is having trouble swallowing and can't consume enough food or liquids by mouth, a feeding tube is put in through a procedure called percutaneous endoscopic gastrostomy (PEG). During the procedure the tube is placed in the stomach for enteral feeding (feeding directly through the gastrointestinal tract) to occur."

http://www.webmd.com/digestive-disorders/feeding-tube-placement

Hank Luniewski

 

What is a PEG tube

Percutaneous endoscopic gastrostomy (PEG) is a surgical procedure for placing a tube for feeding without having to perform an open operation on the abdomen (laparotomy). It is used in patients who will be unable to take in food by mouth for a prolonged period of time. A gastrostomy, or surgical opening into the stomach, is made through the skin using a flexible, lighted instrument (endoscope) passed orally into the stomach to assist with the placement of the tube and secure it in place.

Here is an article that discusses the procedure.

http://www.medicinenet.com/percutaneous_endoscopic_gastrostomy/article.htm

Sent in by Scott Sysum


PEG TUBE

(PERCUTANEOUS ENDOSCOPIC GASTROSTOMY)
TIPS FOR SITE CARE

(Be sure to check with your MD/Nurse regarding specific procedure for you)

CLEAN AND CHECK AT LEAST TWO TIMES A DAY

* Clean around tube at insertion with soap and water
* Rinse and pat dry
* Check the area for any changes such as redness, swelling, discharge, warmth or soreness.
* Notify your MD or Visiting Nurse. (It is important that you are familiar with your insertion site and the area around it. You will then be able to detect if something is not "normal" for you. Never treat the inflammation yourself).
* Cut a 1 1/2" slit in a 4x4 gauze sponge
* Place gauze on abdomen and around tube. Secure with tape.
* Coil feeding tube and secure with tape
* Be sure to leave 4-5" free as this will make it easier to access

FEEDING TIPS FOR PEG
(Check with MD/Nurse for your specifics)

* Flush before feeding (Minimum of 60cc of tap water before and after feeding. I used 120cc for each flush. Use large syringe or run through feeding bag).
* Make sure roller clamp is closed (down) on the feeding bag.
* Put formula in bag
* Prime tubing to purge air if needed (place end of feeding bag tubing over sink or trash can. Open roller clamp and allow formula to come to the end. Close clamp)
* Connect feeding bag tubing to PEG Tube
* Open clamp and administer feeding as ordered.
* Flush feeding tube after feeding.
* HINT-Rinse feeding bag and tubing with water and allow to air dry.

MEDICATION FEEDING TIPS FOR PEG TUBE

* Get supplies together (syringes, medications and tap water for flushing)
* Crush medicines that are not in liquid form. If capsule can be opened, empty contents in small amount of water and do the same to crushed pills and let dissolve. (Use pill crusher or mortar and pestle to crush pills)
* Flush, put liquid medications into syringe and then put into the feeding tube, flush again

NOTIFY MD/NURSE IF

* You cannot *flush tube
* You see formula leaking from insertion site
* Formula will not flow through tube from feeding bag
*(Flush - use warm water and large syringe. Make sure syringe fits securely at the end of tube. Gently push and pull plunger in syringe)
* Redness, swelling, warmth or discharge at insertion site.
* Fever
(Carole Rabin and Debra Rabin Abraham, MSN, RN, C)

 

 

FEEDING TUBES


TUBE FEEDING METHODS

When one goes on a feeding tube there are different ways of taking nutrition through the tube. In the hospital and in some homes a bag system is used where the bag of nutrition is suspended on pole above the patient and the food is fed in via a tube that has a regulating valve on it. This allows the food to be fed at a fixed rate to the patient so as to not upset the stomach.

The other method of tube feeding is through the use of a large syringe. The syringe can draw a nutritional fluid such as Jevity up into the syringe and then attaches to your feeding tube. The syringe of food in injected into your stomach by compressing the plunger on the syringe. You must be careful to inject the food very slowly, again so as not to upset ones stomach.

Many people prefer to not use the plunger and let the food go into the stomach via simple gravity feed. This results in the feeding naturally pacing itself so as not to upset the stomach. This is the method that I prefer.

I know a fellow who swears by the plunger method and force feeds various soups and other foods. One problem with that is that the tube can get clogged and be very difficult to unclog. In fact, he clogged it so firmly he actually had to go in and have a new tube put in his stomach.

Hank Luniewski

 

PERSONAL EXPERIENCE

I have had feeding tubes through the nose, through the TEP puncture, and of course the PEG or stomach tube. I found the tube through the nose to be the worst of all and I would never let them do that again if I had a choice. I have had a variety of stomach tubes, some easy to live with and others very difficult. The gravity fed tube: I found to be very slow and cumbersome. Of course you can vary different types of foods this way but since you can't taste it, I could not see any benefit is using soft foods over just Ensure. It takes longer with this type of feeding than any other and requires a lot more cleanup. At other times I used a syringe with a plunger for feeding. This is ok but I found that I forced the food in too fast at times and it made me ill. Presently I use the syringe without the plunger. I pour the liquids in and let gravity do the rest. If the tube is clogged I use an air bulb the clear the obstruction. (You can also pour coca cola in the tube and it will clear about most anything). I have found this the best method of feeding for me. It takes me a total of 5 minutes to feed myself and the gravity keeps me from forcing it in too quickly.

Types of Stomach tubes

There are a wide variety of stomach tubes and I think I have tried them all at one time or another. I have found that the MIC-G, Gastrostomy tube is the best choice and the easiest for me to maintain. Some tubes are sewn to your skin; others have a hard rubber ridge inside that keeps the tube intact. The ones with the ridge hurts when installed or when they come out. The MIC tube has a bulb inside that is filled with water after insertion. It is no more than just discomfort when it comes out or when it is installed. In fact I install my own tube and do not need any assistance to do so. The instructions on the MIC tube recommends using 5-15cc of water. At first I used 15cc of water and the tube would last about 3-4 months before the bulb would burst and need replaced. I now put 5cc of water in the bulb and the tube lasts about 5-6 months before it needs replaced.

Care of the stomach tube

I went to the Mayo Clinic for 3 years before I found out they had a PEG Nurse who specialized in the care of stomach tubes. Until I talked to her I had no idea what to do to maintain my tube. Of course the doctors never tell you anything. The nurse showed me how to care for my stomach tube and even taught me how to change it out myself.

1. Wash the perimeter of the tube daily with mild soap and water.
2. Nearly all tubes will leak stomach acid a little. If the tube starts leaking more than normal, the nurse should be made aware and a larger diameter tube should probably be used.
3. Stomach acid will cause the skin around the tube entry to become red and irritated. Apply Calmoseptine to the reddened area and it will combat the stomach acid. If it becomes infected or real sore call the nurse and let her know.
4. A 4x4 gauze should be worn for protection until the incision for the tube is healed. Once the incision is healed a covering is no longer a necessity but can be worn if a person chooses to go to the trouble. Personally I haven't worn a covering over my tube for 4 years now.
5. The biggest problem with a tube is it always seems to get in the way. The MIC tube has a round, plastic circle to keep the tube from going too far into the stomach. The large circle makes the tube stick straight out and it is bothersome. The nurse and I trimmed the circle and made it smaller to where the tube will hang down and not be so bothersome, yet it still is large enough to maintain it's purpose. You can also get a belt made specifically for a stomach tube. It is an elastic belt with a pouch attached to put the tube in. I use it sometimes when I go hunting or fishing to keep the tube out of my way.

Important: When you have to live on a feeding tube ALWAYS make sure you are putting enough water into your system. I make sure that I always put enough water in when I feed myself that my urine maintains a clear color.

I am not a doctor and am only passing on what I have learned and my experiences.
(Bill D. Hathcock)

 

FACING LIFE WITH A FEEDING TUBE

 

#1 I just had my first dilation. It didn't take and I am not a good candidate for repeat dilations. I have a feeding tube and can eat some soft foods by mouth. I may be on the feeding tube indefinitely. If I am, so be it. I certainly would not let that impact on my appreciation of quality of life. I can still live my life to the fullest and having to deal with a feeding tube and soft foods are not going to be allowed to be a problem.
Hank Luniewski
Charlottesville, VA

 

NUTRITIONAL REQUIREMENTS FOR TUBE FEEDING

 

There are various nutrition sources for tube feeding. The canned food that is put into a PEG tube is not for drinking. It tastes terrible. I use Jevity 1.5 which includes fiber in the mix. Other choices are available. A nutritionist will set you up before you leave the hospital with the food that is appropriate for you. This food, at least in my case, is payed for by my insurance and is provided by a home health care organization. Over the counter foods such as Ensure, Boost, Carnation Instant Breakfast, Skandia Shakes and others can be purchased at your local super market.

Subsisting via a feeding tube is not difficult or complicated. It is called Enteral Nutrition. The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) is dedicated to improving patient care by advancing the science and practice of nutrition support therapy. Information for patients and caregivers can be found at http://www.nutritioncare.org/

Hank Luniewski
Charlottesville, VA

 

 

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