Guidelines+for+Gastrostomy+Feeding+Final 753 6sW

7/29/2019 Guidelines+for+Gastrostomy+Feeding+Final 753 6sW

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GastrostomyFeedingCARE GUIDELINESFOR PATIENTS & CARERS

ENTERAL NUTRITION


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GP

Address

Tel / Fax / Email

Hospital Dietitian

Address

Tel / Fax / Email

Community Dietitian

Address

Tel / Fax / Email

Nutrition Nurse

Address

Tel / Fax / Email

District Nurse

Address

Tel / Fax / Email

Nutrition Feed Company/Nurse Advisor

Address

Tel / Fax / Email

Hospital ConsultantAddress

Tel / Fax / Email

USEFUL CONTACTS

Fresenius Kabi: 01928 533 533


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Contents

Introduction 1

What is gastrostomy feeding? 1

How is the tube inserted? 1

Why do I need a gastrostomy feeding tube? 2

How long will the tube last? 2

How soon after the tube insertion can I begin feeding? 2

What feed will I receive? 2Feeding regimen 2-3

Tube care 3

Administration of medication 3

Methods of flushing the tube 3

Tube blockage 4

Attaching a new Freka PEG luer lock adaptor 4

Skincare 5

Rotation of the Freka PEG 5-6

Frequently asked patient questions 7


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Introduction

This booklet aims to provideyou with information about your

gastrostomy feeding tube and toanswer any questions. If you haveadditional questions or would likefurther explanation please contactyour Nurse or Dietitian who willbe able to help you. Please put thisbooklet in a safe place as you maywish to refer to it in future. Foradditional information regarding

your tube type please refer to thespecific aftercare sheet.

What isgastrostomy feeding?

A gastrostomy feeding tube (orPEG as you may hear it referredto) is a small feeding tube which

is inserted directly into the stomachso that you can have feed, fluid andmedication without swallowing.It will provide you with a safe andlong-term method of obtaining

nutrition.

How is thegastrostomy tubeInserted?

The procedure is performed

with sedation under localanaesthetic. It is carried out usinga gastroscope (a flexible instrumentused to examine the inside ofyour stomach).

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Why do I need agastrostomy feedingtube?

You are currently unable to takeenough food and fluid by mouthto meet all your nutritional needs.The gastrostomy feeding tubewill provide access for feedadministration into your stomach.

How long will

the tube last?The tube is made from polyurethane,which is compatible with the humanbody and if the tube is well caredfor, it can last for a few years.

How soon aftertube insertion canI begin feeding?Water will be used as an initialfeed, fed down the tube. This willbe decided by your GP, Dietitianor Nurse, but your feed usuallycommences about 6-12 hours after

your tube has been placed. Thefeed is introduced slowly to beginwith, so that your body can adjustto the feed.

What feed willI receive?You will receive a prescribed,commercially produced liquid feedwhich contains all the essentialnutrients you will need on adaily basis.

You may receive part or all yourdaily food via your gastrostomyfeeding tube, depending onyour specific medical conditionand needs.

You may also need extrafluids through you gastrostomyfeeding tube. Water can beadministered using a syringeor administration set.

Feeding regimen

Your Dietitian will prescribe thevolume and rate of your feed tosuit your needs. You may be fedintermittently or continuouslyduring the day or overnightdepending on which is best for you.

Always follow the recommendedregimen. If you have any

problems with the feed youshould inform your Dietitian.

To prevent heartburn and feedrefluxing you should feed in anupright position. For overnight

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feeding you should use supportingpillows or a backrest. If you findthis uncomfortable you can raisethe mattress at the head of thebed instead.

Tube careThe gastrostomy feeding tubeshould be flushed with at least 30mlof cooled, boiled water beforeand after feed, or medicineadministration or as directed by

your Healthcare Professional toprevent tube blockage. You shouldonly use the tube to administerfeed, water and liquid medicines.

Administrationof medicines

All medicines should beadministered in liquid form.The same applies to self medication(e.g. for headache) and yourpharmacist will recommend liquidform of pain relief.

Do not crush sustained-releasetablets/capsules. They are

unsuitable for crushing becausethe whole dose is released at once.

Drugs with enteric coatingsshould not be crushed and givenvia your gastrostomy tube as they

are designed to be releasedin the small intestine.

Do not add medicines to yourenteral feed as it may cause

physical/chemical instability ofthe feed and cause a blockage.Flush your tube before and afteradministration of each medicine.Medication should be givenseparately to prevent possibleinteraction.

Methods offlushing the tubeIt is recommended that a 30-50mlsyringe is used.

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1. Connect luer syringe to the drug port of the giving

set. Turn the drug port to 90 in order to administer

water or medication.

2. Connect the catheter tip syringe to the universal

funnel adaptor and secure to the tube.


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Skincare

The area where the tube entersyour stomach is called the stoma

site. You may experience adischarge at the stoma site forthe first few days. A loose, thin,absorbent dressing may be usedto cover the site until the stomahas healed. Do not place bulkydressings under the externalplate. When the stoma site hadhealed (usually 7-10 days after

placement) a dressing is notneeded. It is important to cleanyour stoma site daily, as advisedby your Healthcare Professionaland keep it dry. After the tubehas been place for 10 days andthe stoma site has healed, youshould start to rotate it after youhave cleaned it (see next section).

However, if rotation causes excesspain and/or the tube will not turn,stop and try again the next day.If at this time it is still painful andwill not turn do not attempt tocarry out the rotation. Contactyour Healthcare Professional forfurther advice.

If you notice any redness, pain,odour or discharge, you shouldcontact your Nurse or GP whowill take a wound swab to identifywhat is causing the problem. Your

doctor may prescribe antibioticswhich you can administer in thesame way that you administeryour regular medicines (see underAdministration of Medicines). If you

notice feed leakage around thestoma site you should stop feedingand contact your HealthcareProfessional. If you experiencenausea, vomiting or constipationyou should contact you HealthcareProfessional immediately for advice.

Rotation ofthe Freka PEG

It is known that some people maybe prone to what is called BuriedBumper Syndrome (where theinternal disc of the PEG tubebecomes buried and the stomach

lining grows around it). The PEGshould be rotated once a week.Rotation should be carried out atleast once a week and no morethan once a day.

This means holding the endof the tube and rotating it 360(a complete circle).

Do not rotate the tube if the siteis discharging or not healed.

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Always check with your HealthcareProfessional about when to startrotation.

A suggestion to rotate on a specific

day as follows:1. Wash hands thoroughly with

soap and water.

2. Clean the external plate asadvised by your HealthcareProfessional.

3. Open the fixation catch(see Fig 3).

4. Detach tube from groovein fixation plate (see Fig 4).

5. Move plate away from skin(see Fig 5).

6. Clean tube and stoma area andthe underside of the plate anddry. Push 2-3cm of the tube into

the stomach and rotate, gentlypull back the tube to feelresistance.

7. Place the fixation plate back toits original position (approx 1cmaway from the skin). Re-inserttube in the groove (see Fig 6) andclose the fixation catch (see Fig 7).

8. Your fixation plate should notbe too tight or too loose. If youfeel that it is, your HealthcareProfessional will be able toadvise you.

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Fig 3

Fig 4

Fig 5

Fig 6

Fig 7


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Frequently askedpatient questions

Can I swim, bath or shower?

After the site is fully healed, youcan bathe or shower as normal.Ensure the clamp is closed.Thoroughly dry the area afterwards.

How long will the tube last?

This will depend upon the typeof tube you have placed. Your

healthcare professional can providethis information. Following theaftercare information will helpto prolong the life of the tube.

Can I put tea, coffee or alcoholdown the tube?

Yes providing the tube is flushed as

per the flushing recommendationsset out earlier in the booklet.

Who do I contact if the tube getsdamaged or I get a problemwith the site?

Contact your local healthcareprofessional.

Can I go on holiday?

Enteral feeding does not stop yougoing on holiday but it is a goodidea to have a letter from your

doctor and make sure you havethe necessary insurance. Contactyour local healthcare professionalfor advice about replacementtubes and information regarding

the supply of your feed.

If I cannot eat what will happento my mouth?

Plaque can build up very quickly soit is important brush your teeth atleast twice a day. A mouthwash orartificial saliva, such as Glandosane

may help if your mouth is dry.

How do I clean the site?

Refer to the information given byyour local healthcare professional.

Are there are any patientsupport groups available?

PINNT Patients on Intravenousand Naso-gastric Nutrition Therapy

PINNT supports people on enteraland parenteral nutrition, providingadvice and local support groups.

PINNT Contact Information:-

Tel: 01202 481625

www.pinnt.com

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EN00001

Fresenius Kabi Limited

Cestrian Court, Eastgate Way, Manor Park, Runcorn, Cheshire WA7 1NT

tel: 01928 533533 fax: 01928 533534

email: [email protected] www.fresenius-kabi.co.uk

Documents

Guidelines+for+Gastrostomy+Feeding+Final 753 6sW