Guide to Adult Tube Feeding at Home

The Adult Tube Feeding at Home Book is a helpful guide for patients and caregivers to use as a resource to successfully transition to tube feeding at home.

Guide to ADULT TUBE FEEDING

Throughout this booklet you will see use of the words health care provider, which may be your doctor, nurse, or pharmacist. Please work with your preferred health care provider as part of your prescribed care plan. The following booklet provides guidance for patients and caregivers on enteral nutrition. Patients and caregivers should first consult with their health care providers regarding any signs or symptoms (eg, diarrhea, dehydration, constipation, etc) and any other problem or concern associated with enteral feeding. This guide has undergone review and approval by the American Society for Parenteral and Enteral Nutrition (ASPEN). This guidance does not constitute medical or other professional advice and should not be taken as such. To the extent that the information published herein may be used to assist in the care of patients, this is the result of the sole professional judgment of the attending health care professional whose judgment is the primary component of quality medical care. The information presented in these recommendations is not a substitute for the exercise of such judgment by the health care professional. Circumstances in clinical settings and patient indications may require actions different from the guidance in this document. In those cases, the judgement of the treating professional should prevail.

Contents Introduction 3 Finding Community Support 4 Types of Tube Feeding at Home 6 Understanding the Tube Feeding System 10 Monitoring Your Response to Tube Feeding 12 Taking Charge of Your Health Care Provider Visits 22 Tube Feeding Monitoring Checklist 24 Medication Record 32 Notes 34 Glossary 36 Guide to Adult Tube Feeding | 1

Introduction We know that tube feeding brings major changes to your life. But you don’t have to face them alone. We hope you find this guide a useful, practical resource that can help you tube feed successfully at home. You’ll find step-by-step instructions on handling issues you face every day, from coping with infections to preparing for your next appointment. The guide includes worksheets (pages 24-35) that make it simple to record important information about your progress. We also added a helpful glossary (pages 36-37) that you can refer to if you come across any unfamiliar terms. While technical and medical support form the foundation of tube feeding success, we believe that emotional support is just as important. Hopefully, you’ll find resources in this guide that make your journey easier. Guide to Adult Tube Feeding | 3

Finding Community Support With support and guidance, you can take control of the tube feeding process and adjust successfully to this new lifestyle change. Visit the link below to find educational resources, support groups and the opportunity to connect with others in your situation. The Oley Foundation The Oley Foundation is a nonprofit organization for people who depend on home enteral (tube) feeding or parenteral (intravenous) feeding. Resources include: n Access to a network of individuals n Equipment and supply exchange and caregivers who are involved in n Conference for you, family tube feeding at home members, and caregivers n Education and troubleshooting n Community enrichment programs materials n Newsletters www.oley.org Call 1-800-776-OLEY (6359) or visit Oley.org for more information about tube feeding. Abbott is a supporter of The Oley Foundation. 4

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Types of Tube Feeding at Home Tube Feeding Methods Feeding Methods Delivery Methods Your health care provider will determine the Bolus Syringe or Gravity delivery method for your tube feeding, along Intermittent Gravity or Pump with your feeding schedule. Continuous Gravity or Pump There are three ways to deliver a tube feeding: syringe feeding, gravity feeding, and pump feeding. Always refer to the feeding plan recommended by your health care provider. Syringe Feeding n In syringe bolus feeding, formula is placed into a syringe without a plunger and flows slowly into the feeding tube. The height of the syringe controls the feeding rate. n In push syringe feeding, the formula can be injected gently into the tube, Preparing Your Feedings using the syringe with a plunger. Follow these steps to prepare the tube feeding: Gravity Feeding 1. Wash your hands. n In gravity feeding, formula is placed in a 2. Gather all the equipment you need: container hung above you. Formula flows a. The formula through the tubing into your body. b. A feeding container (a gravity bag, Pump Feeding syringe, or pump and pump set) n In pump feeding, formula is placed in a c. An IV pole or wall hook feeding container and is pumped through d. A 30-mL to 60-mL syringe the tubing into your body. This is the e. A clean cloth preferred method for feeding into the jejunum of the small bowel. It is also possible f. Tap or bottled water to pump formula into the stomach if it is 3. Write the date and time on the feeding clinically appropriate. container when the formula is opened. 4. Wash hands thoroughly when finished. 6

Keep head raised at 30 degrees or more while 7. If your health care provider has told you to administering tube feeding. DO NOT lie flat take extra water after feedings, pour the during your feeding, and wait for 1 hour after prescribed amount into the syringe. your feeding before you lie down (lying down 8. Flush tube with water per prescription can cause you to vomit or cough). Vomiting after the feeding. or coughing up small amounts of liquid can be dangerous, causing you to inhale extra water or Push Syringe Method: formula into your lungs. 1. Flush the tube with water per prescription Syringe (Bolus) Feeding before the feeding. In syringe feeding, formula flows slowly into the 2. Use the plunger of the syringe to draw feeding tube, or it can be injected gently into the formula from the measuring cup into the tube. Follow the syringe feeding method the syringe. recommended by your health care provider. 3. Place the syringe tip into the feeding tube. You can also use a syringe to give extra water 4. Inject the formula into the feeding tube or fluids. slowly and gently until gone (about 10 to Before each syringe feeding: 15 minutes). This may take multiple syringe fillings based on your feeding prescription. 1. Ask your health care provider how often 5. If your health care provider has told you you should check the tube position. to give extra water after feedings, use 2. Flush the feeding tube, per your health the plunger of the syringe to draw the care provider orders. prescribed amount into the syringe. Gravity Syringe Method: 6. Inject the water into the feeding tube slowly and gently. 1. Remove the plunger from the barrel of After each syringe feeding: the syringe. 2. Place the syringe tip into the feeding tube. 1. Flush the feeding tube with the amount of water prescribed by your health care 3. Hold the syringe above your stomach. provider. 4. Pour measured formula into the syringe. 2. Close the cap on the feeding tube until the This may take multiple syringe fillings based next feeding. on your feeding prescription. Ask your health care provider about care of 5. Slow the flow by lowering the syringe, or the container and syringe, and if/how often speed the flow by raising the syringe. the syringe should be replaced. 6. Allow the formula to flow into the feeding tube until gone (about 10 to 15 minutes). Guide to Adult Tube Feeding | 7

8. If your health care provider has told you to take extra water after feedings, pour the prescribed amount into the container. Once again flush after with syringe. 9. Open the clamp and let the water flow until gone. Gravity Feeding 10. Close the clamp and disconnect the feeding set. Before each gravity feeding: After Each Gravity Feeding: 1. Prepare feeding (see page 10). 1. Flush the feeding tube with the amount 2. Flush the feeding tube with the of water prescribed by your health care amount of water prescribed by your provider. health care provider. 2. Close the cap on the feeding tube until the Follow these steps: next feeding. 1. Hang the feeding container above For intermittent and continuous feeding, (about 2 feet) and to the side of your bed. throw away container and feeding set every 2. Remove the cover from the end of the 24 hours. Ask your health care provider feeding set. about care of the container and feeding set between feedings. 3. Prime the feeding set. Let formula flow until it comes out the end of the tube. Pump Feeding 4. Insert the tip of the feeding set into the In pump feeding, a pump moves the formula feeding tube. through the feeding tube and into the 5. Slowly open the clamp on the tubing. stomach or small intestine. 6. Set the flow to the gravity flow rate written on your feeding plan. Use the Before each pump feeding: clamp to control the flow until you achieve your desired rate. Make the 1. Prepare feeding (see page 10). flow faster by slowly opening the clamp. 2. Ask your health care provider Make the flow slower by partially closing how often you should check the the clamp. tube position. 7. When the feeding is complete, close 3. Flush the feeding tube with the the clamp. amount of water prescribed by your health care provider. 8

Follow these steps: Hang Time and Storage 1. Hang the filled feeding container or place Cover any unused formula and write the date on it in an ambulatory carrier. it. Store it in the refrigerator. 2. Connect the feeding set to the pump. For formula that has been hung for a feeding, 3. Remove the cap from the end of the follow the guidelines below: feeding set. 4. If your feeding set has a clamp, open n Hang reconstituted formula (restored to its it completely. original state by the addition of water) up to 5. Prime the feeding set. 4 hours. 6. Insert the tip of the feeding set into n Hang ready-to-use formula decanted to a the feeding tube. bag (open system) up to 8 hours. 7. Turn on the pump and set the flow rate. n Hang ready-to-use formula (closed system) Refer to your pump user up to 48 hours, unless a shorter hang time is manual for complete pump programming specified by the manufacturer set. information. n Hang home blenderized formula up to 2 8. Start the pump. hours. 9. After the feeding container is empty or Throw away any open, unused ready-to-use dose has been fed, stop pump, disconnect formula that has been stored in the refrigerator from feeding set, and flush tube with the after 48 hours. Throw away any open, unused amount of water prescribed by your health reconstituted powdered formula or blenderized care provider. If your care professional formula after 24 hours. has told you to take extra water after the feedings, pour the prescribed amount into container. (not applicable if ready to hang (RTH) container). Start the pump. 10. When the water is gone, stop the pump. Ask your health care professional about care of the container and feeding set between feedings. Guide to Adult Tube Feeding | 9

Understanding the Tube Feeding System A tube feeding system has a lot of parts and pieces. This diagram can help you see how they all work together. Gravity Feeding Pump Feeding Feeding bag (formula) Feeding bag (formula) Drip chamber Enteral Drip chamber feeding pump Roller clamp Rotor 10

New Connectors for Feeding Tubes are Now Available ENFit® was designed to standardize the Learn more about ENFit at the connection between tube feeding devices following websites: and ensure they will not fit into other types of • Oley.org devices (such as intravenous ports) to reduce • feedingtubeawareness.org the possibility of harmful misconnections. • stayconnected.org ENFit suggests cleaning with a quality toothbrush and warm water daily to avoid buildup and residue. Visit this website for helpful resources and checklists about ENFit: https://stayconnected.org/transition-checklist-for-patients-and-caregivers/ Guide to Adult Tube Feeding | 11

Monitoring Your Response to Tube Feeding By keeping records of your response to tube The Tube Feeding Monitoring Checklist feeding, you provide accurate information (pages 24-31) gives you an easy way to for your health care provider – and save track signs and symptoms that can provide yourself time. When you write things down information important to your health. The right away, you don’t have to spend time Medication Record (pages 32-33) allows later trying to recall important details when you to monitor your medication schedule. they’re no longer fresh in your mind. Sharing these records with your health care provider can help him or her identify and address any issues that may arise. Medication Record Tube Feeding Monitoring Checklist 12

Tube Feeding Intolerance It is important to monitor and document the presence (or absence) of symptoms Look for: associated with intolerance, as it can lead n Nausea to complications such as dehydration. n Vomiting Typically, patients experiencing n Diarrhea intolerance to tube feeding will have more than one of these symptoms. n Bloating When you show signs associated with n Constipation intolerance, it is important to determine n Abdominal discomfort whether the intolerance is related to the formula or something else. Inform your health care provider as soon as you can if you suspect you are experiencing symptoms of intolerance. Guide to Adult Tube Feeding | 13

Causes of Intolerance Symptoms n Medication side effects. • Bolus feeding may be reserved for Many medications in liquid form contain tube feeders who have demonstrated sorbitol, a sugar alcohol, that may cause tolerance to a continuous method diarrhea in some people. of feeding. n Type of formula doesn’t meet your nutrition needs. n Formula is spoiled from contamination n Formula is going in too fast. during preparation, storage or • When you are new to tube feeding, administration. feedings may be started and n Formula is the wrong temperature. advanced at a slow rate. This allows Taking formula out of the refrigerator your gastrointestinal tract to adjust and administering it before it has had to the formula and method of time to rise to room temperature can delivery. Some prescribing health lead to abdominal cramping and other care providers start tube feeding intolerance-related symptoms. at lower volumes or rates and work up to a final volume or rate. Check n Volume of formula is too large. with your health care provider to see what they recommend. Your head should be raised 30 degrees or more while tube feeding. 14

Nausea, Vomiting, and Abdominal Discomfort Possible Causes Prevention and Treatment Not tolerating the formula • Work with your health care provider to determine cause and talk about switching to a different formula. Formula may be going in too fast • Begin at a slow rate. • I ncrease the rate and amount gradually over 24-48 hours. Formula may be spoiled or contaminated • Wash and dry your hands prior to preparing during preparation or delivery a feeding or touching the feeding tube. • A void touching any part of the feeding tube system that will come in contact with the formula. • Record date and time on can after it is opened and store covered in the refrigerator. • Discard unused formula after 48 hours or as recommended by formula manufacturer. Incorrect position or incorrect tube • C onfirm tube placement prior to placement during and after feeding feeding if recommended by your health care provider. • Ele vate your head 30 degrees or more by propping yourself up in bed or on a couch. • K eep your body in a raised position for at least one hour after feeding. Medication side effects • Ask the health car e provider or your pharmacist to see if an alternative medication is available. • Sometimes s witching to another form of the medication (i.e. from liquid to pill) can help alleviate side effects. Stomach, esophagus, or intestine not • H ealth care provider may order additional working properly tests following examination. Guide to Adult Tube Feeding | 15

Diarrhea Possible Causes Prevention and Treatment Not tolerating the formula • You may have an intolerance to specific formulas. • It may be necessary to switch to a different formula. • Switching to a fiber-containing formula can sometimes help alleviate the diarrhea. • Note that there are multiple medical causes of diarrhea. Consult with your health care provider or pharmacist if needed. Small intestinal bacterial overgrowth • Diagnosis is typically made once other causes are excluded. Medication side effects • Ask your health care provider or pharmacist to review your medication list. • Diarrhea can be worsened by antibiotics or by medications containing sorbitol, magnesium or phosphorus. Bloating and Constipation Possible Causes Prevention and Treatment Not taking enough liquids or fiber • Ask the health care provider how much extra water (free water) you should be taking in each day. • If the current formula does not contain fiber, discuss changing to a fiber-containing formula with the health care provider. Medication side effects • Ask the health care provider if any of your medications could be causing constipation. • Pain meds, iron and anti-diarrheals are common medications that can contribute to the development of constipation. • Ask if there is an alternative medication that may have fewer side effects. • Note that there are multiple medical causes of constipation. Consult with your health care provider or pharmacist if needed. 16

Tube Site Complications Prevention and early intervention are key to decreasing the risk of complications associated with the feeding tube site. (For comparison, here is a healthy tube feeding/stoma site located right.) Tube site complications can include: A healthy feeding tube/stoma site n Hypergranulation Tissue Thick, red, raised tissue that can form Healthy Stoma Site around the feeding tube where it enters Look for: the body. The tube site will be red and may bleed easily. In some cases, a clear n Stoma pink in color, no redness or cloudy discharge may be present. This or drainage discharge can lead to breakdown of the n No rash, ulcers or swelling in the skin at the tube site. surrounding skin n Tube Site Infection n No inflammation or excess skin at These infections can occur with all types of stoma site abdominal feeding tubes. Infection usually is limited to the skin and tissue below the n Free of odor skin, although more severe infections can occur. Tube site infections are usually from yeast or bacteria. Your health care provider should see you to make a proper diagnosis and recommend a treatment to you. n Leakage Around G-Tube Drainage of any type of liquid around Types of discharge from around the the exit site of the tube allows risk for tube site can include: gastric content, skin breakdown and infection. Leakage is secretions from stoma tissue, tube considered a symptom of an underlying feeding formula, or medications. Talk problem such as: to your health care provider if you have • Inward or outward movement discharge from your stoma. of the tube • Tube tract enlargement • Overfeeding • Balloon deflation • Delayed gastric emptying Guide to Adult Tube Feeding | 17

Hypergranulation Tissue Causes Prevention and Treatment Trapped moisture • Keep skin around the tube dry. Clean site with soap and water or non-toxic Tube causes a foreign body reaction, skin cleanser. resulting in rapid development of thick, • No dressing is necessary unless directed red tissue by your health care provider. • Protect skin with a waterproof ointment Excessive tube movement when drainage is present. If drainage persists contact your health care provider. • Ask the health care provider if he or she Need to resize low-profile balloon feels that the granulation tissue needs to gastrostomy tubes be reduced. • Minimize tube movement by making sure skin disk is placed properly close to the skin as told to you by your health care provider. Look for: n Thick, red, raised tissue around the stoma site n Bleeding at the tube site n Clear or cloudy discharge A stoma site with hypergranulation tissue 18

Tube Site Infections Causes Prevention and Treatment Yeast or bacteria normally found on the • Wash hands before preparing and skin may cause infection administering tube feeding and before performing tube site care. Displacement of the tube • Make sure the external tube disc or bar is positioned properly as instructed by your health care provider. • Keep skin around the tube dry. Clean site with soap and water or non-toxic skin cleanser. • Verify tube placement using method recommended by your health care provider. If tube is out of place, notify health care provider to receive additional instructions. • Stop tube feedings and call your health care provider as soon as possible if you suspect a wound infection. You may need topical antibiotic ointment and/or antibiotics. Contact your health care provider to determine if treatment should be given. Look for: n Redness n Tenderness n Swelling and firmness at the site n Pus-filled drainage n Possible fever n Foul odor An infected stoma site Guide to Adult Tube Feeding | 19

Leakage Around the G-Tube Causes Prevention and Treatment Inward and outward movement of the • Verify tube placement using method tube recommended by your health care Tube tract enlargement caused by provider. excessive back-and-forth motion • Stabilize the feeding tube externally Rapidly infusing formula via bolus by adjusting the external skin disk, as recommended by your health care Balloon internal bumper is defective or provider. needs more water • Infuse medications and formula slowly. • Monitor water volume of the feeding tube balloon to ensure proper inflation. Yeast Infection Causes Prevention and Treatment Infrequent dressing changes (if using) • Remove the cause. Preventing moisture buildup is the most important intervention. Prolonged skin contact with moisture • Keep area dry and open to air – a fan or (wet dressings) hair dryer on a cool setting may be used Susceptibility to yeast to dry the area. (immune-compromised, diabetes) • Ask your health care provider if an Antibiotic therapy antifungal powder or cream would be helpful. Look for: n Redness n Skin breakdown n Small, inflamed, pus-filled blisters n Burning sensation at the tube site A stoma site with yeast infection 20

Dehydration Dehydration occurs when there is an imbalance between the amount of water taken into the body and the amount of water that is lost. Dehydration means that the body needs more water. Dehydration can present itself in a number of different ways, including increased thirst, dry lips, dry and warm skin, rapid weight loss, weakness, and urine that is dark and strong-smelling. Causes Prevention and Treatment Diarrhea • Notify your health care provider if you are experiencing vomiting, fever, or diarrhea Vomiting that lasts longer than 24 hours, a sudden decrease in urine output, dizziness, or an Fever altered mental state. • Record the amount of water and formula Excessive sweating or drooling that you are taking each day and make note of the color and odor of the urine. Inadequate water intake • Ask your health care provider how much extra water (free water) you should be taking on a daily basis. Extra water can be Excessive urination given through the feeding tube using a syringe or feeding bag. Urine Dehydration Reference 1 Good Look for: n Increased thirst 2 Good n Dry lips 3 Fair n Dry and warm skin 4 Dehydrated n Rapid weight loss 5 Dehydrated n Weakness 6 Very dehydrated n Dark, strong-smelling urine n Dizziness upon standing 7 Severely dehydrated When dehydration is present, urine becomes darker and more concentrated. Guide to Adult Tube Feeding | 21

Taking Charge of Your Health Care Provider Visits During a health care provider’s appointment, you have many issues to discuss in a short amount of time. It’s easy to forget something important and realize afterward that you didn’t get the answers you need. One way to make the most of your appointment is to think of your appointment as having three stages: before, during and after. Following the easy tips below at each stage can make your visit a lot less stressful – and a lot more productive. What to bring with you: Before the visit: This booklet, which includes your: n Review information that you n Tube Feeding Monitoring Checklist have documented in your Tube (pages 24-31) Feeding Monitoring Checklist and Medications Record. n Medication Record (pages 32-33) n Make a list of questions and concerns n Notes (pages 34-35) that you want to discuss. n A list of questions and concerns n If you are going to be discussing a that you want to discuss problem, be prepared to provide the following information: • A detailed description of the issue, including when and how it began as well as any symptoms • What, if anything, you have done to treat the problem • Things that have made it better or worse uide to G TUBE FEEDING T ADUL 22

During the visit: n Use your list to check off each item as it is addressed. n Take notes so that you can refer back to them after the visit (Use the Notes section on pages 34-35.). n Be sure to provide history of medical conditions, all prescribed and over-the-counter medications, and supplements. n If you can’t follow something that is said, ask the health care provider to explain it in a way that you can understand. n If the health care provider suggests a treatment that you are unsure of, communicate this and ask what other treatment options might be available. n If you are discussing a problem, ask how long it should take to improve and/or resolve after starting the prescribed treatment. n Ask when and how you should follow up after the visit (phone call, email or office visit). After the visit: n If you do not see results from the treatment within the expected time frame, inform your health care provider as soon as possible. n Don’t hesitate to call the office if you have questions or concerns. n Don’t be afraid to ask your health care provider for a referral when a problem is not resolving or when input from a specialist might be needed. Guide to Adult Tube Feeding | 23

Tube Feeding Monitoring Checklist Date: Mon. Tues. Wed. Weight Amount of Formula Taken: Volume Calories Rate Oral Intake, Food and Liquid Amount of Water Taken Through the Tube Urine: Color/Odor Stool Consistency: Liquid (#/day) Soft (#/day) Hard (#/day) Constipated Nausea Notes Date: Mon. Tues. Wed. Stoma Site Care Skin: Redness Drainage Granulation tissue Skin breakdown Daily Site Care 24

Date: Date:Mon.Tues.Wed. Thurs. Fri. Sat. Sun. Weight Amount of Formula Taken: Volume Calories Rate Oral Intake, Food and Liquid Amount of Water Taken Through the Tube Urine: Color/Odor Stool Consistency: Liquid (#/day) Soft (#/day) Hard (#/day) Constipated Nausea Notes Thurs. Fri. Sat. Sun. Guide to Adult Tube Feeding | 25

Tube Feeding Monitoring Checklist Date: Mon. Tues. Wed. Weight Amount of Formula Taken: Volume Calories Rate Oral Intake, Food and Liquid Amount of Water Taken Through the Tube Urine: Color/Odor Stool Consistency: Liquid (#/day) Soft (#/day) Hard (#/day) Constipated (Yes/No) Nauseous Notes Date: Mon. Tues. Wed. Stoma Site Care Skin: Redness Drainage Granulation tissue Skin breakdown Daily Site Care 26

Date: Date:Mon.Tues.Wed. Thurs. Fri. Sat. Sun. Weight Amount of Formula Taken: Volume Calories Rate Oral Intake, Food and Liquid Amount of Water Taken Through the Tube Urine: Color/Odor Stool Consistency: Liquid (#/day) Soft (#/day) Hard (#/day) Constipated (Yes/No) Nauseous Notes Thurs. Fri. Sat. Sun. Guide to Adult Tube Feeding | 27

Medication Record Please list all over-the-counter medications and herbal supplements. Date Medication Name Medication Formulation Medication Frequency / Indication (eg, tablet, capsule, Dose Time of Day liquid, injectable, etc) 32

Medication Record Date Medication Name Medication Formulation Medication Frequency / Indication (eg, tablet, capsule, Dose Time of Day liquid, injectable, etc) Guide to Adult Tube Feeding | 33

Notes 34

Notes Guide to Adult Tube Feeding | 35

GGlossarylossary Abdomen: The body space between the Constipation: A condition in which stool chest and the pelvis. This space houses becomes hard, dry, and difÏcult to pass, and the stomach, liver, gallbladder, spleen, bowel movements do not happen very often. pancreas, small bowel (intestine), large Dehydration: A condition in which the bowel (intestine). body does not have enough water. Abdominal Wall: The abdominal wall Delayed Gastric Emptying: A condition represents the skin and tissue covering that slows the movement of food from the the abdomen. stomach to the small bowel (intestine). Absorption: Uptake of nutrients by the Diarrhea: two to three loose bowel digestive system. movements/day. Balloon Port: A port on the proximal end Enteral Nutrition: Also known as tube (end furthest away from the abdomen) of a feeding, is a way of delivering nutrition gastrostomy tube where water is inserted to directly to your stomach or small intestine. inflate the balloon. There is a plastic sleeve around most ports that tell how much water Esophagus: The muscular tube leading is needed to inflate the balloon. from the mouth to the stomach. Bloating: Swelling and tightness of the External Skin Disk: Also called an external abdomen, typically caused by fluid, gas or air. skin bolster, this holds the tube in place as Bolus Feeding: Formula is placed in a it exits the body. Its purpose is to prevent syringe and flows slowly into the feeding lateral tube movement, which could tube; the height of the syringe or bag contribute to leakage of gastric contents controls the feeding rate. onto the skin. Candidiasis: An infection caused by yeast. Feeding Port: The main port of the feeding It can develop on the skin around the tube. Formula is delivered to the patient feeding tube. by connecting a feeding set or syringe to this port. Closed Enteral System: A closed enteral Feeding Rate: Determined by how fast the container or bag, pre-filled with sterile, formula is poured into the syringe, how liquid formula by the manufacturer, and high the rate is set on a pump, or how high considered ready to administer. the syringe or feeding bag is placed above Continuous Feeding: Tube feeding—usually the abdominal wall. by an automatic pump—where the formula is fed slowly over a long period of time, such as all day or night (or both). 36

Feeding Set: Tubing that is connected to Malabsorption: Failure to absorb certain a feeding container and delivers formula nutrients, vitamins and minerals from the into the stomach or small bowel (intestine) intestinal tract into the bloodstream. through the feeding tube. Maldigestion: Inability to digest food in Feeding Tube: A tube into the stomach the intestine. or small bowel (intestine) through which Nasogastric (NG) Tube: A feeding tube formula flows. that goes from the nose to Flushing: The process of pushing water the stomach. through the tube to prevent tube clogging. Nasojejunal (NJ) Tube: A feeding tube that Also for hydration needs. goes from the nose to the jejunum. French Size: A measuring system used to Nausea: Having stomach upset with define the diameter of a feeding tube. the urge to vomit. The larger the number, the bigger the diameter. Open Enteral System: An enteral system Gastrostomy Tube (G-Tube): A feeding in which the clinician/patient/caregiver tube that goes into the stomach through is required to decant formula into the a stoma. enteral container or bag. Gravity Feeding: Feeding method where Parenternal Nutrition: Infusing a formula flows from a container or syringe, specialty form of feeding through a through a feeding set and into the patient. vein (intravenously). Hypergranulation Tissue: Thick, red, raised Peristomal Infection: Infection of the tissue that can form around the feeding tissue around the feeding tube. tube where it enters the abdominal wall. PEG (Percutaneous Endoscopic Internal Bumper: Also called the internal Gastrostomy): A non-surgical way to place bolster, this is found on the distal end of a feeding tube into the stomach through the feeding tube (the end that is inside the the abdominal wall. stomach) and helps hold the tube in place. PEJ (Percutaneous Endoscopic Intermittent Feeding: Feeding method in Jejunostomy): A non-surgical way to place which formula is given 3 to 8 times a day. a feeding tube into the jejunum through a gastrostomy tube. Jejunostomy Tube (J-Tube): A feeding tube Prime the Feeding Set: To pour the that goes into the small intestine. formula into gravity or pump set and Jejunum: The second part of the let it flow to the end of the feeding set small bowel (intestine). to remove the air in the set prior to Low-Profile Gastrostomy Tube (Button): connecting it to the feeding tube. A gastrostomy tube that lies flat against the abdomen. Guide to Adult Tube Feeding | 37

Pump Feeding: Feeding method in which a Sorbitol: A sugar alcohol used in liquid mechanical pump moves formula through medications that can cause diarrhea in the feeding tube. some patients. Reconstitute: To restore to a former Stoma: Opening in the abdominal wall condition by adding water. through which a gastrostomy tube or Residual: The formula that remains in the jejunal tube enters the body. stomach from the last feeding. Syringe: A hollow, plastic tube with a Small Bowel (Intestine): The part of plunger used to draw fluid out of or inject the digestive tract between the stomach fluid into a feeding tube. and large intestine that digests and Syringe Feeding: Feeding method in which absorbs nutrients. formula flows from a syringe into a feeding tube or is injected into the feeding tube using the plunger on the syringe. Additional Notes: 38

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