Gut Check | Tuesday, February 5, 2019
Get the FACTS About Feeding Tube Care
Feeding Tube Awareness Week is February 4-8, 2019, and was created to educate the public about the advantages of feeding tubes. Nurses are also in need of education about feeding tubes, particularly percutaneous tubes (those placed through the skin). These tubes, though common, are not consistently or completely addressed in formal education or during facility orientation. This creates a knowledge and skills gap for many nurses. Guidelines for caring for patients with feeding tubes are listed below, just remember the FACTS:
Flush the tube with 30 ml1 of water before and after feedings, when feedings are stopped or interrupted, every four to six hours during continuous feedings, and at least once a day if the tube is not in use. Flush with 15 ml1 of water before, after and in between administering medications. A.S.P.E.N. recommends using purified water to flush the tube of patients who are immunocompromised or critically ill, especially when the safety of the tap water is not confirmed.
Assess the patient for signs of complications such as feeding intolerance (diarrhea, abdominal cramps, vomiting) and aspiration (respiratory distress, choking, coughing, gagging) during and after feedings. Assess the tube for patency, changes in the length and integrity of the outside of the tube. Assess the tube site (stoma) for leakage and skin abnormalities.
Care for the tube site by keeping it clean and dry. Clean the site daily2 and as needed with water and mild soap. Avoid using peroxide or alcohol because these are very irritating to the skin. Dressings are not usually necessary2 but if used they should be changed when wet or soiled and they should not make the tube fit too tight. Use tape sparingly to avoid skin irritation.
Teach patients and families how to care for the tube as soon as possible and reinforce teaching every day. Use printed materials from your facility’s patient education program and from reliable websites such as the Oley Foundation’s Tube Feeding Trouble Shooting Guide and the Feeding Tube Awareness Foundation’s Parent Guide. Become familiar with the educational materials you give to patients and make sure what you give does not contradict the physician’s instructions.
Safety is key in preventing complications.
- Keep the patient’s HOB elevated 30-45 degrees during and 30-60 minutes after feedings.
- Stabilize/secure tubes in order to prevent them from becoming dislodged or putting tension on the stoma. Some tubes come with an external bolster that stabilizes the tube and nothing else is needed. Inform the physician if the tube is too tight causing redness or pain.
- Stop feedings and notify the physician if the patient is having any complications such as signs of feeding intolerance, aspiration, or tube dislodgement.
- Practice safe administration of feedings and medications. See the Enteral Safety Campaign Posters on the A.S.P.E.N. website.
- Learn the details about each patient’s tube. Know the type of tube, what each port is used for, who placed the tube, how it was placed (surgically, endoscopically or radiographically), where the tube is located (stomach or small intestine), the purpose of the tube (some tubes are used for drainage/ decompression, or medications/fluids only), how the tube is secured internally (balloon, bolster, or sutured) and when the tube site was originally created3.
- Before reinserting a tube, nurses should have training and proof of skills competency along with a provider order. Nurses should also know their facility’s policy and state board of nurses’ position on tube reinsertion.
Feeding tubes can cause serious but often preventable complications. Nurses are in a key position to help prevent these problems. By improving feeding tube knowledge and skills, all nurses have the power to create safer care for their patients.
1 Unless otherwise instructed by physician or policy. Neonates, some pediatric patients and critically ill patients may need a smaller amount of water.
2 Unless otherwise instructed by physician or policy.
3 Newer gastrostomies and jejunostomies have stomal tracts that may not have matured, which increases the risk of the tube not being in the correct place if reinserted. This can lead to peritonitis, a potentially life-threatening condition. Signs and symptoms include abdominal rigidness, pain and fever. This can also happen with older stomal tracts.
American College of Surgeons: Feeding Tube Home Skills Program www.facs.org/education/patient-education/skills-programs/feeding-tube
American Society for Parental and Enteral Nutrition (A.S.P.E.N) www.nutritioncare.org/
Feeding Tube Awareness www.feedingtubeawareness.org/
Oley Foundation http://oley.org/ .
Agre, P., Brown, P., and Stone, K., (2013). Tube Feeding Troubleshooting Guide. Retrieved from https://oley.org/page/HEN_LandingPage
Boullata JI, Carrera AL, Harvey L, et al. A.S.P.E.N. safe practices for enteral nutrition therapy. JPEN J Parenter Enteral Nutr. 2017; 41,15-103