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Tube feeding with a nasogastric or nasojejunal tube

Whāngai ā-ngongo ki te ngongo ā-ihu

A nasogastric (NG) or nasojejunal (NJ) tube is a tube that goes through your nose and into your stomach (NG) or jejunum (NJ). The jejunum is part of the small intestine. The tube allows you to take special liquid food (feed), medications and fluids if you cannot meet all your nutritional needs by eating normally.

Feeding

Important

Only put the following down your feeding tube:

the feed prescribed by your dietitian or doctor
water
prescribed medications (see below for how to put medications down your feeding tube).

Do not put puréed food down your feeding tube.

Flush your feeding tube with warm water before and after you tube feed. Also flush it before and after you take medications down your tube. To stop your tube from blocking, also flush it every 3 to 4 hours during the daytime whether or not you are feeding.

If you have safe drinking water, you can use tap water to flush your tube. Otherwise, use boiled, cooled water.

If you have a jejunal tube, always use boiled, cooled water to flush your tube.

Feeding methods

If you have an NG tube, there are 3 methods of tube feeding, gravity feeding, bolus feeding and pump feeding. Your dietitian will decide which type of feeding is best for you.

If you have an NJ tube, you can only use pump feeding.

Gravity feeding – This is where the feed flows out of a syringe or feed bottle and into the feeding tube by gravity.

Bolus feeding via a syringe – This is when you have a set amount of feed at specified times during the day. This is like having meals at mealtimes.

Pump feeding – This is when a pump is used to continuously deliver a set amount of feed through your feeding tube over a set amount of time.

Your dietitian will discuss the options with you in more detail and provide you with a plan and instructions when needed. See:

Medications

The hospital pharmacist will review your medications before you go home. They will make sure you can take the medications through your feeding tube. There are some important points to note.

Use the main port of your feeding tube for medications.
Use the bolus feeding method (see above) to put medications down your feeding tube unless your dietitian or nurse advises otherwise.
Flush your tube with 20 mL warm water before and after giving medications. This helps to prevent your feeding tube from blocking.
If you have more than one medication, take each one separately. Flush your feeding tube with 10 to 15 mL of warm water between each medication.
Finely crush each solid medication separately (a mortar and pestle is best for this). Mix it with 10 to 15 mL of water before putting it down your feeding tube.
You can take liquid medications down your feeding tube without diluting them.

Caring for your equipment and feed

After feeding, wash the syringe with mild dishwashing detergent, rinse thoroughly and leave it to air dry.
Place the syringe in a clean zip lock bag or a clean container with a lid. Store it in the fridge to prevent it being contaminated by bacteria.
You can use each syringe for about 2 weeks.
Giving sets (only used for pump feeding) can only be used once. Discard them after you have used them for 24 hours and don't reuse them.
Cover open cans or bottles of feed and store them in the fridge. Throw away any open, unused feed after 24 hours.
You can use ready-to-hang bottles of feed for 24 hours. Throw away any unused feed after 24 hours.
Your feed should be at room temperature when you use it. If it has been in the fridge, leave it for 30 minutes before using it.

Feeding tube blockage

Your feeding tube may block if you do not flush it regularly or do not take your medications correctly.

You can stop your tube from blocking by flushing the tube with warm water. You need to do this before and after each feed and before and after giving medications. You also need to do it every 3 to 4 hours during the daytime whether or not you are feeding.

If your tube blocks, try the following to try to clear the blockage:

check for any kinks in the tubing
massage the tube from the nose end, out towards the end of the tube
insert a 60 mL syringe into the end of the tube
pull back the plunger and withdraw as much fluid as possible from the tube
take the syringe out of the tube and throw away the fluid you withdrew
half-fill a 60 mL syringe with warm water and attach it to the end of the tube, move the plunger back and forth to try to dislodge the blockage
massage the tube again and then use the back and forth action with the plunger to try to clear the tube
if you have repeated this three or four times and you cannot unblock the tube, contact _______________ (your dietitian will enter this).

Important

If your feeding tube comes out, contact _______________ (your dietitian will enter this).

Supplies, syringes and giving sets

When you are discharged from hospital, the hospital dietitian will give you a small supply of nose plasters, syringes and giving sets.

When you need more nose plasters, you can order them from your local pharmacy. Nasofix is one of the brands you can use.

Your dietitian will organise your first supply of syringes and giving sets. For an ongoing supply, contact the Canterbury DHB Supply Department (see below).

Give as much notice as possible. Let them know if you cannot collect the syringes and giving sets as they can courier them to you. There is no charge for giving sets, syringes or delivery.

If you are under the care of the Ashburton Hospital dietitians, phone the Ashburton Supply Department (see below). You will need to collect your giving sets from the Supply Department.

Your hospital dietitian will organise your feed when you first go home. After this, your community dietitian or general practice team will organise it. If you need to contact your feed supplier because your feed has not arrived, use the contact details below.