HealthInfo West Coast-Te Tai Poutini

Tube feeding with a gastrostomy tube

This factsheet tells you how to care for your feeding tube and stoma (the artificial opening into your stomach) and how to take your feed and medications via your tube. A ward nurse or dietitian needs to fill in parts of this factsheet.

What is a gastrostomy?

A gastrostomy is an artificial opening through your abdomen into your stomach. A feeding tube is inserted through the opening so that special liquid food (feed), medications and fluids can go directly into your stomach. Some feeding tubes go down into your jejunum, a part of your small intestine.

There are two types of gastrostomy tube, a PEG (percutaneous endoscopic gastrostomy) and a RIG (radiologically Inserted gastrostomy). These terms describe how the tube is fitted.

A – Feeding port. B – Flange. C – Clamp. D – Balloon inflation-deflation port.

You have a   _______________________________   tube.

There are two types of tube feeding, bolus feeding using a syringe, and pump feeding. Both types of feeding are described in the following sections. Your dietitian will decide which type of feeding is best for you.

Getting ready to tube feed

• Always wash your hands with warm soapy water before handling your feeding tube and feed.
• Check the expiry date of the feed before you use it. If it has expired, throw it away.
• Your gastrostomy tube has centimetre (cm) markings. Always check that the flange (or bumper) on the tube is at the same cm marking before starting to tube feed.

  Your flange (bumper) is at   _______________   cm.

• Sit so your back is at least 30 degrees above horizontal when you tube feed and for an hour after feeding. This helps the feed go into your stomach and not your lungs.
• Flush your feeding tube with warm water before and after you tube feed, and before and after you take medications down your tube.
• 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.

Bolus feeding using a syringe

This is when you have a set amount of feed at specified times during the day. This is similar to having meals at mealtimes. Your dietitian will give you a bolus tube feeding plan with the details filled in.

1. Collect all the equipment you'll need (a 60 ml syringe, a measuring and pouring jug, and your feed). Check the expiry date on the feed and shake it well before opening it.
2. Wash your hands with warm soapy water.
3. Close your feeding tube clamp, then open the cap at the end of your feeding tube (a RIG tube doesn't have a clamp).
4. Remove the plunger from the syringe. Connect the syringe to your feeding tube.
5. Hold the syringe upright and pour the prescribed amount of warm water into the syringe to flush the tube. Open the clamp on your feeding tube.
6. Pour the prescribed amount of feed into the syringe. Allow the feed to flow into the feeding tube until it has gone. Close the clamp on your feeding tube.
7. Pour the prescribed amount of warm water into the syringe to flush the tube. Open the clamp and flush the feeding tube.
8. Close the clamp and disconnect the syringe.
9. Close your feeding tube with the attached cap. 

Pump Feeding

Pump feeding uses a feeding pump that continuously delivers a set amount of feed through your feeding tube over a set amount of time. Your dietitian will give you a pump tube feeding plan with the details filled in.

• Your ward nurse or dietitian will teach you how to use your feeding pump. They'll also give you written instructions.
• Your dietitian will give you a feeding pump and giving sets when you're discharged from hospital.
• Feed for pump feeding comes in ready-to-hang bottles like the one shown in the picture.

Medications

The hospital pharmacist will review your medications before you go home to make sure you can take them through your feeding tube.

• Use the main port of your feeding tube for medications.
• Use the bolus feeding method (explained above) to put medications down your feeding tube unless your dietitian or ward 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 and mix it with 10 to 15 ml of water before putting it down your feeding tube (a mortar and pestle is best for this).
• 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 two weeks.
• Giving sets can only be used once. Discard them after you've 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.

Caring for your feeding tube and stoma

Your stoma

• For the first one to two weeks after your tube is inserted, you can expect a small amount of discharge from your stoma as it heals.
• Clean your stoma daily with warm soapy water.
• If the discharge carries on, clean your stoma more regularly using the saline solution provided by the PEG nurse.
• After six weeks, you can swim or have a bath.

Your feeding tube

• Turn your feeding tube 360 degrees and move it slightly in and out of your stoma daily. This stops the tube from sticking.
• Attach your feeding tube to your stomach using the tube fastener supplied to you on discharge from the hospital. This will stop it moving in your stoma.
• If you gain or lose weight, you can reposition the flange (bumper) on the tube by sliding it up or down the feeding tube. It should always sit 1 to 2 mm away from your skin.
• You can remove the feeding port at the end of your feeding tube to clean it or replace it. See the diagram for details of how to reattach the feeding port.
• If you haven't started using the tube for feeding, flush it with 60 ml of warm water twice daily.

RIG tube

If the flange (bumper) is at the same cm marking but further away from your skin than normal, this may mean that the balloon has deflated. If this happens, try to push the tube back into its original position and tape it down. Contact the District Nursing Service urgently (see below). The PEG tube doesn't have a balloon. It has a flange inside your stomach that keeps your feeding tube in the right position.

Tube Blockage

Your feeding tube may block if you don’t flush it regularly or you don’t take your medications correctly.

You can stop your tube from blocking by flushing the tube with warm water before and after each feed, before and after giving medications, and every three to four hours during continuous pump feeding.

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

• check for any kinks in the tubing and that the clamp is open
• massage the tube from the skin 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've repeated this three or four times and you can't unblock the tube, contact the District Nursing Service (see below). They may recommend visiting the hospital to replace or unblock the tube
• if you have a jejunal tube, the tube may be kinked or knotted, an X-ray will identify this. In this case, the tube may need to be replaced.

Contact the District Nursing Service (see below) or your GP if you have:

• pain around your stoma site
• excessive discharge from your stoma
• redness or a raw area around your stoma.

Caring for your mouth

Taking good care of your mouth is important, especially if you can't eat or drink.

• brush all surfaces of your teeth, gums and tongue using a soft toothbrush and toothpaste at least twice a day
• rinse your mouth well with mouthwash and spit it out
• an alternative to commercial mouthwash is a salt and baking soda mouthwash. Mix half a teaspoon of salt and half a teaspoon of baking soda in a glass of warm water
• if you can't swallow safely or are at a high risk of aspiration (fluid going into your lungs) don't rinse your mouth. The hospital can provide you with green Toothette swabs to clean your mouth
• use lip balm to moisten your lips and prevent cracking
• regularly check your mouth and tongue. Redness, or yellow or white patches on your tongue may be a sign of infection or thrush. In this case, see your GP.

Supplies and giving sets

For extra supplies such as syringes and dressings, contact the West Coast DHB Stores Department (see below). If there isn't anyone available to take your call, leave your name, address, phone number and which supplies you need on the answer phone.

For giving sets, contact the West Coast DHB Stores Department (see below).

Give as much notice as possible. Let them know if you can't collect the giving sets as they can courier them to you. There's no charge for giving sets or delivery.

Your hospital dietitian will organise your feed when you first go home. After this, your dietitian or GP will organise it. You'll need to collect your feed from your community pharmacy.

Contact details

District Nursing Service

Refer to the list of service providers.

West Coast DHB Supply Department

Phone: (03) 769-7400 ext. 2806

Address: Grey Base Hospital, High Street Greymouth

Hours: Monday to Friday, 8 am to 4 pm.

Feeding pump suppliers

For any concerns about your pump, use the following contact details:

• FreeGo pump (Abbott). Phone 0800-738-090.
• Flocare Infinity pump (Nutricia). Phone 0800-222-430.
• Kangaroo Joey pump (Cardinal Health). Phone 0800-522-400.

Dietitians

Dietitian:

Phone:

Written by Nutrition & Dietetics and PEG Nursing Service, Canterbury DHB. Adapted by HealthInfo clinical advisers. Page created July 2018. Last updated August 2019.

Page reference: 525276

Review key: HITUB-482880