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HF 295

Enteral Nutrition: Gastrostomy Tube Feeding

A gastrostomy tube (g-tube) is a tube that enters through your abdomen and rests in your stomach. This tube is used for tube feeding formula, water, and medicine (instead of taking them by mouth). Tube feeding formula is a liquid source of nutrition. It provides calories, protein, water, vitamins and minerals.

Tube feedings that are started in the hospital will require follow-up with a registered dietitian after discharge. Follow these instructions for your g-tube feedings, or as directed by your healthcare provider.

Continuous, Intermittent, or Cyclic Tube Feeds by Pump

Continuous, intermittent or cyclic tube feeds are given using a pump over a specific time frame. Follow these steps:

  1. Wash your hands with soap and water. Dry them with a clean towel.

  2. Use room temperature formula. Very cold formula may cause stomach upset.

  3. Wash the lid of the can and dry the lid with a clean towel.

  4. Only open containers of formula that you will need for the feeding.

  5. Shake the can(s) before opening.

  6. Only place 8 hours’ worth of formula into the bag or as otherwise directed. Leftover formula that is open can be stored in the fridge with a cover. Discard formula that has been open for more than 24 hours.

  7. Open the cap on the feeding tube and using a syringe, insert at least 30 mL of warm water into your tube.

  8. Remove the syringe and put the tubing from the pump into your feeding tube. Start the pump at the prescribed rate.

  9. Keep your head elevated at least 30 degrees while you receive a feeding.

  10. To prevent clogging, flush the tube with 30 mL water every 4 hours while the tube feeding is running.

  11. When the feeding is complete, disconnect the feeding bag. Flush the tube with at least 30 mL of warm water and cap the tube to prevent leaking.

Cleaning

  1. Rinse the feeding bag and tubing with water and then swish with warm water and a small amount of liquid dish soap. Rinse and allow to air dry.

  2. Clean the syringe with warm, soapy water and allow to air dry completely.

Change the tube feeding bag every 3 days and change the syringe each week.

To allow you more freedom, there are special backpacks you can get for feeding pumps. Check with your medical supplier about this option.

Gravity Tube Feeds

Gravity tube feeds are given multiple times per day, several hours apart. They are given using a feeding bag over 30 minutes or less. The feeding bag hangs above the head which allows the formula to drip in.

Complete steps 1-3 listed under the topic of tube feedings by pump. Check the roller clamp to ensure that the tubing is pinched closed. Follow these steps for gravity tube feeds.

  1. Pour the formula into the feeding bag. No more than 2 cans or 480 mL of formula will be put into the feeding bag at a time. Close the lid on the feeding bag and hang the bag on a pole/hook at least 12 inches higher than your stomach.

  2. Open the cap on the feeding tube and using a syringe insert at least 30 mL of warm water into your tube.

  3. Remove the syringe and connect the tubing from the feeding bag to the g-tube.

  4. During feedings, sit upright so that your shoulders are higher than your stomach. Sit in a chair or prop yourself up in a bed or on the couch. Never lay flat on your back during feedings.

  5. Unclamp the tubing coming from the feeding bag. Control the flow rate by using the roller clamp. A good rate to start at is 1-2 drips per second. You may control the speed of flow per your comfort.

  6. Once your feeding is finished, clamp the tube, remove the tubing from the feeding bag and unhook the feeding from your g-tube.

Cleaning

  1. Flush your g-tube with at least 30 mL of warm water. Close the cap on your feeding tube.

  2. Rinse the feeding bag and tubing with water and then swish with warm water and a small amount of liquid dish soap. Rinse and allow to air dry.

  3. Clean the syringe with warm, soapy water and allow to air dry completely.

Change the tube feeding bag every 3 days and change the syringe each week.

Bolus (Syringe) Feeds

Bolus (syringe) tube feeds may be given multiple times per day, several hours apart and are given through a syringe over 15-30 minutes. If you have been able to handle tube feeds by the gravity drip method, you may try the syringe method.

Complete steps 1-3 listed under the topic of tube feedings by pump. Then, follow the steps below for bolus feedings.

  1. Open the cap on the feeding tube and use a syringe to insert at least 30 mL of warm water into your tube.

  2. Fill the syringe with formula and allow the formula to flow slowly. You may adjust the flow rate by gently pinching the feeding tube or raising/lowering the height of the syringe. Do not use the plunger of the syringe to force formula into the tube. This can cause bloating and pain.

  3. Repeat step 2 as many times as needed to complete the feeding. It will take about 4 full syringes to complete 1 can of formula or about 15 minutes.

Cleaning

  1. After the feeding is complete, flush tube with 30 mL of warm water.

  2. After all the water has gone through the tube, place cap on the feeding tube.

  3. Clean the syringe with warm, soapy water and allow to air dry completely.

Change the syringe each week.

Water Flushes

Your body needs enough fluid each day to stay hydrated. Your tube feed formula will provide some fluids. The rest of your fluid will be met by oral intake (if safe) and/or by doing water flushes through your feeding tube. You may not be getting enough fluid if you have: dizziness, dry mouth, dry lips, lower urine output than normal and darker urine.

Medicines

You can give medicine through the feeding tube if you cannot swallow them. Follow these instructions:

  1. Do not add medicine directly to the formula. Give each medicine one at a time; do not mix together.

  2. Flush the tube with 30 mL water before giving a medicine. If giving more than one medicine at one time, flush in between each dose with 10 mL water.

  3. Crush and dissolve pills in at least 30 mL water before flushing them through the tube. Never crush enteric-coated or time-release capsules. Flush the tube again with 30 mL water after you give the medicine.

My Tube Feed and Hydration Plan

Tube Feed Formula: ________________

Amount of Tube Feed Formula Needed Daily

You need a total of _____ cartons. This will provide _______ calories, _______ grams (g) of protein and _________ milliliters (mL) of water.

Additional Water Flushes

In addition to goal tube feeds, you need______ mL of water per day

Feeding and Hydration Schedule

_______________________________________________________

When to Call

  • The tube clogs. Your tube may clog at times because of medicines or if you are not flushing with water often enough. This is not an emergency. First try to flush the tube with 30 mL of warm water. Never force fluid into the tube. If this does not unclog the tube, call the clinic.

  • Tube falls out. It becomes harder to replace the tube the longer it is out.

  • You are losing weight. Weigh yourself 3 times a week at the same time of day on the same scale. Early morning is best, after urinating. Keep a record of your weight. If you notice weight gain or loss of more than 2-3 pounds per week contact your healthcare team.

  • Nausea or upset stomach for more than 24 hours.

  • Diarrhea (3 or more loose, watery bowel movements) for more than 2 days.

  • Constipation (lack of bowel movement) for more than 5 days.

  • Anything that causes you to stop giving tube feedings for more than one day.

Who to Call

If you are a UW Health patient and have more questions, please contact UW Health at one of the phone numbers listed below. You can also visit our website at www.uwhealth.org/nutrition.

Nutrition clinics for UW Hospital and Clinics (UWHC) and American Family Children’s Hospital (AFCH) can be reached at: (608) 890-5500. Nutrition clinics for UW Medical Foundation (UWMF) can be reached at: (608) 287-2770.