1. Transabdominal tube feeding and care 1

2. Objectives Discuss Transabdominal tube feeding and care procedure. Demonstrate the correct procedure in performing transabdominal tube feeding and care. Perform the procedures through return - demonstration correctly. 2

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4. In contrast… A percutaneous endoscopic gastrostomy (PEG) or (PEJ) jejunostomy tube can be inserted endoscopically without the need for laparotomy or general anesthesia. Used for nutrition, drainage, and decompression. 4

5. Contraindications to endoscopic placement Obstruction Previous gastric surgery Morbid obesity Ascites 5

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7. Gastrostomy Feeding Tubes 7

9. Frequently used for infants or children. 8

10. In this film you can see the outline of the balloon and the barium entering the stomach. 9

11. It is easy to visualize the G-tube radiographically, but once contrast is added the position of the G-tube is easily confirmed. 10

12. Jejunostomy Feeding Tubes 11

13. Gastrojejunostomy Feeding Tubes 12

14. Nursing care 13

15. Equipment Feeding 14

16. Equipment: feeding Feeding formula Large – bulb or catheter – tip syringe 120 ml of water 4” x 4” gauze pads Soap Skin protectant Hypoallergenic tape Gravity – drip administration bags Mouthwash, toothpaste, or mild salt solution 15

17. Equipment: feeding Stethoscope Gloves Optional: enteral infusion pump 16

18. Preparation of equipment 17

19. Preparation of equipment Always check the expiration date on commercially prepared feeding formulas. If the formula has been prepared by the dietitian or pharmacist, check the preparation time and date. Discard any opened formula that’s more than 1 day old. Commercially – prepared administration sets and enteral pumps allow continuous formula administration. 18

21. implementation 20

22. implementation Provide privacy, and wash your hands. Confirm the patient’s identity using two patient identifiers according to facility policy. Explain the procedure to the patient. Tell him, for example, that feedings usually start at a slow rate and increase as tolerated. After he tolerates continuous feedings, he may progress to intermittent feedings, as ordered. 21

25. If residual contents remain too high, notify the physician.

26. Chances are the formula isn’t being absorbed properly.

27. Keep in mind that residual contents will be minimal with PEJ tube feedings. 23

28. implementation Allow 30 ml of water to flow into the feeding tube to establish patency. Be sure to administer formula at room temperature. Cold formula may cause cramping. 24

29. implementation Intermittent feedings 25

30. Intermittent feedings Allow gravity to help the formula flow over 30 to 45 minutes. Faster infusions may cause bloating, cramps, or diarrhea. Begin intermittent feeding with a low volume (200 ml) daily, according to the patient’s tolerance increase the volume per feeding, as needed, to reach the desired calorie intake. 26

31. Intermittent feedings When the feeding finishes, flush the feeding tube with 30 to 60 ml of water to maintain patency and provide hydration. Cap the tube to prevent leakage. Rinse the feeding administration set thoroughly with hot water to avoid contaminating subsequent feedings. Allow it to dry between feedings. 27

32. implementation Continuous feedings 28

33. Continuous feedings Measure residual gastric contents every 4 hours. To administer the feeding with a pump, set up the equipment according to the manufacturer’s guidelines, and fill the feeding bag. To administer the feeding by gravity, fill the container with formula and purge air from the tubing. Monitor the gravity drip rate or pump infusion rate frequently to ensure accurate delivery of formula. 29

34. Continuous feedings Flush the feeding tube with 30 to 60 ml of water every 4 hours to maintain patency and to provide hydration. Monitor intake and output to anticipate and detect fluid and electrolyte imbalances. 30

35. implementation Decompression 31

36. Decompression To decompress the stomach, connect the PEG port to the suction device with tubing or straight gravity drainage tubing. Jejunostomy feeding may be given simultaneously via the PEJ port of the dual – lumen tube. 32

37. implementation Tube exit site care 33

38. Tube exit site care Provide daily skin care. Gently remove the dressing by hight and. Never cut away the dressing over the catheter because you might cut the tube or the sutures holding the tube in place. 34

40. Rinse the are with water and pat dry. Apply skin protectant if necessary.35

41. Tube exit site care Anchor gastrostomy or jejunostomy tube to the skin with hypoallergenic tape to prevent peristaltic migration of the tube. This also prevents tension on the suture anchoring the tube in place. Coil the tube, if necessary and tape it to the abdomen to prevent pulling and contamination of the tube. PEG and PEJ tubes have toggle – bolt – like internal and external bumpers that make tape anchors unnecessary. 36

42. Special considerations 37

43. Special considerations If the patient vomits or complains of nausea, feeling too full, or regurgitation, stop the feeding immediately and assess his condition. Flush the feeding tube and attempt to restart the feeding again in 1 hour (measure residual gastric contents first). You may have to decrease the volume or rate of feedings. 38

44. Special considerations If the patient develops dumping syndrome, which includes Nausea Vomiting Cramps Pallor Diarrhea The feedings may have been given too quickly. 39

46. Special considerations Control diarrhea resulting from dumping syndrome by using continuous pump or gravity – drip infusions, diluting the feeding formula, or adding antidiarrheal medications. 41

48. Website: Nasogastric tube insertion; Department of Emergency Medicine: University of Ottawa

49. Website: Radiographic Imaging CEU Source, LLC 42

50. Thank you  43