Nasogastric Intubation and Feeding

Programming the Pump

Tube Feedings
Patients with renal failure may require low-protein formulas with lower concentrations of minerals and vitamins. Translation of feed Nglish: If you experience diarrhea, sweating and flushing after eating, contact the healthcare team. Learn how to prepare for it and what's involved. At hospital discharge, an expected average of 4. Select the text below and copy the link. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision.

Tube Feedings

Bolus, Gravity, and Intermittent Feeds

A nasoduodenal tube goes into the first part of the small intestine, called the duodenum. A nasojejunal tube goes into the second part of the small intestine, called the jejunum. Once the tube is correctly positioned, it will be taped to your nose or cheek to keep it in place. Placement of the tube will be checked with an x-ray before the first feeding is given.

You will need surgery to put a gastrostomy or jejunostomy tube in place. Gastrostomy tubes are placed directly into your stomach. Jejunostomy tubes are placed directly into the jejunum of the small intestine. Gastrostomy and jejunostomy tubes are used if you: A surgical gastrostomy feeding tube is passed through the skin directly into your stomach gastrostomy.

Placing the tube requires surgery to make an opening stoma through the abdominal wall where the feeding tube enters the body. The feeding tube is held in place with either a stitch or a small inflated balloon around the tube just under the skin. A PEG tube is a gastrostomy feeding tube that is passed through the skin directly into the stomach. An endoscope is inserted through the mouth and down the throat into the stomach to help guide the placement of the feeding tube.

A surgical jejunostomy tube J tube is passed through the skin directly into the jejunum of the small intestine. A surgical jejunostomy may be used if you have problems in the upper GI tract, a high risk of aspiration or a blockage obstruction in the stomach.

A surgical J tube causes fewer problems with leakage, skin irritation, nausea, vomiting and bloating than a surgical gastrostomy tube, but it has an increased risk of diarrhea. More recently, gastrostomy and jejunostomy tubes are being inserted by a radiologist. The radiologist uses x-rays to locate the stomach or small intestine and then inserts the tube without using an endoscope.

Tube feeding formulas are prescribed based on your nutritional needs and the condition of your GI tract. Formulas have different levels of protein, carbohydrates, fat, calories, vitamins and minerals. Sometimes fibre is added to the formula to help prevent diarrhea. The main types of tube feeding formulas are: When having tube feeds, you may not have the same bowel patterns as when you were eating. To prevent diarrhea, the formula should be given at room temperature at the recommended rate.

The strength of the formula or feeding rate may need to be reduced. Make sure all tube feeding supplies are cleaned well or changed daily and practise good hygiene techniques such as washing hands well. The healthcare team may recommend using a lactose-free formula, adding fibre to the formula or taking anti-diarrhea medicines. Aspiration happens when the nutritional formula enters the lung. This is very serious because it can cause breathing problems and infection. Signs of aspiration include: To prevent aspiration, sit upright or raise the head of the bed during and for 30 to 60 minutes after the feeding.

If you think aspiration has occurred, stop the feeding immediately, make sure you are sitting up and your airway is clear, and call for medical help.

Regurgitation is when food from the stomach comes back into the feeding tube. If regurgitation occurs, the feeding schedule may need to be adjusted. It may be helpful to use a smaller feeding tube and to sit upright or raise the head of the bed during the feeding and for at least 60 minutes after. Medicines may also be given to increase the muscle contractions in the gastrointestinal tract. Nausea and vomiting may occur if you are sick or too full, or the feeding is given too quickly.

To prevent vomiting, start the feeding at a slow rate and then increase to the desired rate. When feeding, it may be helpful to sit up or have the head of the bed raised. The healthcare team may recommend using a different formula, such as a lactose-free formula. You may experience gas or bloating if the feeding is given too quickly. If this happens, decrease the feeding rate or stop the feeding and then restart at a slower rate after a few hours.

Your healthcare team may recommend using a low-fat formula. Being more physically active may also help to reduce gas or bloating. Dehydration can be caused by vomiting, diarrhea and excess sweating. Signs of dehydration include a dry, sticky tongue, sunken eyes, cracked or dry lips, thirst or a small amount of dark yellow urine.

When you are on tube feeds, you may not have the same bowel patterns as when you were eating. To prevent constipation, make sure the recommended amount of water flushes are given and try to be as physically active as possible each day.

Your healthcare team may recommend a different formula, more water or medicines to help manage constipation. You may experience a dry mouth. Rinsing your mouth often may help. Check with the healthcare team about chewing gum or sucking on mints.

Crushing medicines to a fine powder and dissolving them in a small amount of warm water will also help. Contact the healthcare team if the feeding tube becomes blocked. If warm water does not unclog the tube, special enzymes may be needed. If the tube cannot be cleared, it may need to be replaced. Dumping syndrome occurs when food moves too fast from the stomach into the small intestine. To prevent dumping syndrome, give formula at room temperature and increase the feeding rate gradually. If you experience diarrhea, sweating and flushing after eating, contact the healthcare team.

The feeding rate may need to be reduced. Try to prevent the feeding tube from falling out by always checking the position of the tube before feeding or giving medicines and measure the length of the feeding tube outside of the body to make sure it is the correct length.

If the feeding tube falls out, it will need to be replaced. Contact the healthcare team immediately or go to the emergency department since the tube can be replaced without the full procedure needing to be repeated if caught in time. To prevent fluid from leaking around the tube, make sure to use the correct flow rate and volume of formula.

Frequently flush the tube with water to avoid a blocked tube. Make sure the tube is securely taped to prevent pulling on the stoma. If leaking occurs, check to see if the tube is blocked or if the tube has moved out of position. Contact the healthcare team if the tube if blocked or has moved out of position. The skin around the tube or stoma site may become irritated or infected. Keep the skin clean and dry and cover with a dressing. Clean the skin daily with soap and water.

If a skin infection occurs, call the healthcare team. Signs of skin infection may include red, hot and swollen skin, discharge from the stoma, pain around the stoma, fever or a bad smell around the stoma.

If the feeding tube comes out, clean the skin around the stoma and apply a sterile dressing. Parenteral nutrition sometimes called total parenteral nutrition, or TPN provides fluids and essential nutrients directly into the bloodstream through an intravenous IV catheter. The nutrients do not go through the GI tract.

Parenteral nutrition is used if you: Parenteral nutrition is prepared by a pharmacist. A doctor and dietician usually work closely with the pharmacist to make sure that the parenteral nutrition solution meets your specific nutritional needs.

Blood tests will be done to check the levels of potassium, sugar, sodium and other substances in your blood. Parenteral nutrition is usually started in the hospital as a non-stop infusion over a hour period. This virtual lab is an introductory course for undergraduate students and deals with the storage and retrieval of data from different biological databases like Gene, Pubmed, GEO, TAIR, Prosite etc. The exercises mainly deal with the different algorithms in sequence alignment and provides a computational exploration to the use of various tools used for sequence alignment.

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Care of the feeding tube and surrounding skin