Tube Placement

Final confirmation of tube placement is considered mandatory and the method used is radiographic confirmation. Other methods can be used before radiographic testing to reduce the number of radiographic tests that might be required, including pH of gastric aspirate or listening for sounds when air is introduced through the tube for gastric placement. Routine testing to check on the tube placement is important to assure that it maintains position. Marking and monitoring the external length of the tube is one method. Others include monitoring residual volumes for unexpected changes and measuring pH of aspirates. In some cases, chronic problems with displacement may lead to longer term tube feeding placements. Enterostomies are used in longer term feedings and are indicated if the need for tube feeding is at least 4 weeks. These can include endoscopic, laparoscopic, fluoroscopic placements of tubes through a stoma. A fairly common placement is a percutaneous-endoscopic gastrostomy or PEG. Tubes may also be placed in the jejunum (PEJ) or as a gastrojejunostomy (PEGJ), which is a jejunal tube that is placed via a gastrostomy. Careful maintenance of the enterostomy is required to prevent several complications. Whatever the tube placement, confirmation is mandatory!

Patient/Caregiver Education

There are several categories and types of patient and caregiver education that can be provided which will help to equip them when implementing home tube feeding. Basic background information includes both general and patient-specific information about enteral nutrition, as well as guidelines for safe home administration. Specific instructions on the type of tube and pump (or other equipment) can help to prepare the patient and caregiver for routine tasks specific to their needs. A daily log may be provided to assist in the routine care and maintenance of the equipment, formula, and prevention of complications and conditions that may occur.

Routine care and maintenance should be covered and includes tube placement, formula preparation and storage, formula administration, residual checks, and body care around the tube to prevent irritation and infections. In addition, patients and caregivers can be instructed on mouth care, including tooth brushing with a soft bristle toothbrush, wiping the inside of the mouth with a damp washcloth, and applying lip balm to keep lips moist.

In some cases, medications may be taken through the tube. In such cases, clear instructions on how to best accomplish that safely, followed by flushing the tube to prevent clogs will be important.

Long-term tube feeding may benefit from instruction and connection to resources for coping with the issues confronted by many patients to integrate tube feeding into their daily lives. In many cases, additional education regarding specific nutrition and medical care for diseases or other conditions may be required.

The Oley Foundation and the American Society for Parenteral and Enteral Nutrition (ASPEN) have a number of patient and caregiver targeted materials that can be used to empower and reinforce patient and caregiver education.[3] The Oley Foundation provides information and support for patients, caregivers, and clinicians involved in home nutrition support. Social workers and other health care professionals can help to connect patients and their caregivers who have long-term home enteral nutrition support needs, with these resources.

3. ASPEN: Information for Patients and Caregivers. Available at: http://www.nutritioncare.org/Information_for_Patients/Information_for_Patients/.