Patient Checklist

 

A change in tube length could indicate tube displacement. If the health care professional deems the movement to be minor, adjustment by the patient or caregiver may be possible. For instance, if it is too short, it may be gently pulled to the correct length. If it is too long, in some cases it may be gently pushed in ½ inch to an inch. However, if it cannot be adjusted, feeding should be discontinued and the physician should be notified.

If the tube is disconnected from the port, it may be cleaned and reconnected. If this is an ongoing problem, there may be a need to notify the physician.

Tube displacement can be a common occurrence. Securing the tube may help to prevent this problem. The tube length should be checked before each feeding. This can be done if the tube is marked at 1 inch from the entry point. A tube attachment device can be used, or the tube can be carefully taped to the patient’s nose or cheek (for nasally-placed tubes) or the abdomen or clothing for stoma-placed tubes. There are also undergarments that are specially designed to secure tubes for active patients. Excessive or accidental pulling of the tube, persistent vomiting, or gastric balloon deflation can lead to tube displacement.

Signs of this problem may include obvious tube displacement or even a tube that is completely out of the body. Other symptoms may include choking and difficulty breathing, nausea, vomiting, and abdominal pain.

If this occurs, feeding should be stopped. If a nasally-placed tube is curled in the back of the throat, it will be important to gently pull the tube out from the nasal passage (the point of entry) and not through the throat. An enterostomy tube that is displaced should not be removed, and if the tube has completely fallen out, the tube should be replaced using aseptic technique. It also may be worth inserting a tube while calling the physician to assure that the stoma doesn’t close. Displacement should be reported and resolved quickly.

     feeling better

     call the doctor

 

Vomiting can be caused by a number of factors, including formula intolerance, mechanical problems, medication side-effects, gastrointestinal dysfunction, stress, coughing, and intolerance to orally consumed foods.

The problem may be prevented in some cases by assuring that the upper body is elevated during feeding, as feeding rates and volume are increased slowly while monitoring carefully for symptoms. In some cases, switching formulas may be required. As always, good sanitary technique to reduce the risk for formula contamination will be important. The hang time recommendations for formulas should be followed, not exceeding 8-12 hours maximum. Refrigerator temperatures should also be carefully observed for storage of prepared formula. As discussed on the previous slide, tube placement should be checked as a displaced tube can lead to the problems of nausea and vomiting. The patient/caregiver and clinician should be made aware of any medication side effects that includes nausea and vomiting. Anti-emetic medications should be given at least a half-hour to an hour before feeding so that they can adequately take effect. Care should be taken to consider the potential for bowel obstruction. Any persistent nausea/vomiting, cough, nasal drip, infection, or sore throat should be reported to the physician for further care. Nausea may require attention to removing sights or odors that may cause a problem, stress management and coping skills should be taught where necessary, and the health care professional should assure that any medications are monitored and taken as prescribed.

Feeding should be stopped and resumed when the patient feels better. In the meantime, especially if the problem continues, the physician should be notified so that any appropriate interventions can be taken to prevent further problems, such as dehydration.