Tube feeding at home

Nutricia Homeward: 03457 623632

Abbott Hospital to Home: 08000 183799

Fresenius Homecare: 08081 001990

This information pack has been put together to provide you with general information on tube feeding at home. You will also receive a separate booklet which will explain how to care for your particular tube.

Introduction to tube feeding

What is tube feeding?

Tube feeding (also called enteral feeding) is the name given to a method of providing you with food and fluids when you are unable to eat or drink enough to keep you healthy.

A specially made liquid feed, containing all the nutrients you require, is given to you through a tube placed into your stomach or small bowel. This could be done using a pump overnight, or at intervals throughout the day using a syringe, called bolus feeding.

Some people may also be able to eat or drink whilst tube feeding. You will be advised by your doctor and dietitian whether you can eat or drink.

How much do I need?

You will be regularly reviewed by the dietitian who works out your nutritional needs and selects the most appropriate feed for you. Your dietitian will discuss with you and devise a plan of when to feed and which feed best suits you.

Where do I get my feed?

When you leave hospital you will go home with eight days’ supply of feed and equipment, including the feeding pump if needed. Your dietitian and the nutrition nurse specialists will arrange for further supplies to be delivered to your home by one of three companies. The company used will depend on where you live and where your GP is located, you will be told which company you will use before you go home.

If you have not had contact from one of the companies and are running low of feed and equipment, please contact your dietitian or the nutrition nurse specialists.

All the numbers you will need can be found in the ‘useful contacts’ section below.

What support is available at home for Cambridge patients?

Dietitian

Based at Addenbrooke's, your dietitian will regularly review how much feed you require. If you are unable to come to hospital to be seen in clinic, you may be visited at your home.

Nutrition nurse specialists

Based at Addenbrooke's, these registered nurses offer advice and support on all tubes and exit sites.

Nutricia homeward nurse

Employed by Nutricia, these registered nurses are your main point of contact at home. They will visit you when you are discharged to make sure you are coping and provide further training if you need it. They can visit you if you have any problems and try to solve them at home to avoid you coming to hospital. They work closely with the nutrition nurse specialists.

Nutricia homeward co-ordinator

The homeward co-ordinator will contact you to discuss your equipment needs for your deliveries.

Nutricia homeward helpline

There is a 24-hour helpline available to help with pump problems. A nurse advisor is available to provide advice over the telephone on any other problem you may have.

GP

Your GP will be involved in writing the prescription for your feed and will send it directly to Homeward. They may also be needed to review your tube, and depending on what type of tube you have they may need to prescribe antibiotics or dressings as you can occasionally develop infections; these are usually very easily treated.

Who should I contact when things go wrong?

• Pump, equipment, delivery problems: Contact Nutricia homeward co-ordinator.
• Feeding problems (eg nausea, vomiting, diarrhoea, constipation): Contact dietitian.
• Tube or exit site problems: Contact Nutricia homeward nurse, nutrition nurse specialists or GP.
• Any problem occurring outside of working hours, or at the weekend: Contact Nutricia homeward helpline.

What support is available for those patients outside of Cambridge?

Dietitian

Based at a local hospital, your dietitian will regularly review how much feed you require. They may be able to review you either in clinic or at home. They will contact you when you are discharged to arrange review.

Nutrition nurse specialists

These nurses can help with any problems concerning your tube or exit site, they are often based at your nearest main hospital. However, some hospitals may not have a nutrition nurse specialist and your dietitian or company nurse will be able to help you with such concerns.

Company nurse

Employed by the company who provide your feed, these registered nurses are your main points of contact at home. They will visit you when you are discharged to make sure you are coping and provide further training if you need it. They can visit you if you have any problems and try to solve them at home to avoid you coming to hospital.

Company co-ordinator

They will contact you to discuss your equipment needs for your deliveries.

Company helpline

There is a 24-hour helpline available to help with pump problems. A nurse advisor is available to provide telephone advice on any other problem you may have (08457 623636).

Your GP will be involved in writing the prescription for your feed and will send it directly to your company. They may also be needed to review your tube, and depending on what type of tube you have they may need to prescribe antibiotics or dressings as you can occasionally develop infections; these are usually very easily treated.

The importance of good hygiene

Why is good hygiene important?

It is important to maintain good hygiene and cleanliness when looking after your tube and setting up your feed. This is to reduce the risk of any harmful bacteria which may cause an infection either at your exit site or give you a stomach bug.

When should I wash my hands?

You should wash your hands before and after you touch your tube, exit site or any other products involved with tube feeding. Use hot soapy water to wash your hands and dry them thoroughly.

Do I need to wear gloves?

If you are looking after yourself, or if a family member is helping, you do not need to wear gloves. Healthcare workers who are looking after other people should apply antibacterial hand gel, wear gloves and aprons to reduce the risk of passing on any infection to you.

How long do I keep equipment?

Syringes

For most people, syringes can be washed out, dried and reused for up to 14 days. They should be stored in a clean, lidded, plastic container.

If you are:

• in a nursing home
• feeding into the jejunum
• having carers
• syringe (bolus) feeding

... you will have one syringe per day. It should still be washed between each use.

Giving sets

Giving sets are the tubes that connect the bag of feed, through your pump to your feeding tube. Giving sets should be thrown away after 24 hours.

Feed

Feed containers and giving sets should be thrown away after 24 hours.

If you are advised to decant your feed into a container, this should be discarded every four hours. (A new container should be used if you need to continue your feed beyond four hours.)

Water flushes

Why do I put water down my tube?

A water flush is given before and after anything is put down the tube. This is to ensure that the tube is clear and working before you start to feed, and to clear the tube after you have finished feeding to prevent it blocking.

Your dietitian may also request that you give some extra water in the day to make sure you have enough fluid and do not get dehydrated.

If you have a nasojejunal tube it is important to give a water flush every four to six hours when you are not feeding to help prevent the tube from blocking.

If you have a nasogastric tube it is important to note that you must always check the pH of your aspirate to ensure positioning before any use of the tube.

How do I give a water flush?

1. Pour some water into a clean cup or glass.
2. Draw up enough water into a 60ml purple syringe.
3. Close the clamp on your tube if needed.
4. Remove the cap from the end of your tube and attach the syringe.
5. Open the clamp and inject the water slowly through your tube.
6. When finished, close the clamp, remove the syringe and reattach the cap.

Can I use tap water?

Tap water can be used for most patients who are feeding into their stomach. However, cooled, boiled water should be used if you are feeding into your jejunum or if you are immuno-compromised (eg having chemotherapy or have had a transplant).

To get cooled, boiled water; boil your kettle and let it cool down. This can be kept in a clean bottle in your fridge for 24 hours.

You will be given advice as to which water you can use.

Pump feeding

What is pump feeding?

This is when you receive your feed slowly through an electronic pump. The pump delivers the feed at a steady rate prescribed by your dietitian, to allow you to feed over several hours.

Why should I use pump feeding?

Pump feeding allows you to receive the feed slowly reducing the risk of nausea and diarrhoea. You can feed overnight or during the day depending on what suits your lifestyle. Your dietitian and the nutrition nurse specialists will discuss this with you to find the option that best suits your needs.

How do I use the pump?

You, or your family or carers, will be given full training on how to use the pump before you go home. If you would like further training please contact your company nurse. Please also refer to your pump instruction booklet for help.

Don’t forget to flush with water before and after your pump feed.

Can I lie down flat if I am feeding at night?

It is important to be propped up at an angle of about 30 to 45 degrees. This helps to stop you feeling sick whilst feeding and to reduce the risk of chest infections.

Use several pillows to help prop you up to the correct angle.

Bolus / syringe feeding

What is bolus feeding?

This is when your feed is given using a syringe at intervals throughout the day.

Why should I use bolus feeding?

Bolus feeding may suit your lifestyle if you are very active. Some people do not like feeding using the pump and use bolus feeding to ‘top up’ their pump feeding or oral intake. Your dietitian can discuss with you the options to best suit your individual needs.

How do I give a bolus feed?

Bolus feeding is given in the same manner as a water flush. However, it is very important that you give the feed more slowly than you would do with water flushes. We recommend that 50ml of feed is given over at least three minutes. This helps to reduce the risk of diarrhoea or any discomfort.

It is important to be propped up at an angle of about 30 to 45 degrees. This helps to stop you feeling sick whilst feeding and to reduce the risk of chest infections.

Don’t forget to flush with water before and after your bolus feed.

Giving medications through your tube

When you are discharged from hospital, you will be told which medications you need and when to take them.

Why should I be careful when giving medications?

Putting medications through your tube can increase the risk of your tube blocking.

What form should my medications be in?

Liquid is best form for medications to go through you tube. However some liquids can be very thick and sticky and will need diluting with water.

Tablets and capsules need to be crushed or opened and mixed with water before you put them in your tube. Some tablets are not suitable to be crushed, for example slow release tablets, cancer drugs or hormone treatment drugs, so alternatives will need to be found.

The best person to talk to if you have any questions about your medicines is a pharmacist who you can find at your local pharmacy, or your GP surgery.

How do I give my medications?

It is very important to follow these instructions as medications can block your tube.

1. Flush your tube with 30ml water.
2. Ensure all medications are prepared separately and are mixed well or thoroughly dissolved in water.
3. Give the medication quickly into the tube and flush immediately with at least 10ml water.
4. Never mix medications.
5. Flush with at least 10ml water between each medication.
6. Flush your tube with 30ml water at the end.

Your dietitian may advise different amounts of fluids depending on individual needs.

Warning – Omeprazole or Lanzoprazole can block the tube entirely. Please do not crush these to put down your tube. There are dispersible forms available, but you need to carefully follow the instructions to help you give it. Please speak to your GP about changing the form to a tablet that can be dissolved under your tongue.

Tube blockages

Please note: If you have a nasogastric tube you must not attempt to unblock the tube as safe position cannot be confirmed. In this instance the tube will require replacement – please refer to your individual replacement plan.

What is a tube blockage?

This is when something, usually medication or feed, blocks your tube with the result that nothing can pass in or out of it.

How do I avoid my tube blocking?

To reduce the risk of your tube blocking, follow these tips:

• Ensure you flush your tube as soon as your feed is finished.
• Ensure all medications are diluted and given properly, and that flushes are given in between each medication.
• Give your regular water flushes as indicated by your dietitian.

Nasojejunal tubes are at greater risk of blocking as they are very long and thin. Ensure you flush with water every four to six hours when not feeding to reduce this risk.

What do I do if it blocks?

If your tube becomes blocked, try the following:

• Massage the tube with your fingers and run your thumb nail along the tube to remove any buildup.
• Try pulling and pushing with the empty syringe, using 20ml of air to loosen the blockage.
• Mix one teaspoon of bicarbonate of soda in a cup of warm water and insert as soon as possible into the tube.

If you are unable to unblock your tube, please contact:

• Your company nurse

Or

• Nutrition nurse specialists for advice during Monday to Friday 08:30 (8:30am) to 16.00 (4pm). Your tube may need to be replaced if it cannot be unblocked.

If you are reliant on your tube for all your feed, fluids and medications you may have to be admitted to hospital until your tube can be replaced.

Never attempt to unblock your tube by inserting something sharp into your tube.

Mouth care

Why is it important?

Although you may not be eating or drinking it is important to keep your mouth and teeth clean to prevent infection or soreness from a dry mouth.

How do I keep my mouth fresh?

Continue to brush your teeth using a toothbrush and toothpaste. You can use a mouthwash if you are safe to drink or if you spit all of it back out. A lip balm can be used to prevent your lips from getting dry and cracking.

Can I have extra water?

Yes, extra water can be given down your tube using a syringe, especially if the weather is hot or you are thirsty. You may notice that you aren’t passing as much urine or it is darker in colour which could indicate you need some more water. If you regularly need to give more water please contact your dietitian for advice.

Do other people feed like this?

Yes, at Addenbrooke's we discharge over 150 people a year with tube feeding.

There is a support group for people with tube feeding called Patients on Intravenous and Nasogastric Nutrition Therapy (opens in a new tab) or PINNT. Family members may also join.

All members receive a quarterly newsletter written by people on tube feeding and a local meeting is held at Addenbrooke's twice a year where you can get to know others who are tube feeding.

You can contact PINNT by email.

Useful contacts

Cambridge patients

Dietitians

01223 216655 Monday to Friday, 09:00 (9am) to 17:00 (5pm).

Nutrition nurse specialists

01223 216037 Monday to Friday, 08:30 (8:30am) to 16:00 (4pm).

Nutricia out of hours helpline

08457 623636 24 hours a day.

Outside Cambridge

Dietitian

Available Monday to Friday, 09:00 (9am) to 17:00 (5pm).

Company nurse

Available Monday to Friday, 09:00 (9am) to 17:00 (5pm).

Abbott out of hours helpline

08000 183799 24 hours a day.

Fresenius out of hours helpline

08081 001990 24 hours a day.

Nutricia out of hours helpline

084576 23636 24 hours a day.