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In a decision, the California Supreme Court ruled that a patient's tube feedings could not be discontinued under the circumstances of the Wendland v. Did my first bolus feeding without medical supervision. We give him med or water every 4 hours…Does that all sound right? This provides about 25 ml of water per kilogram of his body weight which falls in line with what is recommended. Enteral tube feeding administration can be accomplished by one of several different feeding schedules. Thanks for your question, Arlene!
Drieling tube a double-lumen tube having a metal weight at one end to carry it past the stomach into the duodenum. At the other end are two tails, one used to collect gastric specimens and the other to collect specimens from the duodenum. The tube is used in the secretin test for pancreatic exocrine function.
Durham's tube a jointed tracheostomy tube. It can be used as the only source of nutrition or as a supplement to oral feeding or parenteral nutrition. Patients who may require tube feeding include those unable to take in an adequate supply of nutrients by mouth because of the side effects of chemotherapy or radiation therapy, those with depression or some other psychiatric disorder, and those suffering from severe hypermetabolic states such as burns or sepsis, or malabsorption syndromes.
Other conditions that may require tube feeding include surgery or trauma to the oropharynx, esophageal fistula, and impaired swallowing such as that which occurs following stroke or that related to neuromuscular paralysis. There are commercially prepared formulas for tube feeding. Some contain all six necessary nutrients carbohydrates, fats, proteins, vitamins, minerals, and trace elements and need no supplement as long as they are given in sufficient volume to meet nutritional and caloric needs.
Other types of tube feeding formulas are incomplete and therefore will require some supplementation. Choice of formula is based on the patient's particular needs, presence of organ failure or metabolic aberration, lactose tolerance, gastrointestinal function, and how and where the feeding is to be given, that is, via nasogastric, gastrostomy, or enterostomy tube. In addition to frequent and periodic checking for tube placement and monitoring of gastric residuals to prevent aspiration, other maintenance activities include monitoring effectiveness of the feeding and assessing the patient's tolerance to the tube and the feeding.
Special mouth care is essential to maintain a healthy oral mucosa. A summary of the complications related to tube feeding, their causes and contributing factors, and interventions to treat or prevent each complication is presented in the accompanying table.
Levin tube a gastroduodenal catheter of sufficiently small caliber to permit transnasal passage; see illustration. Two types of nasogastric tubes. From Ignatavicius et al. Linton tube a triple-lumen tube with a single balloon used to control hemorrhage from esophageal varices. Once it is positioned under fluoroscopic control and inflated, the balloon exerts pressure against the submucosal venous network at the cardioesophageal junction, thus restricting the flow of blood to the esophageal varices.
Miller-Abbott tube see miller-abbott tube. Minnesota tube a tube with four lumens, used in treatment of esophageal varices; having a lumen for aspiration of esophageal secretions is its major difference from the sengstaken-blakemore tube. Rehfuss tube a single-lumen oral tube used to obtain specimens of biliary secretions for diagnostic study; it is weighted on one end so that it can be passed through the mouth and positioned at the point where the bile duct empties into the duodenum.
See also biliary drainage test. Salem sump tube a double-lumen nasogastric tube used for suction and irrigation of the stomach. One lumen is attached to suction for the drainage of gastric contents and the second lumen is an air vent. Sengstaken-Blakemore tube see sengstaken-blakemore tube. T-tube one shaped like the letter T and inserted into the biliary tract to allow for drainage of bile; it is generally left in place for 10 days or more in order to develop a tract through which bile can drain after the tube is removed.
A T-tube cholangiogram is usually performed prior to removal of the tube in order to determine that the common duct is patent and free of stones. If stones are found they can be removed through the tube tract by instruments inserted under x-ray guidance.
See also chest tube. Called also tympanostomy tube. Polyethylene tubes are inserted surgically into the eardrum to relieve middle ear pressure and promote drainage of chronic or recurrent middle ear infections. Tubes extrude spontaneously in 6 months to 1 year. Wangensteen tube a small nasogastric tube connected with a special suction apparatus to maintain gastric and duodenal decompression.
Whelan-Moss T-tube a t-tube whose crossbar tube is larger in diameter than the drainage tube. When suitable potential is applied, electrons travel at high velocity from cathode to anode, where they are suddenly arrested, giving rise to x-rays. The conditions for which tube feeding is administered include after mouth or gastric surgery, in severe burns, in paralysis or obstruction of the esophagus, in severe cases of anorexia nervosa, and for unconscious patients or those unable to chew or swallow.
Also called esophageal feeding, gavage feeding, jejunostomy feeding , nasogastric feeding. See also drip gavage , enteral tube feeding. Administering nutrition or other fluids by means of a tube inserted directly into the enteral tract. Thank you for your help.
Thanks for your question, Arlene! It all depends on his tolerance. You could increase each feeding gradually to test it, for example start out with 2. If you absolutely need to reduce the number of feeds to 2 per day, maybe you could still do the 3 feeds a day on some days, alternating between the 2 schedules. My husband is age 77 , bedridden,has dementia from closed head trauma due to accident in Navy. I feed him via a PEG tube. For years we gave Jevity 1. A nurse suggested we switch to Two Cal HN twice a day.
I believe he has lost weight on the Two Cal. When we feed and the amount of water given is in direct correlation to the suctionings due to phlegm in his throat. Bolus is 60ml water before, 60ml feed, 60 ml after. We wait 1 to 2 hrs between feedings until the ml can of Two Cal is gone.
We give 2 cans a day. Is that enough feed and are we giving the feed and water too fast and too often? Hi Mary, thank you for your question! With the difference in treatment plans you mention, there is a deficit of calories daily. Over time this could have led to weight loss. Was there a specific reason the change was made? He is also getting significantly less fiber. How are his bowel habits? For more calories, you could add an additional half-can of the Two Cal HN in another feeding or you could try going back back to the the 3 cans of Jevity 1.
Another option would be to syringe in a liquid protein supplement, such as Promod, which would contribute an additional calories and 10 grams of protein. I watch a 18 month old with a Mickey button. All his fluids are given through his tube, but he consumes most food orally. We give him 4ozs of pediasure at a time, every hours. I was taking my time pushing them, but his mom just pushes it all straight in, in a matter of about 2 minutes.
I started doing this as well. Thank you in advance! Hi Heather, thanks for your question! Watch for signs of intolerance, such as nausea, vomiting, abdominal distension or fussiness. My mom 93 years old was order 40cc of g-tube feeding. The Kangaroo feeding machine was ordered. The machine arrived and the hospital expected the private CNA to assemble. The nurse cane out and gave my mom cc through via Bolus at one time.
The next day cc although the doctor ordered 40cc per hour. A week before she had fluid removed from her lungs and scar tissue had developed.
Rushed her hospital discovers fluid had build up again in her lungs. I believe it was from the Bolus feedingof at on time which created more fluid. I am seeking answers as we speak. I am unclear what to do but I believe both times the Bolus created the problem. The additional fluid buildup in her lungs was probably more related to her medical condition than the feeding, but her pulmonary doctor should be able to explain the situation.
Our thoughts are with you, I hope she gets better! My husband has just been given a gtube still in hospital. Hi Charlotte, thank you for your question!
Make sure they send you home with written instructions for the feeding plan, including water flushes. Choose a medical supply company that has a registered dietitian. Read up before he comes home. Here are some articles to start with: In addition to support from your healthcare professionals and medical supply company, check out the Oley Foundation for information, tips and support from others who care for someone with a tube or who have a tube themselves.
My 37 year old daughter, Natalie, was born with severe cerebral palsy and is now a pounds nonverbal quadriplegic. She has had a gtube for 3 months and we are still trying to adjust her feedings so my husband and I can sleep through the night. Jevity upset her stomach in the hospital, so they changed her to Vital. She was prescribed 5 Vital cartons along with ml water daily.
We have tried 3 feedings of 1. Testing for residual dictates we must wait hours between feedings. Natalie requires miralax, dulcax, and fleet enemas for her bowel to act every other day. Her abdomen remains distended. I am so frustrated and worried I am not doing what is best for Natalie! I would appreciate any suggestions! I have lots of questions to to try and get to the bottom of this. Is your daughter on anything for gas? Ask her doctor if this might help. Is she having regular soft bowel movements?
If not, maybe her bowel regimen needs to be adjusted. What amounts are you pulling out when you check residuals? Is her abdomen distended all the time or just after feedings?
How long does it take you to administer each feeding? The higher or lower from her stomach, the faster or slower it will go. You might also check in with the doctor to see if she needs to be seen or change something about her medication regimen. I am a support worker and have a client who is gravity peg fed…. I would like some advice if possible. Hi Lynn, thank you for your question! The total fluid he needs daily depends on several factors, such as weight, age and medical conditions.
The amount he can tolerate at one time probably varies but you can think about it like this: Most people might not feel great after downing this amount of liquid quickly. She was eating before this happened modified. She is non verbal so it is hard to know can I flush a pureed bannana in with ensure maybe it will help and other foods if goes through tube? Hi there, thank you for your question.