Managing Feeding Tubes
Most ALS patients at some point lose the ability to swallow food safely. This is when a feeding tube can be helpful. A feeding tube can allow you to receive the calories, water and medicine you need without having to worry about choking.
It may seem hard at first, but in time you will be able to better manage the feeding tubes. This information can help you on your way. Here are some tips and advice for tube feeding or caring for someone who is tube-fed.
Cleaning the tube
After each use, the tube should be flushed—whether you are giving a nutritional feeding or dose of medicine. The tube is always flushed with water and may be followed with about 1/4 cup of cleanser. Viokase is a product used as a routine gastric tube cleanser. It is available by prescription.
Avoiding dumping syndrome
In the beginning, the liquid feeding should take about 15 to 20 minutes or more. This slower pace helps to prevent problems, such as stomach cramps, regurgitation, and diarrhea. If feedings are too fast, dumping syndrome can occur. Symptoms can include:
Dumping syndrome may be lessened by doing the following:
Caring for the insertion site
The insertion site on the abdomen (around the feeding tube) should be cleaned with hydrogen peroxide. A cotton Q-tip or gauze can be used. An ointment or solution may be placed at the site until it is healed. A small dressing may be placed around the opening to absorb the small amounts of secretions that tend to ooze out on the skin.
Checking for infection
On rare occasions, stomach juices will leak into the abdominal tissues and infection may result. You should press around the opening with your finger to check for any secretions that might look like pus. Call your healthcare provider if you see any white or yellow pus-looking secretions.
Caring for the outer tube
The feeding tube should not be too long. If it is too long, the length and weight of the outer tube will pull on the opening and be uncomfortable. Sometimes it is helpful to tape the tube to the abdomen with hypoallergenic tape. You may take a shower, but should not submerge the opening in bathtub water.
Replacing the tube
The tube may need to be replaced if it stops working or the parts wear out. Some tubes can be replaced by a nurse or caregiver, but others must be reinserted in a hospital setting. Your healthcare provider will tell you how to replace the tube and how often it should be done.
What do I put down the tube?
If your tube is the type that ends in the stomach, anything you can get down the tube is all right. That includes all drinks, blenderized thinned soups, and crushed medicines. Check with your pharmacist first. Some medicines can’t be crushed, and will clog the tube. If the feeding tube ends in the intestine (jejunum), a predigested product may be preferable to lessen dumping syndrome. Normally, a formula such as Jevity is well-tolerated.
Usually, a registered dietitian will give you exact directions as to the kind and amount of feedings. Feeding should begin slowly and build up the amount according to your tolerance. You may take several days or even a week or so to tolerate the feedings without symptoms such as diarrhea, flushing, and perspiration. Occasional blood tests may be needed to check your nutritional status.
Here are a few methods of giving nutrition through the feeding tube:
Kangaroo bag/gravity method. This method uses a plastic bag connected to a long piece of extension tubing. This tubing is then attached to the feeding tube. The liquid flows via gravity into the stomach. The bag can be hung on a hook, an IV pole, or anything else that is stable and approximately 18 inches higher than the stomach.
Kangaroo bag/pump method. This method is basically the same procedure as above, except that instead of letting the liquid flow by gravity, it flows through a pump at a rate you set. This method is always used with J-tubes which require a slower rate of infusion and are more problematic. You can also use a simple funnel for introducing liquid down the tube.