water diet nhs

hi, my name is katelynn maniatis and i'm a registered dietician here at sunnybrook. over the next few minutes, we'll be discussing methods of insertion, benefits, care and feeding of g tubes. the gastrostomy, or g tube, is a

water diet nhs, feeding tube that goes through the skin and abdominal wall and allows liquid nutrition and medications to be administered directly into the stomach. g tubes provide a route to deliver nutrition and medication

to people who are having difficulty swallowing or cannot take enough food by mouth. g tubes help prevent weight loss, maintain nutritional status and minimize risk of aspiration. individuals with cancer, als, or those who have had a stroke or trauma often require g tubes. oral intake is encouraged even after g tube insertion. g tubes can provide liquid nutrition formulas as either a sole source of nutrition or to supplmement oral intake.

g tubes may be placed by gastroenterology or interventional radiology. gastroenterology will insert a percutaneous endoscopic g tube or a peg tube using an endoscope which travels through the mouth, down the esophagus and into the stomach to aid tube insertion. interventional radiology will use x-ray technology to aid in the insertion of the tubes. g tubes can inserted on an inpatient or outpatient basis. before your g tube is inserted, you'll be advised not to have

anything to eat from midnight before the night of the procedure. following tube insertion, you'll be instructed to either drink clear fluids, such as water or apple juice, or be provided with iv fluids to maintain hydration. following an abdominal exam by your physician, you'll be able to begin using the g tube and resume oral intake of regular solid foods if appropriate. if swallowing function improves, or risk of aspiration is minimized, transitions can be made back to oral

intake. tubes can be removed, and the removal procedure will vary depending on the method of insertion. clean the skin under the tab and around the tube everyday for the first five days after insertion with a q tip dipped in chlorhexidine. imagine the q tip is the arms of a clock and clean in a clockwise manner around the tube. after these first five days, you can dip the q tip in benadine

and this cleaning should be done once per day. when you're in the shower clean the skin around the tube with a mild soap and water and ensure that you're drying the area completely when you're done. do not take baths and gauze dressing is not necessary unless you're having drainage from that tube site. clean the tube and stoma site daily. wash your hands thoroughly completing any tube checks and make sure you're gently lifting the sides of the tube to examine the skin around the area. signs of infection include fever,

redness, tennderness and any discharge that may be discolored or foul smelling. secure the free end of the tube with tape on the abdomen or with a stretch gauze band. check to see if the mark on your skin is at the same point as it was when it was initially placed. do not pull on the tube because it can dislodge. certain tubes inserted by interventional radiology have an anchoring device that require sterile water to fill them up and ensure that your tube remains in place. the amount of water required to inflate the anchoring device

is indicated on a port that's directly on the g tube. there are two methods that can be used when feeding through the g tube: syringe feeding and feeding by gravity. remember to sit in an upright position when feeding and for 30 to 45 minutes after feeding to prevent regurgitation. the first step is to wash your hands. next, fill the syringe with 60ml of lukewarm water. strain out the feeding tube and check tube placement. the mark on the tube should be the same place as when it was placed initially. hold the tube

above stomach height or pinch the tube and open the stopper or tube tip. place the tip of the syringe into the end of your feeding tube and plunge the water through the tube. cap the tube tip. now you're ready to set up your feeding set. the first step is to shake the formula well. wipe off the top of the can with a clean damp paper towel and don't forget to check the expiration date. close the roller clamp so roll the clamp down. pour the desired amount of formula into the bag and hang it above

head level. remove the plastic cover from the tip of the feeding set and insert the tip of the feeding set into the feeding tube. open the roller clamp, or roll it up to start the feeding. you can adjust the rate the feed runs through by opening the opening or closing the rolling clamp. at the end of feeding close the roller clamp and disconnect the feeding set from the feeding tube. finally, flush your tube with 60ml of lukewarm water and close the feeding tube.

you would follow the same steps to flush your tube with water the next step is to fill the syringe with formula the same way you would with water. open the tube tip and place the tip of the syringe into the end of your feeding tube and slowly push the formula in. refill the syringe until you've had the desired amount of feed. after feeding, run another 60 ml of lukewater water through the tube to flush it clear. hold the tip above stomach level or pinch

and disconnect the syringe from the tube. close your feeding tube. medications can be administered through the feeding tube, but just check with your pharmacist to ensure your medications are crushable and don't require liquid form, which may also be available. ensure that you're flushing with water before and after medication administration and don't mix the medications with feeding formula. after feedings, clean the syringe parts with warm

soapy water and let them air dry. a bottle brush may be useful for syringes. once per day soak the syringe parts as well as the feeding set in a mixture of a quarter cup of vinegar and one cup of water for five minutes. rinse with fresh water and ensure that you're allowing this fresh water to run through the tubing of the feeding set. store these supplies in a container or a ziplock bag in the fridge to decrease the risk of bacterial growth.

do not put substances other than medications or tube feeding formulas into the tube as they may cause blockage. sometimes, medications and feeding formulas can get stuck in the tube and cause blockage. this is why you want to ensure that you're always flushing the tube. if you do see some build up in the tube when you're flushing, try and apply a bit more pressure with that syringe. if that doesn't work, contact your healthcare professional.

don't pull on the tube because it can fall out. if it does, it needs to be replaced as soon as possible. clean the area and cover with a sterile gauze pad and come to hospital as soon as possible. always sit upright in a chair or in bed when feeding. cover your formula cans and store then in the fridge for up to 24 hours after they have been opened. if you have a feeling or uncomfortable fullness or bloating, slow down

the rate of feeding. if you're using a feeding set, roll the roller clamp to decrease the rate and if you're syringe feeding, slow down the rate that you're pushing through the formula. for more information, speak with your registered dietitian or visit the clinical nutrition section of the sunnybrook website.