Specialized G/J Tube Training

1. SpecializedG/J Tube Training Developed according to MAP policies by Judy Spencer RN North Shore ARC

2. G-tube Training Feeding and Medication Administration Through a G-Tube

3. ObjectivesThe participants will demonstrate understanding of : • The purpose of G-Tube • The equipment • The procedure for feeding and medication administration • Placement and troubleshooting • Site care and maintenance

4. Purpose of the G-Tube To ensure : • Normal growth and development • Maintenance of health and wellness

5. Candidates for a G - Tube • Unable to meet nutritional requirements

6. Reasons for inability to swallow safely may include: • Stroke • Dementia (e.g. Alzheimer's disease) • Medication side effects (dry mouth, motility problems) • C.P. • Muscular Dystrophy

7. Overview of Various types of FeedingTubes Gastrostomy (G-Tube) • A flexible tube or button • Placed into the stomach • Through an opening in the abdominal wall • Provides feeding/ medication administration • Provides venting & drainage

8. The Mic – Key *Low Profile G -Tube • Inserted into stomach through the abdominal wall • Inflatable balloon • External base • Anti – reflux valve • Individual measured to ensure correct size

9. Overview of Various types of FeedingTubes Jejunostomy Tube ( J – Tube) • Placed in the jejunum (middle section of the small bowel) • Through an opening in the abdominal wall or • Through a specific port on a G – tube • Provides food and liquids directly in the jejunum

10. Different Types of Tube Feedings • Intermittent gravity • Continuous/Pump • Syringe bolus

11. Intermittent gravity tube feeding • Given by bottle or bag • Hooked to a feeding tube set • Administer at specific times of the day

12. Continuous Tube Feeding • Given by a bottle , bag or pump • Hooked to feeding set • Administered: around the clock or at specific times over a set time

13. Syringe Bolus Tube Feeding • Given via a syringe • Administered at specific times

14. Preparation of Tube Feeding • Check the formula label • Shake container well • Wipe the top of the can • Check the expiration date

15. Administration of Bolus Feedings • Check HCP orders • Gather equipment • Wash hands • Don clean gloves • Explain procedure

16. Administration of Bolus Feedings • Position individual appropriately • Connect extension tubing • Check for residual /placement • Replace residual and clamp tube

17. Administration of Bolus Feedings • Flush with warm water • Pour feeding into syringe • Hold syringe approximately 8 – 10” above button • Infuse slowly • Avoid air entering tube

18. Administration of Bolus Feedings • Flush extension tubing until clear & clamp • Disconnect the extension set • Reinsert plug • Keep individual upright for 1 hour

19. Administration of Bolus FeedingsUpon completion of feeding: • Document procedure and individual’s tolerance • Clean equipment with warm soap and water • Dry and store equipment

20. Administration of Medication via a G- tube • Wash hands • Prepare medications per MAP regulations & policies • Assemble equipment • Explain procedure to individual

21. Administration of Medication Via G- tube • Position individual appropriately • Don gloves • Connect extension tubing • Check for residual /placement • Replace residual and clamp tube

22. Administration of Medication via a G- tube • Flush tube with warm water • Dissolve medication in warm water • Pour medication into syringe • Rinse med cup with water and administer • Allow to flow slowly by gravity • Flush tube with warm water & clamp

23. Administration of Medication via a G- tube Following medication/flush: • Disconnect the extension set • Reinsert plug • Keep individual upright for 1 hour • Document procedure & observe

24. Administering Medications To ensure proper flow you should give: • Liquid medicines first • Medications that need to be dissolved second • Thick medications last

25. Do’s and Don'ts Do: Prepare/administer medications separately Deliver medication slowly & steadily Flush G-Tube after: checking placement feeding/meds Do not: Force medication or fluid into the tube Mix medication with feedings

26. G – Tube Site Care • Cleanse site with mild soap and water • Keep area clean & dry • Observe the site for: Redness Swelling Warmth Drainage/leakage Bleeding Unusual color or odor • Check site for granulation tissue

27. Mouth Care Maintain oral hygiene • Brush teeth after each meal • Lubricate lips as needed • Dental care as directed

28. When to Stop the Administration of Feedings &/or Medications • Nausea/vomiting • Coughing/choking • Difficulty breathing • Abdominal or chest pain • Formula observed in mouth

29. Observe/Report the Following Potential Complications: • Abdominal distention • Discomfort/fullness/gas • Constipation • Diarrhea • Fever • Wheezing, gurgling, or whistling • Change in behavior • change in behavior

30. Troubleshooting Potential Complications • Accidental tube removal cover hole (stoma) with gauze notify the nursing beeper immediately • Tube/Button clogged check for kinked tube flush with warm water milk tubing notify nursing beeper if unable to unclog • Migration/Displacement notify nursing beeper