Tube feeding is recommended when a person with normal gut function is unable to chew or swallow due to a medical condition or surgery. Tube feeding may also be used for:

The feed may be given in these ways:

a) Continuously

This involves feeding at a slow rate of 50-150 ml/hour over a period of 12 to 24 hours, ensuring the best possible tolerance and absorption of the feed.

b) Intermittently (also known as bolus feeding)

250-400 ml of feed are administered five to eight times a day. This method is preferred for patients who are mobile because it allows more freedom of movement than continuous feeding.

c) Gastrostomy / Jejunostomy feeding

Occasionally, a tube through the nose and oesophagus may not be possible due to various medical reasons. A special tube is then inserted through the abdomen into the stomach (gastrostomy) and jejunum (jejunostomy). The jejunum is part of the small intestine. Management and care of this tube is about the same as a naso-gastric tube except special formulas may be required for better absorption. Check with your doctor or dietitian to see which feed is most suitable.

1. Wash hands thoroughly before preparing the feed.
2. Ensure that all equipment and accessories are clean.
3. The patient should be in a sitting position or raised to an angle of at least 30 degrees while feeding and kept in this position for half an hour after feeding to prevent choking.

• Use boiled water for mixing the feed.
• Always add water to powder.
• Follow instructions carefully and use the correct amount of liquid and powder.

• Check gastric residue before every bolus feed or every two to four hours during continuous feeding.
• If intolerance develops (such as nausea, abdominal cramps, distention or diarrhoea), reduce amount of feeds. After tolerance to feed is established, increase amount of feeds gradually as tolerated.
• Flush the tube with water (e.g. 25-100 ml) after each bolus feed or every three to six hours for continuous feeding to help avoid clogging and to provide additional fluid intake.
  
  

• Check patient’s weight.
• Check blood electrolytes and minerals as indicated by doctor.
• Observe patient for any adverse response to tube feeding (nausea, vomiting, diarrhoea, etc.)
  

• Contamination Of Feeds
  • Change the infusion bag or bottle and feeding tube every eight hours to avoid bacterial overgrowth. For bolus feeding, the syringe should be cleaned after each feed.
  • Any unused, opened formula should be refrigerated directly after opening or reconstituting and discarded after 24 hours. To prevent contamination, do not allow the hanging time of the feed to exceed eight hours.
  • Intermittent feeds are tolerated better if the formula is at room temperature. You can use lukewarm water to dilute the powder but heating on the stove or in a microwave oven is not recommended because it may destroy the vitamins and coagulate the protein.
• Diarrhoea
  • Reduce delivery rate or bolus volume.
  • Reduce strength or volume of formula if decreased rate does not improve tolerance.
  • Review any inappropriate delivery method such as wrong dilution of formula or poor hygiene practice.
• Tube Blockage
  • Avoid administering drugs through the feeding tubes. If this is impossible, ensure that they are in a liquid form or very finely crushed. Flush tube before and after administration.
  • Regular flushing will prevent blockage.
• Dehydration
  • This is usually due to insufficient water intake. Increase additional water via tube flushing. On the other hand, decrease additional water intake if overhydration occurs.

• Liquid, in ready-to-use form.
• Powder which needs reconstituting.

The feed can be in either form but the selection of a tube feeding formula should be based on specific needs and tolerance of the patient. Different formula feeds are available in pharmacies or hospitals. Check with the patient’s doctor or dietitian as to which is most suitable.