Tube Feeding

Feeding Routes

Food travels from the mouth through the pharynx, esophagus, and stomach, then into the small intestine. This process involves peristaltic movement and digestion, enabling nutrient absorption in the intestines.

Most Common Forms of Tube Feeding

NG (nasogastric) tubes go through the nose to the stomach for short-term feeding. G-tubes are inserted through the abdomen. Gastrostomy buttons sit at skin level for long-term access.

Types of Tube-Feeding Formulas

Formulas vary by dietary need: lactose-free (e.g., Ensure), milk-based, elemental for GI issues, or modular (e.g., protein-only). A physician selects the formula based on diagnosis and digestion ability.

Equipment and Adaptive Equipment for Performing Tube Feeding

Equipment includes feeding pumps, PVC or silicone tubes, and gastrostomy buttons like Bard or MIC-KEY. Devices vary by flexibility, shape, and features like anti-leak valves or decompression options.

Instructional Strategies and Modifications for Tube Feeding

Students should be taught to participate in tube feeding steps where possible. Procedures are broken into teachable tasks and adapted based on ability, using prompts, AAC devices, or task analysis.

Tube Feeding Task Analysis (Steps)

Feeding steps include handwashing, preparing formula and equipment, attaching the syringe, pouring formula, and monitoring flow. Each step can be individually taught and tracked to promote safe, independent feeding.

 Time-Limited Steps and Caution Steps

Some steps must be done quickly (e.g., clamping the tube) to prevent harm. Caution steps pose injury risks and may require physical prompts, modeling, or shadowing depending on student ability.

Aspiration

Aspiration occurs when formula enters the lungs, causing respiratory symptoms and risk of pneumonia. Proper tube placement, positioning, and monitoring signs like coughing or rapid breathing are crucial to prevent it.

Tube Displacement

If a gastrostomy tube/button is dislodged, quick action is needed. The tube should be covered, kept clean, and given to a designated adult. Proper taping prevents accidental pulling or snagging.

 Nausea, Vomiting, and Cramping

These symptoms may result from feeding too quickly, air in the tube, or poor digestion. Feeding should be stopped and adjusted. Proper technique and following IHPs help prevent these issues.

Diarrhea

Diarrhea may result from rapid feeding, formula issues, or bacterial contamination. It’s important not to stop feeding without guidance. Parents should be informed, and proper hygiene must be maintained

Site Infection

Infections can occur at gastrostomy sites, especially with prolonged use. Redness, drainage, or odor should be reported. Proper hygiene, drying, and medication are key to prevention and treatment.

 Leaking of Stomach Contents

Leaks may result from poor clamping or faulty buttons. Check the clamp, cap, and anti-reflux valve. If leaking continues, tape the tube and notify parents or physician for further action.

Clogged Tube

Clogs are caused by formula buildup, medications or pills. Regular flushing, proper prep, and avoiding incompatible substances help prevent clogs. Cleaning and monitoring are critical during and after feeding.

Management Issues for Tube Feeding

IHPs and IEPs must include clear feeding steps, emergency plans, and individualized goals. Instructions cover everything from formula prep to cleaning. Daily monitoring and documentation ensure consistency and safety.

Moving to Feeding

Transitioning to oral feeding is gradual and based on physician guidance. Students progress through textures, starting with liquids. Food presentation, stimulation and sensory comfort are crucial for successful oral intake.