Specialized G/J Tube Training Developed according to MAP policies by Judy Spencer RN North Shore ARC
G-tube Training Feeding and Medication Administration Through a G-Tube
Objectives The 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
Purpose of the G-Tube To ensure : • Normal growth and development • Maintenance of health and wellness
Candidates for a G - Tube • Unable to meet nutritional requirements
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
Overview of Various types of Feeding. Tubes 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
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
Overview of Various types of Feeding. Tubes 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
Different Types of Tube Feedings • Intermittent gravity • Continuous/Pump • Syringe bolus
Intermittent gravity tube feeding • Given by bottle or bag • Hooked to a feeding tube set • Administer at specific times of the day
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
Syringe Bolus Tube Feeding • Given via a syringe • Administered at specific times
Preparation of Tube Feeding • Check the formula label • Shake container well • Wipe the top of the can • Check the expiration date
Administration of Bolus Feedings • • • Check HCP orders Gather equipment Wash hands Don clean gloves Explain procedure
Administration of Bolus Feedings • • Position individual appropriately Connect extension tubing Check for residual /placement Replace residual and clamp tube
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
Administration of Bolus Feedings • Flush extension tubing until clear & clamp • Disconnect the extension set • Reinsert plug • Keep individual upright for 1 hour
Administration of Bolus Feedings Upon completion of feeding: • Document procedure and individual’s tolerance • Clean equipment with warm soap and water • Dry and store equipment
Administration of Medication via a G - tube • Wash hands • Prepare medications per MAP regulations & policies • Assemble equipment • Explain procedure to individual
Administration of Medication Via G- tube • • • Position individual appropriately Don gloves Connect extension tubing Check for residual /placement Replace residual and clamp tube
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
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
Administering Medications To ensure proper flow you should give: • Liquid medicines first • Medications that need to be dissolved second • Thick medications last
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
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
Mouth Care Maintain oral hygiene • Brush teeth after each meal • Lubricate lips as needed • Dental care as directed
When to Stop the Administration of Feedings &/or Medications • Nausea/vomiting • Coughing/choking • Difficulty breathing • Abdominal or chest pain • Formula observed in mouth
Observe/Report the Following Potential Complications: • Abdominal distention • Discomfort/fullness/gas • Constipation • Diarrhea • Fever • Wheezing, gurgling, or whistling • Change in behavior
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
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