Transabdominal Tube Feeding and Care

Transabdominal Tube Feeding and Care

To access the stomach, duodenum, or jejunum, the doctor may place a tube through the patient’s abdominal wall. This procedure may be done surgically or percutaneously.

A gastrostomy or jejunostomy tube is usually inserted during intra-abdominal surgery. The tube may be used for feeding during the immediate postoperative period or it may provide long-term enteral access, depending on the type of surgery. Typically, the doctor will suture the tube in place to prevent gastric contents from leaking.

In contrast, a percutaneous endoscopic gastrostomy (PEG) or percutaneous endoscopic jejunostomy (PEJ) tube can be inserted endoscopically without the need for laparotomy or general anesthesia. Typically, the insertion is done in the endoscopy suite or at the patient’s bedside. Ultrasound can be used to confirm placement. A PEG or PEJ tube may be used for nutrition, drainage, and decompression. Contraindications to endoscopic placement include obstruction (such as an esophageal stricture or duodenal blockage), previous gastric surgery, morbid obesity, and ascites. These conditions would necessitate surgical placement.

With PEJ tube placement, feedings may begin after 24 hours (or when peristalsis resumes). A PEG tube can be used for feedings within 2 hours of placement in adults and 6 hours in infants and children.1

After a time, the tube may need to be replaced and the doctor may recommend a gastrostomy button—a skin-level feeding tube. Tubes not intended for use as enteral feeding devices, such as urinary or GI drainage tubes, shouldn’t be used because these tubes don’t have an external anchoring device. Use of these tubes may lead to misconnection or tube migration, which may cause obstruction of the gastric pylorus or small bowel.1

Nursing care for patients receiving transabdominal feedings includes providing skin care at the tube exit site, maintaining the feeding tube, administering feeding formula, monitoring the patient’s response to feeding, adjusting the feeding schedule, and preparing the patient for self-care after discharge.

Preparation of Equipment

Always check the expiration date on commercially prepared feeding formulas. If the formula has been prepared by the dietitian or pharmacist, check the preparation time and date. Discard any opened formula within 24 hours of preparation if not used.1

For Continuous Feedings

Commercially prepared administration sets and enteral pumps allow continuous formula administration. Set up the equipment according to the manufacturer’s guidelines. Fill the feeding bag and purge air form the administration tubing. If a prefilled container is available, attach it to the administration set and then purge air from the tubing. Make sure that the feeding bag or container is clearly labeled with a statement such as “WARNING! For Enteral Use Only—Not for IV Use” to prevent administration errors.1

To avoid contamination, hang only a 4-hour supply of reconstituted formula at a time. Sterile, decanted formula can hang for 8 hours. Closed-system formulas can hang for 24 to 48 hours according to the manufacturer’s guidelines.1

For Intermittent Feedings

Prepare the gavage set and administration equipment. Make sure the formula is room temperature. Cold formula may cause cramping.

Jul 21, 2016 | Posted by in NURSING | Comments Off on Transabdominal Tube Feeding and Care

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