M. D. Anderson Cancer Center
Date: November 2009
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Hello! The purpose of this program is to teach you how to use tube feedings while you're receiving cancer treatment. Nutrition is always important, but it's especially so during this time. Good nutrition includes a balance of protein, calories, fluids, vitamins, and minerals. It helps the body heal, fights infections, and helps to maintain overall health. Cancer and cancer treatments affect the body in different ways. For example, they can change how you taste, swallow, or chew your food and can temporarily change how your body uses food. To make sure you receive adequate nutrition, your doctor and your dietitian may recommend that you have a feeding tube placed.
If you don't have the proper calories or proper nutrition, you're going to be falling behind everyday and you're not going to be feeling very well. Cancer treatments often make you feel lousy, and if you don't have enough nutrition and you don't have enough hydration, you're going to feel even lousier and it may even impact or limit the amount of treatment that you can tolerate.
If you're getting chemo or radiation maybe, or even surgery, then your body is going through a lot of trauma. If your body is lacking what it usually needs as a fuel, it will struggle through the treatment.
Even though patients know that a feeding tube will help them, some feel anxious about having one placed.
Just thinking about a tube going into your stomach that whole thought is what made me think that's not for me, I won't need that. I went long after that, maybe halfway into my radiation treatments that I began to have a somewhat unusual reaction to the radiation. I was very nauseous and the radiation doctors determined that the radiation was causing the nausea and the typical medicines weren't alleviating it. At that point, the decision was made and I wholeheartedly agreed and I was ready. Let's get the tube in, and make that eating process easier and get some nutrition in me.
We let them know that it is temporary, in most cases. There are a few patients that may need a feeding tube long term. For most patients, it is a temporary deal until they get over their treatment and the symptoms, which are keeping them from eating and drinking in the first place, improve and then they can slowly wean themselves off the feeding tube and get back to more of a p.o. intake.
The worst part is getting past the stigma that you might have about this feeding tube. What is it, you know, it's got to be some big cumbersome device. Well, I'm wearing one now. It's taped up close and you'd have to really be studying me to see if I had something on the other side of my shirt. Don't get stuck on the stigma, I would focus more, and I'm saying this from experience, on what you need to get through this treatment.
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A feeding tube is a flexible plastic tube that a doctor places into your stomach. Feeding tubes are not painful and are not easily visible under clothing. Before your procedure, you'll meet with the doctor who will place your feeding tube. During this visit, you'll learn about the procedure and what to expect. You may ask questions and discuss any concerns you have. You'll also meet with a dietitian. The dietitian will review your medical history and your current nutrition, discuss your nutritional needs, and the formula that's best for you, and give you information about tube feedings and a feeding schedule. On the day of the tube placement procedure, plan to be at the hospital all day. In addition to having the tube placed, a nurse will teach you how to assemble the tube feeding equipment and will give you your first feeding.
The day after the procedure I see them and it's amazing to me how they come in the first day and they're just wiped out, okay. They get the feeding tube in place and they get a few calories, you know, from the formula they get some water through that tube and the next day they come and they say, “Geez, I feel so much better.” So the adjustment is, you know, very minimal. They don't like the fact that they've got this tube in there, but they understand that in general for the most part, it's going to be temporary and so they're willing to put up with that.
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Before you leave the hospital, the nurse will teach you how to change your dressing. When you return home, you'll do this for seven days. After seven days, you'll no longer need to use the dressing, but you may continue to use it if you feel more comfortable with the area covered. It's important to keep the tube site clean and dry. To change your dressing, follow these steps: Gather all supplies; wash your hands with soap and water; remove and throw away the soiled dressing; using a circular motion, clean the tube site with water and a mild non-deodorant soap such as Ivory; rinse well with water; lift the tube as needed to clean and rinse under it; make sure that you remove all drainage, dried blood, or crust with each cleaning; dry the skin around the tube well; apply a new dressing over the skin at the feeding tube site; secure the tube with paper tape.
So they're usually able to do that for a week. After a week, they don't require to use a bandage any more. Still clean everyday with soap and water around the tube and make sure there is no crusting that develops. You want to make sure you get all the crusting off, which is around the tube, keep the wound as clean as possible. With the tube itself, you know, the tube is fairly robust, it'll last for a long time if you take care of it properly.
It's important to take good care of yourself when you return home. You'll need to follow some guidelines that your medical team will go over with you. For example, you should keep your mouth clean by brushing your teeth every day. You may shower the second day after your feeding tube is placed. If you bathe, keep the water level below the tube site. Because swimming increases your risk for infection, do not swim with a feeding tube in place. Your feeding tube will be in place for at least six weeks before it can be removed.
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Now let's talk about how you and your caregiver will do a feeding at home. First, be sure your kitchen sink and surrounding countertops are clean. Wash your hands with soap and water before preparing to do the feeding. Gather your feeding equipment, which includes water, the bag with tubing, a syringe, and formula. Check the expiration date on the formula. The formula should be at room temperature. If it's refrigerated, take it out of the refrigerator about 30 minutes before you'll use it. Do not microwave the formula. Do not use formula that's been open for more than 24 hours. Un-refrigerated or open formula can spoil. Thoroughly shake the formula before using it. Do not mix the formula with anything such as juice, carbonated beverages, or medicines.
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Before pouring the formula, make sure the roller clamp is all the way down. Pour the formula into your feeding bag. Make sure the formula is smooth with no particles.
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Hang the prepared bag on the IV pole. Squeeze the chamber on the top and let it fill to the line. Let the formula flow continuously through the tubing by adjusting the roller clamp that is attached to the bag. Stop the flow when the formula is at the end of the tubing. Fill your syringe with at least 30 milliliters of water. Make sure that the tube is closed before opening the end cap. Depending on the type of tube you have, there are three ways of closing it - by pinching, by clamping, or by turning the stopcock to the off position. Connect the syringe to your feeding tube, then open your feeding tube, flush the water through. This helps the formula flow freely through the tube. Close the tube and remove the syringe. Connect the feeding bag to your tube. Open your feeding tube to allow the formula to flow into the tube. Adjust the roller clamp to a rate that is comfortable for you. To do this, roll the clamp up for a faster drip and down for a slower drip. The formula should drip at about one drop per second. Be careful because if the formula is given too fast you may experience nausea, vomiting, or abdominal discomfort. Each can of formula may take up to 30 minutes to infuse. Sit in an upright position. Do not lie flat when feeding. When your feeding is complete, turn your feeding bag off by rolling the roller all the way down. Remember to close off your feeding tube. Disconnect the feeding bag from your tube. Attach the syringe to your feeding tube and open the tube. Flush with the recommended amount of water. Then close off the feeding tube. Secure your feeding tube by taping it to your body. This will prevent accidental removal of the tube. After your feeding is complete, do not lie down or bend over for about 30 minutes. Use the written materials that your dietitian gave you to help with feedings at home. While you have a feeding tube in place, it's okay to continue to eat by mouth if you can tolerate it and if your doctor approves.
When patients have their feeding tube placed they eventually and gradually meet all their nutritional needs and hydration needs. This prevents them from having any more muscle loss, any more weight loss or dehydration, or anything like that. Patients will also notice that they're getting comfortable using the tube and it literally improves their quality of life.
We do encourage you to continue to use the oral cavity as much as you possibly can. So having a feeding tube in place doesn't preclude you from trying, but it just ensures that you're going to get the proper nutrition that you need.
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It's important to clean your equipment every day. After each feeding, rinse and drain the bag and tubing with warm tap water. Place the bag and tubing in a self-closing zipper style plastic bag. Store the bag in the refrigerator. Each day after the final feeding, dissolve about one-fourth teaspoon of liquid dishwashing soap with hot tap water in a glass. Pour the mixture into the feeding bag. Recap the bag.
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Close the roller clamp and shake the bag well. Open the roller clamp and run the soap mixture through the tubing. Add clean water and thoroughly rinse the bag and tubing. The bag should be completely clean with no remaining soap or bubbles. Turn the bag upside down to drain the water out.
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Place the clean bag into the plastic storage bag and place it in the refrigerator. Feeding bags can vary. Please ask your supply company or dietitian for their recommendation on how many days you can safely use a feeding bag.
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Some patients have problems while tube feeding. If you do, your nurse, dietitian, or doctor can help you. Here are some guidelines to follow. Contact your nurse if: your tube is clogged or cracked; if your tube site bleeds; if you see blood in your stool or have black stool; if you have a temperature above 101 degrees Fahrenheit or 38 degrees Celsius; if you have sharp unmanageable pain in your belly and red tender swollen or painful skin around the tube; if you have vomiting that you cannot control. Contact your dietitian if: you cannot follow your feeding plan or you're losing weight; if you feel more full than usual; if you have nausea or vomiting; if you have bowel problems such as bloating, cramping, diarrhea, or constipation; if your tube is clogged. If your tube comes out, do not try to reinsert the tube yourself, immediately contact your doctor or dietitian for help. You can also go to the emergency center or your clinic for help. The reason for this is to prevent your tube feeding site from closing off.
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When it's time to resume eating by mouth, you'll need to decrease the amount of formula you take in and increase the amount of food you eat. Weaning off of the feeding tube is a gradual process. You will lose weight if you suddenly stop using your feeding tube. Your feeding tube can be removed if you're able to eat food by mouth and maintain your weight for at least two weeks. When you're no longer using your tube, flush it with 30 milliliters of water twice a day to keep the tube open in case you need to use it again. Do not try to remove the tube yourself. It's important to schedule an appointment to have the tube removed. To help you with all aspects of your tube feeding, use the written material that your dietitian gave you. This will explain how to do what we have discussed in this video and answer the questions that you may have. Keep in mind that what you are going through is temporary. The support of your health care team along with your family and friends will help you through this.
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