How do you feed a gastrostomy tube? A comprehensive guide

In the year 2000, over 216,000 gastrostomy tubes were placed in the United States, highlighting the widespread need for effective enteral feeding solutions. Understanding how to properly feed through a gastrostomy tube is crucial for ensuring adequate nutrition and preventing common complications.

Quick Summary

A gastrostomy tube can be fed using either bolus or continuous methods with proper technique and hygiene. Key steps involve preparing the feed, positioning the patient, flushing the tube with water, and administering nutrition or medication to support health.

Key Points

• Hand Hygiene: Wash hands thoroughly before every feeding or tube interaction to prevent infection.

• Upright Positioning: Always position the patient with their head elevated at 30-45 degrees or sitting upright during and for up to one hour after feeding to reduce aspiration risk.

• Proper Flushing: Flush the tube with water before and after each feed and medication to prevent blockages.

• Method Choice: Choose between bolus feeding (larger, intermittent feeds) and continuous feeding (slow, pumped feeds) based on a healthcare provider's instructions and patient tolerance.

• Safe Medication Administration: Only give liquid or properly crushed medications, one at a time, with water flushes in between. Never crush extended-release tablets.

• Monitor the Stoma: Check the tube insertion site daily for signs of infection or irritation, and report any concerns to a healthcare professional.

Preparing for Gastrostomy Tube Feeding

Proper preparation is essential for a safe and successful feeding session. Always begin with excellent hygiene to prevent infection, especially since compromised individuals may be more vulnerable.

Supplies Needed

• Your prescribed liquid nutrition formula
• Water for flushing (amount and temperature as recommended by your healthcare provider)
• Syringes (often 60mL size with a catheter tip)
• Extension set for low-profile buttons (e.g., MIC-KEY®)
• A feeding pump and tubing (for continuous feeds)
• Clean, warm water and soap for handwashing
• Clean towels or paper towels

Step-by-Step Preparation

1. Wash your hands: Always wash your hands thoroughly with soap and water before handling any feeding equipment.
2. Inspect the tube site (stoma): Check the skin around the tube for any signs of infection, such as redness, swelling, warmth, or discharge. A small amount of clear drainage is normal, especially in a newer site.
3. Position the patient: Ensure the patient is sitting upright or has their head and upper body elevated to at least a 30 to 45-degree angle. This position should be maintained throughout the feeding and for 30–60 minutes afterward to minimize the risk of reflux and aspiration.
4. Confirm tube placement: Before each use, verify the tube's position by checking the measurement or marker on the tube. Any significant change in length or resistance during flushing should be reported to a healthcare provider.
5. Gather formula: Have the prescribed formula ready. If it has been refrigerated, warm it to room temperature by placing the container in a bowl of warm water. Never use a microwave, as it can cause uneven heating and dangerous hot spots.

Methods for Feeding a Gastrostomy Tube

There are two primary methods for administering food: bolus feeding and continuous feeding. Your doctor or dietitian will prescribe the best method based on the patient's specific needs.

Bolus Feeding

This method uses a syringe to deliver a larger volume of formula over a shorter period, mimicking a traditional meal. It is a gravity-based process that typically takes 15–20 minutes per feed.

1. Attach the syringe: Remove the plunger from the syringe and connect the syringe to the feeding port on the gastrostomy tube or extension set.
2. Pour formula: Pour the formula into the syringe until it is half full.
3. Control the flow: The formula will flow down the tube by gravity. You can control the speed by raising or lowering the syringe. Aim for a steady, comfortable flow. If the flow stops, gently raise the syringe or adjust the patient's position. Do not use the syringe plunger to force the feed in, as this can cause discomfort and complications.
4. Refill and repeat: Continue refilling the syringe with formula until the prescribed volume has been administered.
5. Flush with water: After the feed, pour the prescribed amount of water into the syringe to flush the tube completely. This prevents blockages and ensures adequate hydration.

Continuous Feeding

This method uses a pump to deliver a consistent, slow rate of formula over a longer period, often throughout the night. It is suitable for patients who cannot tolerate larger volumes at once.

1. Prepare the pump: Hang the feeding bag and tubing on an IV pole. Fill the bag with the prescribed formula (do not exceed 8 hours' worth).
2. Prime the tubing: Place the tubing into the pump and run the formula through until the air is flushed out, ensuring no air bubbles enter the tube.
3. Connect to the tube: Connect the end of the feeding set to the feeding port on the gastrostomy tube or extension set.
4. Set the rate and start: Set the pump to the prescribed rate and start the infusion. Check for any leaks or discomfort during the process.
5. Flush the tube: For continuous feeds, the tube should be flushed with water every 4 hours while the feed is running, or as directed by your healthcare provider, to prevent blockages.

Administering Medication

Giving medication through a gastrostomy tube requires careful attention to prevent tube blockages. Always consult your pharmacist to determine if a medication can be administered via the feeding tube.

• Liquid form is best: Use liquid medications whenever possible. If not available, ask your pharmacist if the tablet is safe to crush and dissolve. Never crush enteric-coated, sustained-release, or time-release tablets.
• Prepare separately: Crush one pill at a time into a fine powder, dissolve it in a small amount of warm water, and administer it through the tube.
• Flush between meds: Flush the tube with at least 5-15mL of water between each medication to prevent interactions and blockages.
• Flush before and after: Always flush the tube with water before and after giving all medications, just as you would with a feed.

Troubleshooting Common Issues

• Blocked Tube: If the tube clogs, first check for kinks. Then, try flushing with warm water using a 20mL syringe and a gentle push-pull motion. If this fails after a few tries, contact your healthcare provider. Avoid using excessive force or unapproved substances like carbonated drinks.
• Skin Irritation: Keep the skin around the stoma site clean and dry. Use a mild soap and water daily. If irritation, redness, or leakage occurs, contact your healthcare team for advice on skin protectants or potential tube adjustments.
• Granulation Tissue: This is a red, bumpy tissue that can form around the stoma. It is common and often benign, but if it causes pain or bleeding, consult your healthcare provider.
• Leakage: Check if the balloon (for balloon-style tubes) has the correct amount of water. If the fit is too loose, the tube may be leaking. Ensure the external bumper is snug but not too tight against the skin.

Comparison of Feeding Methods

Feature	Bolus Feeding	Continuous Feeding
Administration Method	Intermittent delivery via syringe, uses gravity.	Continuous, slow delivery via a pump.
Schedule	Multiple times per day, often 4-8 times, mimicking meal times.	Runs over a longer period, typically 8-24 hours.
Duration	15–20 minutes per feed.	Hours at a time, determined by the pump's rate.
Tolerance	May not be tolerated well by those with sensitive stomachs or delayed gastric emptying.	Generally better tolerated by patients who experience bloating or nausea with larger volumes.
Patient Mobility	Offers more freedom of movement between feeds.	Restricts mobility while the pump is running.
Equipment	Syringe, extension set (if needed).	Feeding pump, feeding bag, extension set (if needed).

Conclusion

Feeding a gastrostomy tube is a manageable process that becomes routine with practice. By adhering to proper hygiene, using the correct feeding method as prescribed, and being attentive to the tube's condition, patients can receive the necessary nutrition safely at home. Regular communication with your healthcare team is key to addressing any issues and ensuring the feeding plan remains appropriate for your needs. Following best practices, like consistent flushing and appropriate medication administration, is the most effective way to prevent complications and support patient health.

For more detailed information on preventing and managing complications, the NIH provides extensive guidelines on the subject: Prevention and management of minor complications in gastrostomy tubes.

Frequently Asked Questions

What is the difference between bolus and continuous feeding?

Bolus feeding delivers a larger volume of formula over a short period via a syringe and gravity, mimicking meals. Continuous feeding delivers a slow, steady flow of formula over a longer period (often overnight) using a pump.

How do I prevent the gastrostomy tube from getting clogged?

To prevent clogging, always flush the tube with the recommended amount of water before and after every feed and medication. Ensure any crushed medications are dissolved into a fine powder and administered separately.

Can I give medications and feed at the same time?

No, it is best to administer medications separately from feedings. Flush the tube with water, give the medication, flush again between different medications, and then resume feeding.

What if I see redness around the tube site?

Mild redness can be normal, but if you notice increasing redness, swelling, warmth, or pus-like discharge, it could be a sign of infection. Contact your doctor immediately for an assessment.

Is it safe to crush all pills for administration?

No, you should never crush enteric-coated, sustained-release, or time-release tablets, as this can affect the medication's effectiveness and lead to blockages. Always consult a pharmacist before crushing any medication.

How should I clean the gastrostomy site?

Clean the skin around the tube site daily with a mild soap and water, then pat it dry completely. Avoid using alcohol or hydrogen peroxide, as they can cause skin irritation.

What should I do if the tube accidentally comes out?

If a gastrostomy tube is dislodged, especially within the first few weeks, the stoma can close quickly. Cover the site with a dressing and contact your healthcare provider or go to the emergency room immediately.