SpecializedSpecializedG/J Tube TrainingG/J Tube Training

Developed according to MAP policies byDeveloped according to MAP policies by Judy Spencer RNJudy Spencer RNNorth Shore ARCNorth Shore ARC

G-tube TrainingG-tube Training

Feeding and Medication Feeding and Medication Administration Through a G-Administration Through a G-

TubeTube

ObjectivesObjectives

The participants will The participants will demonstrate understanding demonstrate understanding

of :of :•The purpose of G-Tube The purpose of G-Tube •The equipmentThe equipment•The procedure for feeding and The procedure for feeding and

medication administrationmedication administration•Placement and troubleshootingPlacement and troubleshooting•Site care and maintenanceSite care and maintenance

Purpose of the G-TubePurpose of the G-Tube

To ensure :To ensure :•Normal Normal

growth and growth and developmentdevelopment

•Maintenance Maintenance of health of health and wellnessand wellness

Candidates for a G - Candidates for a G - TubeTube

• Unable to meet Unable to meet nutritional nutritional

requirementsrequirements

Reasons for inability to Reasons for inability to swallow safely may include:swallow safely may include:

•StrokeStroke•Dementia (e.g. Dementia (e.g.

Alzheimer's Alzheimer's disease)disease)

•Medication side Medication side effects (dry effects (dry mouth, motility mouth, motility problems)problems)

•C.P.C.P.•Muscular Muscular

DystrophyDystrophy

Overview of Various types of Overview of Various types of FeedingTubesFeedingTubes

Gastrostomy (G-Tube)Gastrostomy (G-Tube)• A flexible tube or A flexible tube or

button button • Placed into the Placed into the

stomach stomach • Through an Through an

opening in the opening in the abdominal wallabdominal wall

• Provides feeding/ Provides feeding/ medication medication administrationadministration

• Provides venting & Provides venting & drainagedrainage

The Mic – Key *The Mic – Key *

Low Profile G -TubeLow Profile G -Tube

•Inserted into stomach through Inserted into stomach through the abdominal wallthe abdominal wall

•Inflatable balloonInflatable balloon•External baseExternal base•Anti – reflux valveAnti – reflux valve•Individual measured to ensure Individual measured to ensure

correct sizecorrect size

Overview of Various types Overview of Various types of FeedingTubesof FeedingTubes

Jejunostomy Tube ( J – Jejunostomy Tube ( J – Tube)Tube)• Placed in the jejunum Placed in the jejunum

(middle section of the (middle section of the small bowel)small bowel)

• Through an opening in Through an opening in the abdominal wall orthe abdominal wall or

• Through a specific Through a specific port on a port on a

G – tubeG – tube• Provides food and Provides food and

liquids directly in the liquids directly in the jejunumjejunum

Different Types of Tube Different Types of Tube FeedingsFeedings

•Intermittent gravity Intermittent gravity •Continuous/PumpContinuous/Pump•Syringe bolus Syringe bolus

Intermittent gravity tube Intermittent gravity tube feedingfeeding

•Given by Given by bottle or bagbottle or bag

•Hooked to a Hooked to a feeding tube feeding tube setset

•Administer at Administer at specific times specific times of the dayof the day

Continuous Tube Continuous Tube FeedingFeeding

•Given by a bottle , bag or pump Given by a bottle , bag or pump •Hooked to feeding set Hooked to feeding set •Administered:Administered: around the clock oraround the clock or

at specific times over a at specific times over a set timeset time

Syringe Bolus Tube Syringe Bolus Tube FeedingFeeding

• Given via a syringeGiven via a syringe• Administered at specific timesAdministered at specific times

Preparation of Tube Preparation of Tube FeedingFeeding

•Check the formula labelCheck the formula label•Shake container wellShake container well•Wipe the top of the canWipe the top of the can•Check the expiration dateCheck the expiration date

Administration of Administration of BolusBolus

Feedings Feedings• Check HCP ordersCheck HCP orders• Gather equipmentGather equipment• Wash handsWash hands• Don clean glovesDon clean gloves• Explain procedureExplain procedure

Administration of Administration of BolusBolus

Feedings Feedings

• Position individual appropriatelyPosition individual appropriately• Connect extension tubing Connect extension tubing • Check for residual /placementCheck for residual /placement• Replace residual and clamp tube Replace residual and clamp tube

Administration of Administration of BolusBolus

Feedings Feedings•Flush with warm waterFlush with warm water•Pour feeding into syringePour feeding into syringe•Hold syringe approximately 8 – 10”Hold syringe approximately 8 – 10”

above buttonabove button•Infuse slowlyInfuse slowly•Avoid air entering tubeAvoid air entering tube

Administration of Administration of BolusBolus

Feedings Feedings

•Flush extension tubing until Flush extension tubing until clear & clampclear & clamp

•Disconnect the extension set Disconnect the extension set •Reinsert plugReinsert plug•Keep individual upright for 1 Keep individual upright for 1

hourhour

Administration of Administration of Bolus FeedingsBolus Feedings

Upon completion of feeding:Upon completion of feeding:•Document procedure and individual’s Document procedure and individual’s

tolerancetolerance•Clean equipment with warm soap and Clean equipment with warm soap and

waterwater•Dry and store equipmentDry and store equipment

Administration of Administration of Medication via a G- tubeMedication via a G- tube

•Wash handsWash hands•Prepare medications per MAP Prepare medications per MAP

regulationsregulations& policies& policies

•Assemble equipmentAssemble equipment•Explain procedure to individualExplain procedure to individual

Administration of Administration of Medication Via G- tubeMedication Via G- tube

• Position individual appropriatelyPosition individual appropriately• Don glovesDon gloves• Connect extension tubing Connect extension tubing • Check for residual /placementCheck for residual /placement• Replace residual and clamp tube Replace residual and clamp tube

Administration of Administration of Medication Medication via a G- tubevia a G- tube

• Flush tube with warm waterFlush tube with warm water• Dissolve medication in warm waterDissolve medication in warm water• Pour medication into syringePour medication into syringe• Rinse med cup with water and administerRinse med cup with water and administer• Allow to flow slowly by gravityAllow to flow slowly by gravity• Flush tube with warm water & clampFlush tube with warm water & clamp

Administration of Administration of Medication Medication via a G- tubevia a G- tube

Following medication/flush:Following medication/flush:•Disconnect the extension set Disconnect the extension set •Reinsert plugReinsert plug•Keep individual upright for Keep individual upright for 1 hour1 hour•Document procedure & observe Document procedure & observe

Administering Administering MedicationsMedications

To ensure proper flow you To ensure proper flow you should giveshould give::

•Liquid medicines first Liquid medicines first •Medications that need to be Medications that need to be

dissolved seconddissolved second•Thick medications lastThick medications last

Do’s and Don'tsDo’s and Don'tsDo:Do:

Prepare/administer medications separatelyPrepare/administer medications separatelyDeliver medication slowly & steadilyDeliver medication slowly & steadilyFlush G-Tube after:Flush G-Tube after: checking placementchecking placement feeding/medsfeeding/meds Do not:Do not:Force medication or fluid into the tubeForce medication or fluid into the tubeMix medication with feedingsMix medication with feedings

G – Tube Site CareG – Tube Site Care•Cleanse site with mild soap and waterCleanse site with mild soap and water•Keep area clean & dryKeep area clean & dry•Observe the site for:Observe the site for:

RednessRednessSwellingSwellingWarmthWarmthDrainage/leakageDrainage/leakageBleedingBleedingUnusual color or odorUnusual color or odor

•Check site for granulation tissueCheck site for granulation tissue

Mouth CareMouth Care

Maintain oral hygieneMaintain oral hygiene•Brush teeth after each mealBrush teeth after each meal•Lubricate lips as neededLubricate lips as needed•Dental care as directedDental care as directed

When to Stop the When to Stop the Administration of Administration of

Feedings &/or Feedings &/or MedicationsMedications

•Nausea/vomitingNausea/vomiting•Coughing/chokingCoughing/choking•Difficulty breathingDifficulty breathing•Abdominal or chest painAbdominal or chest pain•Formula observed in mouthFormula observed in mouth

Observe/Report the Observe/Report the Following Potential Following Potential

Complications:Complications:

•Abdominal distentionAbdominal distention•Discomfort/fullness/gasDiscomfort/fullness/gas•ConstipationConstipation•DiarrheaDiarrhea•FeverFever•Wheezing, gurgling, or whistlingWheezing, gurgling, or whistling•Change in behaviorChange in behavior

•change in behaviorchange in behavior

Troubleshooting Potential Troubleshooting Potential ComplicationsComplications

• Accidental tube removalAccidental tube removalcover hole (stoma) with gauzecover hole (stoma) with gauzenotify the nursing beeper immediatelynotify the nursing beeper immediately

• Tube/Button cloggedTube/Button cloggedcheck for kinked tubecheck for kinked tubeflush with warm waterflush with warm watermilk tubingmilk tubingnotify nursing beeper if unable to unclognotify nursing beeper if unable to unclog

• Migration/DisplacementMigration/Displacementnotify nursing beeper notify nursing beeper