1. Specialized G/J Tube Training Developed according to MAP policies by Judy Spencer RN Judy Spencer RN North Shore ARC

2. G-tube Training Feeding and Medication Administration Through a G-Tube

3. Objectives The participants will demonstrate understanding of : The purpose of G-TubeThe purpose of G-Tube The equipmentThe equipment The procedure for feeding and medication administrationThe procedure for feeding and medication administration Placement and troubleshootingPlacement and troubleshooting Site care and maintenanceSite care and maintenance

4. Purpose of the G-Tube To ensure : Normal growth and developmentNormal growth and development Maintenance of health and wellnessMaintenance of health and wellness

5. Candidates for a G - Tube Unable to meetUnable to meet nutritional nutritional requirements requirements

6. 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

7. Overview of Various types of FeedingTubes Gastrostomy (G-Tube) Gastrostomy (G-Tube) A flexible tube or buttonA flexible tube or button Placed into the stomachPlaced into the stomach Through an opening in the abdominal wallThrough an opening in the abdominal wall Provides feeding/ medication administrationProvides feeding/ medication administration Provides venting & drainageProvides venting & drainage

8. The Mic – Key * Low Profile G -Tube Inserted into stomach through the abdominal wallInserted into stomach through the abdominal wall Inflatable balloonInflatable balloon External baseExternal base Anti – reflux valveAnti – reflux valve Individual measured to ensureIndividual measured to ensure correct size

9. Overview of Various types of FeedingTubes Jejunostomy Tube ( J – Tube) Placed in the jejunum (middle section of the small bowel)Placed in the jejunum (middle section of the small bowel) Through an opening in the abdominal wall orThrough an opening in the abdominal wall or Through a specific port on aThrough a specific port on a G – tube G – tube Provides food and liquids directly in the jejunumProvides food and liquids directly in the jejunum

10. Different Types of Tube Feedings Intermittent gravityIntermittent gravity Continuous/PumpContinuous/Pump Syringe bolusSyringe bolus

11. Intermittent gravity tube feeding Given by bottle or bagGiven by bottle or bag Hooked to a feeding tube setHooked to a feeding tube set Administer at specific times of the dayAdminister at specific times of the day

12. Continuous Tube Feeding Given by a bottle, bag or pumpGiven by a bottle, bag or pump Hooked to feeding setHooked to feeding set Administered:Administered: around the clock or around the clock or at specific times over a set time

13. Syringe Bolus Tube Feeding Given via a syringe Administered at specific times

14. Preparation of Tube Feeding 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

15. Administration of Bolus Feedings Check HCP ordersCheck HCP orders Gather equipmentGather equipment Wash handsWash hands Don clean glovesDon clean gloves Explain procedureExplain procedure

16. Administration of Bolus Feedings Position individual appropriatelyPosition individual appropriately Connect extension tubingConnect extension tubing Check for residual /placementCheck for residual /placement Replace residual and clamp tubeReplace residual and clamp tube

17. Administration of Bolus 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 button above button Infuse slowlyInfuse slowly Avoid air entering tubeAvoid air entering tube

18. Administration of Bolus Feedings Flush extension tubing until clear & clampFlush extension tubing until clear & clamp Disconnect the extension setDisconnect the extension set Reinsert plugReinsert plug Keep individual upright for 1 hourKeep individual upright for 1 hour

19. Administration of Bolus Feedings Upon completion of feeding: Document procedure and individual’s toleranceDocument procedure and individual’s tolerance Clean equipment with warm soap and waterClean equipment with warm soap and water Dry and store equipmentDry and store equipment

20. Administration of Medication via a G- tube Wash handsWash hands Prepare medications per MAP regulationsPrepare medications per MAP regulations & policies Assemble equipmentAssemble equipment Explain procedure to individualExplain procedure to individual

21. Administration of Medication Via G- tube Position individual appropriatelyPosition individual appropriately Don glovesDon gloves Connect extension tubingConnect extension tubing Check for residual /placementCheck for residual /placement Replace residual and clamp tubeReplace residual and clamp tube

22. Administration of Medication via 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

23. Administration of Medication via a G- tube Following medication/flush: Disconnect the extension setDisconnect the extension set Reinsert plugReinsert plug Keep individual upright forKeep individual upright for 1 hour 1 hour Document procedure & observeDocument procedure & observe

24. Administering Medications To ensure proper flow you should give : Liquid medicines firstLiquid medicines first Medications that need to be dissolved secondMedications that need to be dissolved second Thick medications lastThick medications last

25. Do’s and Don'ts Do: Prepare/administer medications separately Prepare/administer medications separately Deliver medication slowly & steadily Flush G-Tube after: checking placement checking placement feeding/meds feeding/meds Do not: Do not: Force medication or fluid into the tube Mix medication with feedings

26. G – 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:RednessSwellingWarmthDrainage/leakageBleeding Unusual color or odor Check site for granulation tissueCheck site for granulation tissue

27. Mouth Care Maintain 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

28. When to Stop the Administration of Feedings &/or Medications Nausea/vomitingNausea/vomiting Coughing/chokingCoughing/choking Difficulty breathingDifficulty breathing Abdominal or chest painAbdominal or chest pain Formula observed in mouthFormula observed in mouth

29. Observe/Report the Following Potential 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

30. Troubleshooting Potential Complications Accidental tube removalAccidental tube removal cover hole (stoma) with gauze notify the nursing beeper immediately Tube/Button cloggedTube/Button clogged check for kinked tube flush with warm water milk tubing notify nursing beeper if unable to unclog Migration/DisplacementMigration/Displacement notify nursing beeper