Feeding Tube Care at Home

Feeding tubes are not interchangeable, and the home routine changes with the type.

A nasogastric (NG) tube runs through the nose into the stomach. It is a short-term tool; NCI's nutrition summary describes nasoenteric tubes as the usual choice when feeding is expected to last under 2 weeks.

A gastrostomy tube goes through the wall of the abdomen straight into the stomach. If it was placed using an endoscope, a camera on a flexible tube passed through the mouth, it is called a PEG. If it was placed under x-ray guidance, it is called a RIG. Either one is meant for feeding that will last longer than a few weeks.

A jejunostomy tube, or J-tube, goes past the stomach into the jejunum, which is the middle part of the small bowel. Teams pick this when the stomach itself is the problem: gastroparesis (a stomach that empties too slowly), gastric outlet obstruction, severe reflux, past stomach surgery, or repeated aspiration. A J-tube cannot take large syringe feeds, so the pump schedule is not optional.

Write the tube type, the size, and the placement date on the same card as the after-hours phone number.

After a gastrostomy is placed, the body builds a gastrocutaneous tract, a healed tunnel from the skin to the stomach. That takes about 2 to 4 weeks. It takes longer in people who are malnourished or whose immune system is weakened, which describes many people on chemotherapy.

Until that tunnel matures, a tube that comes out is a bigger problem. A replacement in the first 4 weeks is usually done with an endoscope rather than at the bedside. After 4 weeks, bedside replacement is generally safe.

Feeding often starts sooner than families expect. It may begin as early as 4 hours after a successful placement, though many teams still wait up to 24 hours.

Flush with water before and after every feed, and before and after every medicine, using the volume your team specified. Clogs are most common in small-bore tubes, which is most of them.

If the tube blocks, warm water in the syringe size your team gave you, pushed and pulled gently, is the usual first move. Use the syringe and the flush volume written in your own instructions, because both differ by tube. Never push anything solid down the tube. When warm water fails, a team may order pancreatic enzymes mixed with a bicarbonate solution, left to sit, then flushed through with warm water. That is a prescribed step, not something to improvise at home. A tube that will not clear has to be replaced.

Have the pharmacist go through every medicine on the list and mark which ones come in a liquid form and which must never be crushed.

Clean the skin around the tube 1 to 3 times a day with mild soap and water. Lift off any crusting gently, then dry the skin well. Skip ointments, powders, and sprays unless the team approves them. If a pad is used, change it daily and any time it gets wet or soiled. Expect the skin to settle down in about 2 to 3 weeks.

On a PEG, the external bumper, meaning the disc on the outside, is set at a specific position by the team who placed it. Do not tighten or loosen it. If it is pressing into the skin, or the tube has become loose or slid, ring the team. Too tight and the pressure between the inner and outer bumpers can cut off blood flow to the stomach wall. That is buried bumper syndrome, in which the inner disc erodes into the tissue.

Redness around the stoma with pus draining out is peristomal infection. It is the most common minor complication of these tubes.

Sit the person upright, in bed or in a chair, for the whole feed. Lying flat during a feed is what drives reflux. Large-volume feeds and lying face down both raise the risk of aspiration pneumonia, meaning lung infection from stomach contents going the wrong way.

One honest caution: moving to a J-tube has not been shown to prevent aspiration. It is chosen for other reasons and should not be sold as a guarantee.

Feed timing, bag changes and how long formula may hang all depend on the formula and the pump you were given, so follow the product and team instructions you have in writing rather than a general figure. Take refrigerated formula out 2 to 4 hours before use so it is not cold going in.

If the person lost a lot of weight before the tube went in, which is common with head and neck, esophageal, and stomach cancers, restarting nutrition can trigger refeeding syndrome. Feeding pulls phosphorus, potassium, and magnesium out of the blood and into cells, and blood levels crash.

Low phosphorus is the hallmark, and it usually shows up in the first few days after feeding restarts.

That is why teams begin at a low feeding rate and build up in steps, checking bloods as they go, and why thiamine is given before any fluid containing sugar. The starting rate, the steps and the vitamin doses are all set by the team running the feed. Never change the rate, the volume or the formula yourself, even if the person seems hungry. A slow ramp-up is deliberate, not a delay.

The tract starts to close somewhere between 8 and 24 hours after the tube is gone. Call the team the moment it happens and follow their instruction to come in. To stop the tract closing, a clinician may put a temporary tube in it until a proper replacement can go in. That is a procedure for the treating service, not something to attempt at home. Do not put a catheter, a spare tube or any other object into the track yourself.

Do not wait until morning. Do not try to push a tube back in during the first 4 weeks, because that tract is not mature yet.

• The tube falls out, or you can see much more of it sticking out than usual
• Fever, or redness with pus around the stoma
• A belly that is hard or swollen one hour after a feed
• Vomiting, or coughing and choking during feeds
• New diarrhea after feeds
• Leaking around the site that soaks the dressing
• A tube you cannot flush with warm water

Keep supplies in one clean, reachable place: syringes, water for flushes, formula, dressings, pump sets, and any spare tube or button the team gave you.

Then write one page and tape it up. It should carry the tube type and size, the placement date, the feed volume and schedule, the flush volume, every medicine with its time, the daytime clinic number, and the after-hours number. Update it when the tube changes, since a gastrostomy tube is often swapped for a low-profile button about 3 to 8 weeks after placement.

If the person is between treatments and eating little by mouth, ask the oncology team where the nutrition threshold sits for them. For people who cannot take in enough by mouth for 7 to 14 days or more, and whose gut still works, tube feeding is the recommended route rather than intravenous nutrition.

https://www.ncbi.nlm.nih.gov/books/NBK559215/ https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/nutritional-support/enteral-nutrition https://medlineplus.gov/ency/patientinstructions/000165.htm https://medlineplus.gov/ency/patientinstructions/000333.htm https://www.ncbi.nlm.nih.gov/books/NBK564513/ https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-hp-pdq