Specialized GJ Tube Training

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SpecializedG/J Tube Training

• Developed according to MAP policies by
• Judy Spencer RN
• North Shore ARC

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G-tube Training

• Feeding and Medication Administration Through a
  G-Tube

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ObjectivesThe participants will demonstrate
understanding of

• The purpose of G-Tube
• The equipment
• The procedure for feeding and medication
  administration
• Placement and troubleshooting
• Site care and maintenance

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Purpose of the G-Tube

• To ensure
• Normal growth and development
• Maintenance of health and wellness

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Candidates for a G - Tube

• Unable to meet
• nutritional
• requirements

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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

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Overview of Various types of FeedingTubes

• Gastrostomy (G-Tube)
• A flexible tube or button
• Placed into the stomach
• Through an opening in the abdominal wall
• Provides feeding/ medication administration
• Provides venting drainage

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The Mic Key Low Profile G -Tube

• Inserted into stomach through the abdominal wall
• Inflatable balloon
• External base
• Anti reflux valve
• Individual measured to ensure
• correct size

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Overview of Various types of FeedingTubes

• Jejunostomy Tube ( J Tube)
• Placed in the jejunum (middle section of the
  small bowel)
• Through an opening in the abdominal wall or
• Through a specific port on a
• G tube
• Provides food and liquids directly in the
  jejunum

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Different Types of Tube Feedings

• Intermittent gravity
• Continuous/Pump
• Syringe bolus

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Intermittent gravity tube feeding

• Given by bottle or bag
• Hooked to a feeding tube set
• Administer at specific times of the day

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Continuous Tube Feeding

• Given by a bottle , bag or pump
• Hooked to feeding set
• Administered
• around the clock or
• at specific times over a set time

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Syringe Bolus Tube Feeding

• Given via a syringe
• Administered at specific times

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Preparation of Tube Feeding

• Check the formula label
• Shake container well
• Wipe the top of the can
• Check the expiration date

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Administration of Bolus Feedings

• Check HCP orders
• Gather equipment
• Wash hands
• Don clean gloves
• Explain procedure

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Administration of Bolus Feedings

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

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Administration of Bolus Feedings

• Flush with warm water
• Pour feeding into syringe
• Hold syringe approximately 8 10
• above button
• Infuse slowly
• Avoid air entering tube

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Administration of Bolus Feedings

• Flush extension tubing until clear clamp
• Disconnect the extension set
• Reinsert plug
• Keep individual upright for 1 hour

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Administration of Bolus FeedingsUpon completion
of feeding

• Document procedure and individuals tolerance
• Clean equipment with warm soap and water
• Dry and store equipment

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Administration of Medication via a G- tube

• Wash hands
• Prepare medications per MAP regulations
• policies
• Assemble equipment
• Explain procedure to individual

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Administration of Medication Via G- tube

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

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Administration of Medication via a G- tube

• Flush tube with warm water
• Dissolve medication in warm water
• Pour medication into syringe
• Rinse med cup with water and administer
• Allow to flow slowly by gravity
• Flush tube with warm water clamp

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Administration of Medication via a G- tube

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

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Administering Medications

• To ensure proper flow you should give
• Liquid medicines first
• Medications that need to be dissolved second
• Thick medications last

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Dos and Don'ts

• Do
• Prepare/administer medications
  separately
• Deliver medication slowly steadily
• Flush G-Tube after
• checking placement
• feeding/meds
• Do not
• Force medication or fluid into the tube
• Mix medication with feedings

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G Tube Site Care

• Cleanse site with mild soap and water
• Keep area clean dry
• Observe the site for
• Redness
• Swelling
• Warmth
• Drainage/leakage
• Bleeding
• Unusual color or odor
• Check site for granulation tissue

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Mouth Care

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

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When to Stop the Administration of Feedings /or
Medications

• Nausea/vomiting
• Coughing/choking
• Difficulty breathing
• Abdominal or chest pain
• Formula observed in mouth

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Observe/Report the Following Potential
Complications

• Abdominal distention
• Discomfort/fullness/gas
• Constipation
• Diarrhea
• Fever
• Wheezing, gurgling, or whistling
• Change in behavior

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Troubleshooting Potential Complications

• Accidental tube removal
• cover hole (stoma) with gauze
• notify the nursing beeper immediately
• Tube/Button clogged
• check for kinked tube
• flush with warm water
• milk tubing
• notify nursing beeper if unable to unclog
• Migration/Displacement
• notify nursing beeper