Specialized G/J  Tube Training

Developed according to MAP Policies by
 Judy Spencer RN
North Shore ARC
G-tube Training
Feeding and Medication Administration Through a G-Tube
Objectives

The 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

Purpose of the G-Tube
To  ensure :
•	Normal growth and               development
•	Maintenance of        health and wellness

		
Candidates for a G - Tube

•	Unable to meet 
        nutritional 
	     requirements
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
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

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
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

Different Types of Tube Feedings
•	Intermittent gravity 
•	Continuous/Pump
•	Syringe bolus 

Intermittent gravity tube feeding

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

Syringe Bolus Tube Feeding

•		Given via a syringe
•		Administered at specific times

Preparation of Tube Feeding

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

Administration of Bolus
 Feedings
•	Check HCP orders
•	Gather equipment
•	Wash hands
•	Don clean gloves
•	Explain procedure

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

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

		

							
			 
Administration of Bolus
 Feedings
                 
•	Flush extension tubing until clear & clamp
•	Disconnect the extension set 
•	Reinsert plug
•	Keep individual upright for 1 hour

Administration of Bolus Feedings
Upon completion of feeding:

•	Document procedure and individual’s tolerance
•	Clean equipment with warm soap and water
•	Dry and store equipment

Administration of Medication via a G- tube
•	Wash hands
•	Prepare medications per MAP regulations
	& policies
•	Assemble equipment
•	Explain procedure to individual

Administration of Medication Via G- tube

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

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

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 

Administering Medications

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

Do’s 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

			
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
Mouth Care

Maintain oral hygiene
•	Brush teeth after each meal
•	Lubricate lips as needed
•	Dental care as directed
When to Stop the Administration of Feedings &/or Medications

•	Nausea/vomiting
•	Coughing/choking
•	Difficulty breathing
•	Abdominal or chest pain
•	Formula observed in mouth
Observe/Report the Following Potential Complications:

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

     

•	change in behavior

	   

		

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