Guide to

ADULT
TUBE
FEEDING Guide to Adult Tube Feeding | 1
 FOREWORD

Throughout this booklet you will see use of the words healthcare
provider, which may be your doctor, registered dietitian, nurse, or
pharmacist. Please work with your preferred healthcare provider as part
of your prescribed care plan.
This booklet provides guidance for patients and caregivers on enteral nutrition, also known
as tube feeding, which is a way of delivering nutrition directly to your stomach or small
intestine. Tube feeding may be used to provide nutritional requirements when someone is not
able to eat or digest foods.

This guide has undergone review and approval by the American Society for Parenteral and
Enteral Nutrition (ASPEN). This guidance does not constitute medical or other professional
advice and should not be taken as such. To the extent that the information published herein
may be used to assist in the care of patients, this is the result of the sole professional
judgment of the attending healthcare professional whose judgment is the primary component
of quality medical care. The information presented in these recommendations is not a
substitute for the exercise of such judgment by the healthcare professional. Circumstances
in clinical settings and patient indications may require actions different from the guidance in
this document. In those cases, the judgment of the treating professional should prevail.

2 | Guide to Adult Tube Feeding

 CONTENTS

INTRODUCTION 3

TUBE FEEDING AT HOME 4

MONITORING YOUR RESPONSE TO TUBE FEEDING 12

FINDING COMMUNITY SUPPORT 20

TAKING CHARGE OF YOUR

HEALTHCARE PROVIDER VISITS 22

TUBE FEEDING MONITORING CHECKLIST 24

MEDICATION RECORD 30

GLOSSARY 32

NOTES 35

Guide to Adult Tube Feeding | 1

2 | Guide to Adult Tube Feeding
INTRODUCTION
We know that tube feeding can bring changes
to your life. But you don’t have to face them
alone. We created this guide to provide you
with resources and tools that you can use while
adjusting to tube feeding at home.
In this booklet you’ll find:
• Step-by-step instructions on how to safely deliver tube feeding at home and
safe handling practices
• Resources for finding community support
• Worksheets to track important information to share with your healthcare provider
• A glossary that you can refer to if you come across any unfamiliar terms

Guide to Adult Tube Feeding | 3

 TUBE FEEDING AT HOME
Your healthcare provider will determine the delivery method for your tube feeding,
along with your feeding schedule.
The chart below identifies the feeding methods, and it highlights the differences between them.
METHOD OF LOCATION DETAILS AND OPTIONS
ADMINISTRATION OF FEEDING

SYRINGE - PUSH METHOD

• Formula is drawn up into a 60-mL (2 fl oz) syringe, then slowly
pushed through the tube into the stomach (the rate of the
bolus can be carefully controlled this way)
• May take multiple syringe fillings based on your feeding
prescription (four — 60-mL syringes will deliver one cup (8 fl oz)
of formula)
BOLUS
Intended for feeding
into the stomach REUSABLE SQUEEZE POUCH
• Formula or blenderized food is poured into a reusable 375-mL
(12.5 fl oz) flexible container used to store and deliver tube
feeding nutrition and water
• The large cap connects the bag to the feeding tube or
extension set
• Thicker formulas and blenderized food can be squeezed through
the system by squeezing or rolling up the flexible container

GRAVITY BAG FEEDING

• The formula is placed in a gravity bag and hung above the level
of your stomach
• Formula flows through the tubing into your stomach (think of
it as a hands-free way of infusing formula)
• A clamp is used to control how fast or slow formula flows into
the feeding tube
Can be used for • Lowering the bag slows down the feeding while raising the
feeding into the bag makes it flow faster
GRAVITY
stomach or small SYRINGE - GRAVITY METHOD
intestine • Formula is poured into a syringe with the plunger removed,
and it flows slowly into the feeding tube
• Lowering the syringe slows down the feeding while raising the
syringe makes it flow faster
REUSABLE SQUEEZE POUCH
• This feeding system has a roller clamp which allows for a more
controlled gravity infusion (this works best with thinner
formulas in a reusable flexible container)
• Formula is placed in a feeding bag and the tubing set is loaded
into the compatible pump
Can be used for • An electronic pump is used to move the formula at a specific
feeding into the
PUMP and programmable rate through the tube and into your
stomach or small stomach or small intestine
intestine
• Tube feeding pumps for home use are portable and can be
placed in compatible backpacks for going out and about

4 | Guide to Adult Tube Feeding

TUBE FEEDING SYSTEMS
Tube feeding systems have a lot of parts and pieces. These illustrations can help you see some
of the differences.
SYRINGE BOLUS GRAVITY FEEDING PUMP FEEDING

SYRINGE

FEEDING
FEEDING
BAG (WITH
BAG (WITH
FORMULA)
FORMULA)

ROLLER
ESOPHAGUS CLAMP
GASTROSTOMY DRIP
STOMACH
FEEDING TUBE CHAMBER

ENTERAL
FEEDING
PUMP
ROLLER
CLAMP

GASTROSTOMY FEEDING TUBE (G-TUBE) ANATOMY JEJUNOSTOMY FEEDING TUBE (J-TUBE) ANATOMY

ABDOMINAL
STOMACH STOMACH WALL
INTERNAL
BUMPER OR G-TUBE
BALLOON OF JEJUNUM
G-TUBE
ABDOMINAL INTERNAL
WALL BUMPER OR J-TUBE
BALLOON OF
J-TUBE

PREPARING YOUR FEEDINGS

Follow these steps to prepare your tube feeding:

1. Wash your hands with soap and warm water
2. Clean your work surfaces to avoid contaminating your feeding and equipment with bacteria
3. Gather all the equipment you need:
a. The formula
b. A feeding container (a gravity bag, syringe, reusable squeeze pouch, or pump and pump set)
c. An IV pole or wall hook (if needed)
d. A 30-mL to 60-mL syringe
e. A clean cloth
f. Tap or bottled water
4. Write the date and time on the feeding container when the formula is opened
5. Wash hands thoroughly when finished

Guide to Adult Tube Feeding | 5

 FLUSHING ALL TYPES OF FEEDING TUBES

Flushing your feeding tube routinely, or as directed, is important to keep the tube
clean inside and to prevent clogging. A syringe filled with water is used to gently
flush the feeding tube after each feeding, or every 4 to 6 hours during continuous
feeding. Flushing removes extra formula from the tube and provides water.
Here is how to do it:
1. Wash your hands with soap and warm water
2. Place the tip of the syringe into a cup of water and pull back
on the plunger until there is 30-mL of water in the syringe
(or the amount of water that your healthcare provider has
prescribed for flushing the tube)
3. Attach the syringe to the feeding tube, unclamp the tube
(if clamp is present), and slowly push the water into the
feeding tube
4. Repeat until the desired amount of water is flushed through
the tube
FLUSHING THE FEEDING TUBE
5. Remove the syringe from the feeding tube after flushing WITH WATER

and close the port on the tube

Flush the feeding tube with 15-mL of water (or amount prescribed by your healthcare professional)
after giving medications, and between each different medication.
Extra water can be given through the feeding tube, as needed. If you are on a fluid restricted diet,
your healthcare provider will provide recommendations for your daily fluid intake.
The gravity method can also be used to administer water. Use the barrel of the syringe as a funnel and
then pour water into the syringe. This method can be used after administering each medication.

ADMINISTERING YOUR FEEDINGS

Always refer to the feeding plan recommended

by your healthcare provider
Let’s start with a few tips before we discuss 30°
the different feeding methods:
• DO NOT lie flat during your feeding Your head should be raised 30 degrees
or more while tube feeding
• Keep your head raised at 30 degrees or
more while administering your tube feeding
• Remember to wait one hour after your feeding before you lie down -- lying down before one
hour can cause you to vomit or cough which may cause you to inhale stomach contents or
formula into your lungs

6 | Guide to Adult Tube Feeding

Syringe/Bolus Feeding
This method allows the formula to flow slowly into the feeding tube.
Before:
1. Gather supplies to prepare for feeding and wash your hands with soap and water
2. Flush the feeding tube with the amount of water prescribed by your healthcare provider
During Syringe “Push” Method:
1. Pour measured formula into a clean cup
2. Place the tip of the syringe into the formula, then pull back on the plunger to draw
up the formula
3. Connect the syringe to the feeding port on the tube and slowly push the plunger to infuse
formula through the tube into your stomach
4. Disconnect syringe from feeding tube, then repeat steps 2 and 3 until the prescribed amount
of formula has been given
5. Take a break in between syringe pushes in order to slow down the speed of feeding and avoid
stomach upset from feeding too fast
After:
SYRINGE
1. Flush the feeding tube again with water, per your
healthcare provider’s instructions
2. Close the clamp on the feeding tube until the next feeding
ROLLER
CLAMP
Ask your healthcare provider about maintaining the syringe, and
how often it should be replaced. TUBING

Always keep head raised above 30 degrees while administering

tube feeding and for one hour after completing the feeding.
SYRINGE BOLUS FEEDING

Guide to Adult Tube Feeding | 7

 Gravity Bag Feeding
Before:
1. Gather supplies to prepare for feeding and wash your hands with soap and water
2. Flush the feeding tube with the amount of water prescribed by your healthcare provider
During Gravity Bag Feeding:
1. Close the roller clamp of the gravity bag and then fill with the prescribed amount of formula
2. Hang the bag above your head (about 2 feet) and to the side using a hook or IV pole
3. Open the roller clamp to allow the formula to flow towards the end of the feeding set to
remove the air from the line (this is called priming the line) and reclamp once the formula gets
within an inch or two of the tip
4. Connect the tip of the feeding set to your feeding tube and then unclamp to allow the
formula to flow
5. Use the roller clamp to slow down the gravity infusion as needed
6. Raising the height of the bag up will allow formula to flow faster, while lowering the bag will
slow down the flow of formula
During Syringe “Gravity” Method:
1. Remove the plunger from the barrel of the syringe
2. Connect the syringe tip to the feeding tube
3. Hold the syringe above your stomach
4. Pour measured formula into the syringe - this may take multiple syringe fillings based on
your feeding prescription
5. Slow the flow by lowering the syringe, or speed the flow by raising the syringe
6. Allow the formula to flow into the feeding tube until gone (about 15 to 20 minutes)
7. Take a break in between syringe pours in order to slow down the speed of feeding and avoid
stomach upset from feeding too fast
After:
1. Flush the feeding tube with the amount of water prescribed by your healthcare provider
2. Close the cap on the feeding tube until the next feeding

Ask your healthcare provider about care of FORMULA

the gravity bag and how often they should FEEDING

POUR
be replaced. FORMULA
BAG TUBE
INTO THE FEEDING
Always keep head raised above 30 degrees FEEDING BAG FEEDING TUBE
PORT
BAG
while administering tube feeding and for one
hour after completing the feeding. ROLLER
CLAMP

GRAVITY DRIP FEEDING

8 | Guide to Adult Tube Feeding
Pump Feeding
Pump feeding moves the formula through the feeding tube and into the stomach or small intestine
at a controlled rate.
Before:
1. Gather supplies to prepare for feeding and wash your hands with soap and water
2. Flush the feeding tube with the amount of water prescribed by your healthcare provider
During:
1. Fill the pump feeding bag with the prescribed amount of formula, close lid securely, then hang
the bag on a hook, IV pole, or place into a tube feeding backpack
2. Load the feeding set into the pump by following pump manufacturer instructions
3. Prime the feeding set, which removes air from the line, by following the
manufacturer instructions
4. Connect the feeding set to the feeding tube
5. Refer to your pump user manual for complete pump programming information
6. Turn on the pump and set the flow rate
After:
1. Stop pump and disconnect feeding set
2. Flush tube with the amount of water prescribed by your healthcare provider

Ask your healthcare professional about care of the feeding set between feedings.
Always keep head raised above 30 degrees while administering tube feeding and for one hour
after completing the feeding.

Guide to Adult Tube Feeding | 9

 HANG TIME AND STORAGE

Different formula types have different hang times, and the below chart provides
the latest guidelines.

FORMULA TYPE HANG TIME

BLENDERIZED FORMULA
(HOME MADE) Up to 2 hours at room temperature

BLENDERIZED FORMULA
(COMMERCIALLY PREPARED) Refer to manufacturer guidelines (up to 2 hours)

• Open system – Up to 12 hours in the home setting

READY-TO-USE FORMULA • Closed system – Up to 48 hours, unless a shorter hang time is
specified by the manufacturer set

Here are a few additional guidelines and recommendations when handling your tube feed:
• Ask your healthcare provider about care of the container and feeding set between feedings
• Cover any unused formula, write the date on it, and store it in the refrigerator
• Throw away any open, unused reconstituted formula or blenderized formula after 24 hours
• Throw away any open, unused ready-to-use formula that has been stored in the refrigerator
after 48 hours

10 | Guide to Adult Tube Feeding

“While it may take time to adapt and learn this new
way of nourishing your body, tube feeding can be
an ally in supporting your health and well-being.”
Guide to Adult Tube Feeding | 11
 MONITORING
YOUR RESPONSE
TO TUBE FEEDING
By keeping records of your response to tube feeding, you provide accurate
information for your healthcare provider. When you write things down right away,
you don’t have to spend time later trying to recall important details when they’re
no longer fresh in your mind.
The Tube Feeding Monitoring Checklist helps you keep track of your tube feeding, and it provides
space to record any signs or symptoms that you may be experiencing. The Medication Record
allows you to monitor your medication schedule. Sharing these records with your healthcare
provider can help him or her identify and address any issues that may arise.

MEDICATION RECORD

TUBE FEEDING MONITORING CHECKLIST

12 | Guide to Adult Tube Feeding

TUBE FEEDING INTOLERANCE
It’s important to monitor how your body is tolerating your feedings and keep track of any signs or
symptoms of intolerance you may have.
Patients that experience intolerance to tube feedings may have more than one sign or symptom,
which may cause dehydration.
Look for:

Nausea Diarrhea Constipation

Vomiting Bloating Abdominal discomfort

If you experience any of the above signs or symptoms, reach out to your healthcare provider as
soon as possible. They will be able to help identify the cause of your symptoms, and determine what
changes may be needed.

Guide to Adult Tube Feeding | 13

 TROUBLESHOOTING INTOLERANCE SYMPTOMS
Always check with your healthcare provider if you are experiencing any signs or symptoms of
intolerance. The below chart will help you better understand the possible causes for each symptom,
as well as potential options to address these symptoms.

SYMPTOM POSSIBLE CAUSES POTENTIAL SOLUTIONS

• Avoid pushing formula in too fast (syringe push

method of bolus feeding)
• Lower the height of the syringe to slow down
rate (funnel method of bolus feeding)
Formula may be going in too fast
• Adjust the clamp on the gravity bag to change
the flow rate of the formula
• Consult your healthcare provider about a lower
rate if using a pump feeding

• Elevate your head 30 degrees or more by

propping yourself up in bed or on a couch
Incorrect positioning
• Keep your body in a raised position for at least
one hour after feeding
Nausea, Vomiting
and/or Abdominal
Discomfort
• Discuss your medications with your healthcare
provider, since many medications may cause side
effects unrelated to enteral nutrition
• Medications in liquid forms may contain sorbitol,
Medication side effects a sugar alcohol, that may cause diarrhea in some
individuals
• Sometimes switching to another form of the
medication (i.e. from liquid to pill) can help
alleviate side effects

• Remove the formula from the refrigerator and

Formula is too cold give it time to warm up before administering

14 | Guide to Adult Tube Feeding

 SYMPTOM POSSIBLE CAUSES POTENTIAL SOLUTIONS

• Ask your healthcare provider or pharmacist to review

your medication list
Medication side effects • Diarrhea can be worsened by antibiotics, stool
softners, or by medications containing sorbitol,
magnesium or phosphorus

Small Intestinal Bacterial • Diagnosis is typically made once other causes are
Overgrowth excluded

• You may have an intolerance to specific formulas and it

Diarrhea may be necessary to switch to a different formula
Not tolerating formula
• Switching to a fiber-containing formula can sometimes
help alleviate diarrhea

• Avoid pushing formula in too fast (syringe push

method of bolus feeding)
• Lower the height of the syringe to slow down rate
(funnel method of bolus feeding)
Formula may be going in too fast
• Adjust the clamp on the gravity bag to change the
flow rate of of the formula
• Consult your healthcare provider about a lower rate if
using a pump feeding

• Ask your healthcare provider how much extra water

(free water) you should be taking in each day
Not taking in enough liquids
or fiber • If the current formula does not contain fiber, discuss
changing to a fiber-containing formula with your
healthcare provider

Bloating and
Constipation • Ask your healthcare provider if any of your medications
could be causing constipation
• Pain meds, iron and anti-diarrheals are common
Medication side effects medications that can contribute to the development
of constipation
• Ask if there is an alternative medication that may have
fewer side effects

Guide to Adult Tube Feeding | 15

 DEHYDRATION
Dehydration occurs when your body loses more fluid than you take in. Dehydration can present
itself in a number of different ways, including increased thirst, dry lips, dry skin, rapid weight loss,
constipation, weakness, urine that is dark and strong-smelling, and dizziness upon standing.

POSSIBLE CAUSES POTENTIAL SOLUTIONS

Diarrhea
• Notify your healthcare provider if you are experiencing vomiting, fever,
or diarrhea that lasts longer than 24 hours, a sudden decrease in urine
Vomiting output, dizziness, or an altered mental state
• Record the amount of water and formula that you are taking each day
Fever and make note of the color and odor of your urine
• Ask your healthcare provider how much extra water (free water) you
Excessive sweating or drooling should be taking on a daily basis. Extra water can be given through the
feeding tube using a syringe or feeding bag
Inadequate water intake • Think of water administration in terms of cups that you should have each
day, for example- 3-4 cups. Keep in mind that a 60-mL syringe is only 1/4
Excessive urination of a cup and 4 syringes of water are needed to make 1 cup of water

URINE DEHYDRATION REFERENCE

1 Good
2 Good
3 Fair
4 Dehydrated
5 Dehydrated
6 Very dehydrated
7 Severely dehydrated
When dehydration is present, urine becomes darker and more concentrated.

16 | Guide to Adult Tube Feeding

TUBE SITE COMPLICATIONS
Monitoring and maintaining the feeding tube site can help reduce the chance of complications.
You should inspect the tube site before each feeding, and clean/dry the site after each feeding.
A healthy tube site will be:
• Pink in color with no redness or drainage
• Rash free with no ulcers or swelling in
the surrounding skin
• Free of swelling and excess skin
• Odor free
Tube site complications can include:
• Leakage around G-tube
• Tube site infection
A healthy feeding tube/stoma site
• Hypergranulation tissue

LEAKAGE AROUND THE G-TUBE

Drainage of any type of liquid around the exit site of the tube allows risk for skin breakdown and
infection. Leakage is considered a symptom of an underlying problem such as:
• Inward or outward movement of the tube
• Tube tract enlargement
• Overfeeding
• Balloon deflation
• Delayed gastric emptying
Types of discharge from around the tube site can include: gastric contents, secretions from stoma
tissue, tube feeding formula, or medications. Talk to your healthcare provider if you have any
discharge from your stoma.

POSSIBLE CAUSES POTENTIAL SOLUTIONS

Inward and outward movement

of the tube • Verify tube is properly sized and fitted to your stoma
• Stabilize the feeding tube externally by adjusting the external skin disk,
Tube tract enlargement caused by as recommended by your healthcare provider
excessive back-and-forth motion
• Infuse medications and formula slowly
Rapidly infusing formula via bolus • Monitor water volume of the feeding tube balloon to ensure
proper inflation (your healthcare provider can check and adjust the
Balloon internal bumper is defective volume of your feeding tube balloon)
or needs more water

Guide to Adult Tube Feeding | 17

 TUBE SITE INFECTIONS
These infections can occur with all types of abdominal feeding tubes. Infection usually is limited to the
skin and tissue below the skin, although more severe infections can occur. Tube site infections are usually
from yeast or bacteria. If you have pain, itching, burning, oozing, or a foul smell at your tube site, you
may have an infection. Schedule an appointment with your healthcare provider for a proper diagnosis
and recommended treatment if you think you have an infection at your tube site.

POSSIBLE CAUSES POTENTIAL SOLUTIONS

Yeast or bacteria normally found on • Wash hands before preparing and administering tube feeding and before
the skin may cause infection performing tube site care
• Make sure the external bolster is positioned properly as instructed by your
healthcare provider to minimize or eliminate leaking at the stoma site
Displacement of the tube • Keep skin around the tube dry
• Verify tube is properly sized and/or bolster is set properly to prevent
leakage or injury at the stoma site
Moisture or drainage around • Clean site with gentle soap and water
the tube
• Allow the site to breathe and the moisture to dry
• Ask your healthcare provider to adjust the disc so that it can be gently
rotated, or to assess the size of the of the tube for the best fit
The external disc may be too tight or
the tube may be too small

Look for:
• Redness
• Tenderness
• Swelling and firmness at the site
• Pus-filled drainage
• Possible fever
• Foul odor
An infected stoma site

18 | Guide to Adult Tube Feeding

HYPERGRANULATION TISSUE
Thick, red, raised tissue that can form around the feeding tube where it enters the body, sometimes
referred to as “proud flesh.” The extra tissue at the tube site will be bright pink or red and may bleed
easily. In some cases, a clear or cloudy discharge may be present. This discharge can create a chronically
moist environment at the stoma site leading to a yeast infection or skin breakdown.

POSSIBLE CAUSES POTENTIAL SOLUTIONS

Chronic exposure to moisture

• Keep skin around the stoma site clean and dry
The body’s natural reaction to the • Clean site daily with gentle soap and water
presence of the tube resulting in rapid
development of thick, red tissue • No dressing is necessary unless directed by your healthcare provider
• Protect skin with a barrier cream/skin protectant when drainage is present
Excessive tube movement • If drainage persists contact your healthcare provider
• Ask your healthcare provider if he or she feels that the granulation tissue
needs to be reduced
Need to resize low-profile balloon • Minimize tube movement by making sure external bolster (disk) is set
gastrostomy tube properly against the skin, tube is properly stabilized, or low-profile tube
is sized properly

Look for:
• Thick, red, raised tissue
around the stoma site
• Bleeding at the tube site
• Clear or cloudy discharge

A stoma site with hypergranulation tissue

YEAST INFECTION
POSSIBLE CAUSES POTENTIAL SOLUTIONS

Infrequent dressing changes

(if using) • Preventing moisture buildup is the most important intervention
Prolonged skin contact with • Keep area dry and open to air – a fan or hair dryer on a cool setting may
moisture (wet dressings) be used to dry the area
• Ask your healthcare provider if an antifungal powder or cream would
Susceptibility to yeast be helpful
(immune-compromised, diabetes)

Antibiotic therapy

Look for:
• Redness • Satellite lesions
• Skin breakdown • Skin with a scaly
• Small, inflamed, pus-filled blisters appearance
• Burning and/or itching sensation
at the tube site
A stoma site with yeast infection Guide to Adult Tube Feeding | 19
 FINDING
COMMUNITY SUPPORT
Here you’ll find resources that can help you get the support and
guidance you need with the changes to your lifestyle. You’ll have
access to educational resources, support groups, and opportunities to
connect with others going through similar situations.

THE OLEY FOUNDATION

The Oley Foundation is a nonprofit organization for people who depend on home enteral (tube)
feeding or parenteral (intravenous) feeding.
Resources include:
• Access to a network of individuals and • Equipment and supply exchange
caregivers who are involved in tube feeding • Conference for you, family members, and
at home caregivers
• Education and troubleshooting materials • Community enrichment programs
• Newsletters

www.oley.org

Call 1-800-776-OLEY (6359) or visit Oley.org for more information about tube feeding. Abbott is a
supporter of The Oley Foundation.

20 | Guide to Adult Tube Feeding

Guide to Adult Tube Feeding | 21
 TAKING CHARGE OF
YOUR HEALTHCARE
PROVIDER VISITS
During an appointment, it’s easy to forget something important and realize
afterward that you didn’t get the answers you need. Preparing for your
appointment with your healthcare provider will help you remember key details
about your progress or concerns.
One way to make the most of your appointment is to think of your appointment as having three
stages: before, during and after. Following the easy tips below at each stage can make your visit a
lot less stressful – and a lot more productive.

BEFORE THE VISIT:

• Review information that you have documented in your Tube Feeding Monitoring
Checklist and Medications Record
• Make a list of questions and concerns that you want to discuss
• If you are going to be discussing a concern, be prepared to provide the following information:
1. A detailed description of the concern, including when and how it began as well as
any symptoms
2. What, if anything, you have done to manage the concern
3. Things that have made it better or worse

22 | Guide to Adult Tube Feeding

WHAT TO BRING WITH YOU:
This booklet, which includes your:
• Tube Feeding Monitoring Checklist
• Medication Record
• Notes
• A list of questions and concerns that you want to discuss

DURING THE VISIT:

• Use your list to check off each item as it is addressed
• Take notes so that you can refer back to them after the visit
• Be sure to provide your history of medical conditions, all
prescribed and over-the-counter medications, and supplements
• If you don’t understand something that is said, ask your
healthcare provider to explain it in a different way so that you
can better understand
• If your healthcare provider suggests a treatment that you are
unsure of, communicate this and ask what other treatment
options might be available
• If you are discussing a problem, ask how long it should take to improve and/or resolve after
starting the prescribed treatment
• Ask when and how you should follow up after the visit (phone call, email or office visit)

AFTER THE VISIT:

• If you do not see results from the changes within the
expected time frame, inform your healthcare provider as
soon as possible
• Don’t hesitate to call the office if you have questions
or concerns
• Don’t be afraid to ask your healthcare provider for a
referral when a problem is not resolving or when input
from a specialist might be needed

Guide to Adult Tube Feeding | 23

 TUBE FEEDING MONITORING CHECKLIST

DATE: MON. TUES. WED.

WEIGHT

NAME OF FORMULA

AMOUNT OF
FORMULA GIVEN:
VOLUME
CALORIES
RATE

ORAL FEEDS

AMOUNT OF
WATER GIVEN

URINE:
COLOR/ODOR

STOOL
CONSISTENCY:
LIQUID (#/DAY)
SOFT (#/DAY)
HARD (#/DAY)

CONSTIPATED

NAUSEA

VOMITING
# OF EPISODES

DATE: MON. TUES. WED.

SKIN:
REDNESS
DRAINAGE
HYPERGRANULATION
TISSUE
SKIN BREAKDOWN

24 | Guide to Adult Tube Feeding

 Date:

THURS. FRI. SAT. SUN.

THURS: FRI. SAT. SUN.

Guide to Adult Tube Feeding | 25

 TUBE FEEDING MONITORING CHECKLIST

DATE: MON. TUES. WED.

WEIGHT

NAME OF FORMULA

AMOUNT OF
FORMULA GIVEN:
VOLUME
CALORIES
RATE

ORAL FEEDS

AMOUNT OF
WATER GIVEN

URINE:
COLOR/ODOR

STOOL
CONSISTENCY:
LIQUID (#/DAY)
SOFT (#/DAY)
HARD (#/DAY)

CONSTIPATED

NAUSEA

VOMITING
# OF EPISODES

DATE: MON. TUES. WED.

SKIN:
REDNESS
DRAINAGE
HYPERGRANULATION
TISSUE
SKIN BREAKDOWN

26 | Guide to Adult Tube Feeding

 Date:

THURS. FRI. SAT. SUN.

THURS: FRI. SAT. SUN.

Guide to Adult Tube Feeding | 27

 TUBE FEEDING MONITORING CHECKLIST

DATE: MON. TUES. WED.

WEIGHT

NAME OF FORMULA

AMOUNT OF
FORMULA GIVEN:
VOLUME
CALORIES
RATE

ORAL FEEDS

AMOUNT OF
WATER GIVEN

URINE:
COLOR/ODOR

STOOL
CONSISTENCY:
LIQUID (#/DAY)
SOFT (#/DAY)
HARD (#/DAY)

CONSTIPATED

NAUSEA

VOMITING
# OF EPISODES

DATE: MON. TUES. WED.

SKIN:
REDNESS
DRAINAGE
HYPERGRANULATION
TISSUE
SKIN BREAKDOWN

28 | Guide to Adult Tube Feeding

 Date:

THURS. FRI. SAT. SUN.

THURS: FRI. SAT. SUN.

Guide to Adult Tube Feeding | 29

 MEDICATION RECORD
Please list all over-the-counter medications, vitamins, and herbal supplements.

MEDICATION
FORMULATION FREQUENCY/
DATE MEDICATION NAME DOSAGE INDICATION
(eg, tablet, capsule, TIME OF DAY
liquid, injectable, etc)

30 | Guide to Adult Tube Feeding

MEDICATION RECORD
Please list all over-the-counter medications, vitamins, and herbal supplements.

MEDICATION
FORMULATION FREQUENCY/
DATE MEDICATION NAME DOSAGE INDICATION
(eg, tablet, capsule, TIME OF DAY
liquid, injectable, etc)

Guide to Adult Tube Feeding | 31

 GLOSSARY

ABDOMEN: The body space between the DEHYDRATION: A condition in which the
chest and the pelvis. This space houses the body does not have enough water.
stomach, liver, gallbladder, spleen, pancreas,
small bowel (intestine), large bowel (intestine). DELAYED GASTRIC EMPTYING: A
condition that slows the movement of
ABDOMINAL WALL: The abdominal wall food from the stomach to the small bowel
represents the skin and tissue covering the (intestine).
abdomen.
DIARRHEA: two to three loose bowel
ABSORPTION: Uptake of nutrients by the movements/day.
digestive system.
ENTERAL NUTRITION: Also known as tube
BALLOON PORT: A port on the proximal feeding, is a way of delivering nutrition directly
end (end furthest away from the abdomen) to your stomach or small intestine.
of a gastrostomy tube where water is inserted
to inflate the balloon. There is a plastic sleeve ESOPHAGUS: The muscular tube leading
around most ports that tell how much water is from the mouth to the stomach.
needed to inflate the balloon. EXTERNAL SKIN DISK: Also called an
BLOATING: Swelling and tightness of the external skin bolster, this holds the tube in
abdomen, typically caused by fluid, gas or air. place as it exits the body. Its purpose is to
prevent lateral tube movement, which could
BOLUS FEEDING: Formula is placed in a contribute to leakage of gastric contents onto
syringe and is slowly pushed into the feeding the skin.
tube.
FEEDING PORT: The main port of the
CANDIDIASIS: An infection caused by a type feeding tube. Formula is delivered to the
of yeast. It can develop on the skin around the patient by connecting a feeding set or syringe
feeding tube. to this port.
CLOSED ENTERAL SYSTEM: A closed FEEDING RATE: Determined by how fast
enteral container or bag, pre-filled with sterile, the formula is poured into the syringe, how
liquid formula by the manufacturer, and high the rate is set on a pump, or how high the
considered ready to administer. syringe or gravity feeding bag is placed above
the stomach.
CONSTIPATION: A condition in which stool
becomes hard, dry, and difficult to pass, and FEEDING SET: Tubing that is part of a gravity
bowel movements do not happen very often. or pump feeding bag and delivers formula into
the stomach or small bowel (intestine) through
CONTINUOUS FEEDING: Tube feeding— the feeding tube.
usually by an automatic pump—where the
formula is fed slowly over a long period of time,
such as all day or night (or both).

32 | Guide to Adult Tube Feeding

FEEDING TUBE: A tube into the stomach or MALABSORPTION: Failure to absorb
small bowel (intestine) through which formula certain nutrients, vitamins and minerals from
flows. the intestinal tract into the bloodstream.
FLUSHING: The process of pushing water MALDIGESTION: Inability to digest food in
through the tube to prevent tube clogging. the intestine.
Also for hydration needs.
NASOGASTRIC (NG) TUBE: A feeding
FRENCH SIZE: A measuring system used to tube that goes from the nose to the stomach.
define the outer diameter of a feeding tube.
The larger the number, the bigger the diameter. NASOJEJUNAL (NJ) TUBE: A feeding tube
that goes from the nose to the jejunum.
GASTROSTOMY TUBE (G-TUBE): A
feeding tube that goes into the stomach NAUSEA: Having stomach upset with
through a stoma. the urge to vomit.

GRAVITY FEEDING: Feeding method that OPEN ENTERAL SYSTEM: An enteral

allows gravity to control the rate of feeding system in which the clinician/patient/caregiver
either through a syringe or gravity feeding bag. opens and pours formula into a feeding bag.

HYPERGRANULATION TISSUE: Thick, PARENTERNAL NUTRITION: A method of

red, raised tissue that can form around the feeding that bypasses the gastrointestinal tract,
feeding tube where it enters the abdominal infusing liquid nutrients directly into the blood
wall. stream through a vein (intravenously).

INTERMITTENT FEEDING: Feeding PERCUTANEOUS ENDOSCOPIC

method in which formula is given 3 to 8 times GASTROSTOMY (PEG) TUBE: A feeding
a day. tube that is surgically placed through your
abdomen into your stomach using a lighted
INTERNAL BUMPER: Also called the flexible scope called an endoscope.
internal bolster, this is found on the distal end
of the feeding tube (the end that is inside the PERCUTANEOUS ENDOSCOPIC
stomach) and helps hold the tube in place. JEJUNOSTOMY (PEJ) TUBE: A feeding
tube that is surgically placed through your
JEJUNOSTOMY TUBE (J-TUBE): A feeding abdomen into your jejunum using a lighted
tube that goes into the small intestine. flexible scope called an endoscope.
JEJUNUM: The second part of the small PERISTOMAL INFECTION: Infection of
bowel (intestine). the tissue around the feeding tube.
LOW-PROFILE
GASTROSTOMY TUBE (BUTTON):
A gastrostomy tube that lies flat against the
abdomen.

Guide to Adult Tube Feeding | 33

 PRIME THE FEEDING SET: To pour the STOMA: Opening in the abdominal wall
formula into gravity or pump set and let it flow through which a gastrostomy tube or
to the end of the feeding set to remove the air jejunostomy tube enters the body.
in the set prior to connecting it to the feeding
tube. SYRINGE: A hollow, plastic tube with a
plunger used to infuse formula, medication, or
PUMP FEEDING: Feeding by an electronic water into a feeding tube.
pump—where the formula is fed slowly over
a longer period of time, or programmed to SYRINGE/BOLUS FEEDING: Formula is
deliver a bolus over a shorter period of time. poured in a syringe and flows slowly into the
feeding tube; the height of the syringe controls
SMALL BOWEL (INTESTINE): The part of the feeding rate. A syringe push method can
the digestive tract between the stomach also be used to bolus feed.
and large intestine that digests and absorbs
nutrients. SYRINGE FEEDING: Feeding method in
which formula flows from a syringe into a
SORBITOL: A sugar alcohol used in liquid feeding tube or is infused into the feeding tube
medications that can cause diarrhea in some using the plunger on the syringe.
patients.

34 | Guide to Adult Tube Feeding

NOTES

Guide to Adult Tube Feeding | 35

 NOTES

36 | Guide to Adult Tube Feeding

NOTES

Guide to Adult Tube Feeding | 37

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38 | Guide to Adult Tube Feeding