FEEDING TUBES This infrmatin aims t help yu understand the peratin, what is invlved and sme cmmn cmplicatins that may ccur. It may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice r discussin between yu and yur cancer care team. AN OVERVIEW TO FEEDING TUBES A feeding tube is a tube that is put int the stmach t help deliver nutritin, in thse unable t swallw r eat enugh. It is ften temprary, but may be permanent fr sme peple. Fd and water are delivered directly t the stmach r smetimes the small bwel (jejunum) t help ensure prper nurishment during treatment and recvery. There are a number f different types f feeding tubes. These include a: Gastrstmy tube: this ges directly int yur stmach thrugh an pening made n the utside f yur abdmen. A percutaneus endscpic gastrstmy (PEG) tube is a cmmn type that is inserted using a telescpe (gastrscpe). Nasgastric (NG) tube: this is a thin tube put thrugh the nse, dwn the thrat and fd pipe (esphagus) int the stmach. WHY IS A FEEDING TUBE NEEDED Nutritin is very imprtant t help recver frm head and neck cancer treatment. A feeding tube may be required, if it is difficult t swallw as a result f: a cancer in the muth r thrat the side effects f chemtherapy r radiatin therapy surgery t the muth r thrat area. 2016 Beynd Five 1
HOW TO PREPARE FOR THE PROCEDURE A feeding tube can be inserted while yu are awake, under tpical anaesthesia (using a medicine t numb the area f the surgery) r while yu are asleep (using a general anaesthetic). If yu are having ther surgery fr yur cancer, yur feeding tube may be inserted at the same peratin. If yu are having a general anaesthetic (yu will be asleep and will nt remember what happens during the peratin), yu will need t fast (have nthing t eat r drink) fr 6 hurs befre yur peratin (unless advised differently by yur surgen r anaesthetist). The dctr perfrming the prcedure will explain the details f yur peratin. Be sure t bring up any questins r cncerns, and share yur needs and wishes with yur cancer care team. Talk t yur cancer care team abut any likely risks r side effects t expect fllwing the peratin. Yu may find it useful t talk t allied health prfessinals abut supprtive care issues. Visit the Beynd Five website fr further infrmatin abut the specific surgery yu are having fr yur particular cancer and fr questins t ask yur dctr. WHAT TO EXPECT DURING THE PROCEDURE A nasgastric feeding tube may be put in place either: while yu are awake, using a numbing spray (tpical anaesthetic). Yu may feel sme discmfrt, but this will nly last fr a few minutes. Yu can help by swallwing the tube as part f anther peratin, while yu are cmpletely asleep. A gastrstmy feeding tube may be put in place either: while yu are asleep, in the perating rm using a flexible, telescpe (endscpe), which is passed dwn yur thrat int yur stmach. This is called a percutaneus endscpic gastrstmy (PEG) in the radilgy department with lcal anaesthetic and sme sedatin, using X-rays t check the psitin f the tube. This is called a radilgically inserted gastrstmy (RIG). A RIG tube has a balln that stps the tube frm falling ut. 2016 Beynd Five 2
WHAT TO EXPECT AFTER THE PROCEDURE After a nasgastric tube is inserted, an X-ray is perfrmed t check the tube is in the stmach. Once this is cnfirmed the tube can be used. After a gastrstmy tube is inserted, yu will need t wait fr a few hurs, up t a day, t allw the area arund the feeding tube t heal. The feeding tube is then ready fr use. If yu are staying in hspital the nurse will start giving yu fd thrugh the tube using a special pump, but ften a gastrstmy (PEG r RIG) is dne as a day prcedure and yu will g hme with instructins abut hw t lk after the tube and keep the skin arund the tube clean. An appintment will be made with a dietician t discuss: the type f liquid fd (feed) t use hw much and when t use the feeds. If yu are in hspital, the nurse will start feeding yu slwly, and gradually increase the rate f the feeds. This helps t avid nausea r diarrhea. A dietitian may be invlved in yur care t ensure yu are receiving enugh nutritin and water fr yur bdy weight and nutritinal needs. Specially prepared liquid will be fed thrugh the feeding tube: yu may be fed cntinuusly thrugh the tube by a pump t cntrl the speed. The advantage f cntinuus feeding is that a little ges in at a time s yu dn t feel t full. Yu culd be fed as a blus, which is a larger amunt several times a day. The advantage is that yu nly need t be hked up a few times a day and fr the rest f the day, yur tube can be clamped s yu are free t d what yu want. When a feeding tube is nt being used it needs t be flushed with water regularly t stp it frm getting blcked. It als needs t be flushed after each feed. Medicatins can be put dwn the tube, if they can be crushed r preferably in a liquid frm. It is imprtant t flush the tube prperly after putting medicatins because they can easily blck the tube. 2016 Beynd Five 3
POSSIBLE RISKS OF GASTROSTOMY All peratins carry sme risks such as bld clts, wund infectins, bleeding, chest infectin, adverse reactins t anaesthetic, and ther cmplicatins. These risks will be explained by yur cancer specialist and anaesthetist. Yur dctr will explain details f the peratin, general risks and side effects f the peratin, they may recmmend: stpping bld thinners (e.g. aspirin) befre surgery t reduce the risk f bleeding a bld thinner (called heparin) may be injected befre and after surgery t reduce the risk f bld clts antibitics t reduce t risk f wund infectin early mbilisatin t reduce the risk f bld clts and chest infectin special stckings t reduce the risk f bld clts. There are sme specific risks f a gastrstmy. These include: Bleeding: frm the stmach r where the skin is cut Infectin: in the tissue arund the tube. Antibitics will be given t reduce the risk f infectin. Bwel injury: when the tube is being placed thrugh the abdminal wall. This is a rare cmplicatin but can be serius requiring majr surgery t repair the bwel. Tube migratin: If the tube mves t far inside the stmach, the balln (r flange) can blck the bwel and cause abdminal pain and vmiting. Tube disldgement: If the tube is pulled n, it will cme ut. It is imprtant t make sure it is well supprted. If this happens g t the emergency department and ften the gastrstmy tube can be replaced with a temprary tube t stp the hle frm clsing. 2016 Beynd Five 4
SIDE EFFECTS AND THEIR MANAGEMENT As with all peratins, there is a chance that gastrstmy may lead t a number f side effects. Yu may nt experience all f the side effects. Speak with yur dctr if yu have any questins r cncerns abut treatment side effects. Side effects cmmn fr gastrstmy may include: Nausea: General anaesthetic may cause nausea. This will settle dwn sn after the peratin and can be treated with medicatins. Yu may als feel sme nausea as yu get used t receiving fd thrugh the feeding tube. Discmfrt and irritatin arund the tube: This can be reduced by keeping the skin clean and keeping the tube well supprted. Diarrhea r cnstipatin: The feeds are cncentrated and can cause a blated feeling and/r diarrhea. Feeding mre slwly may help. If yu have diarrhea, yu may als need extra fluids thrugh a drip. Alternatively, if yu get cnstipated after surgery, ask fr medicatin t help. BEFORE GOING HOME Sme patients may need t g hme with a feeding tube; they will be shwn hw t use the feeding tube befre leaving the hspital. Peple usually get the hang f using the feeding tube quite quickly, s dn t wrry and be sure t ask any questins yu have. Keep the skin clean, many peple use a little dressing arund the tube t keep the skin clean. Avid getting the tube clgged, crush any medicatins well and flush the tube regularly. It helps if smene else that yu live with r see regularly, als learns what yu have t d t. Yur dctr will advise yu abut any particular symptms yu shuld lk ut fr such as redness spreading frm the tube r increased pain arund the tube r in the abdmen, r fever. Yur dctr will als advise n what yu shuld d if yu have any f these. If yur tube falls ut, yu shuld call yur dctr r g directly t the hspital emergency department. Yu will be assessed by the team invlved in yur care befre yu g hme and fllw-up will be arranged with yur surgen and GP. Fllw-up may als be arranged with a dietitian, r with any ther allied health prfessinals t assist yu with supprtive care. 2016 Beynd Five 5
Visit the Beynd Five website fr further infrmatin abut the specific surgery yu are having fr yur particular cancer and fr questins t ask yur dctr. Fr tp tips and further infrmatin abut gastrstmy, yu can als refer t https://www.aci.health.nsw.gv.au/resurces/nutritin/hen/gastrstmy-tubes/rbs-stry-life-witha-feeding-tube QUESTIONS TO ASK YOUR DOCTOR What if I think I have an infectin? What if my tube cmes ut? Will I be able t lead a nrmal life? Hw can I care fr the tube? What are sme f the benefits f feeding tubes? Wuld I have t be attached t the feeding tube fr the rest f my life? What are sme f the pssible side effects? 2016 Beynd Five 6
Yu may want t write specific questins here t ask yur dctr r cancer care team Beynd Five disclaimer: Yu acknwledge and accept that the infrmatin in this factsheet is fr general infrmatin purpses nly. It is nt intended, nr shuld it be relied n, as medical r legal advice, r as a substitute fr cnsultatin with a physician r ther licensed healthcare prvider. Yu agree that if yu have individual healthcare-related questins yu shuld cntact yur dctr prmptly and shuld nt disregard prfessinal medical advice, r delay seeking it, because f infrmatin cntained here. Yu als agree that Beynd Five is nt liable fr any injury r damage t persns r prperty (hwsever caused, including by negligence) arising ut f r related t any use f Beynd Five s patient educatin materials, r fr any errrs r missins. Last updated: 24 Octber 2016 2016 Beynd Five 7