Tube Feeding Troubleshooting
Contents
1. diarrhea fistulae ostomy output urine output See tips in the sections on Nausea Vomiting and Diarrhea on pages 3 and 4 Decreased urine output Take all tube feeding formula and fluids as ordered by your doctor Discuss with your doctor when you should take more or less fluid You may be asked to keep a daily log of fluid intake weight and urine stool output in order to spot any significant changes Additional Resources Oley Foundation www oley org 800 776 OLEY Offers patients tube feeding tips opportunities to meet other tube feeders caregivers equipment supply exchange information on traveling with tube feeding and more Offers clinicians patient education and discharge materials A S P E N www nutritioncare org 301 587 6315 Offers clinicians tube feeding standards guidelines patient education materials and hospital long term care facility safety programs Doctor s office Home care company Emergency Room 43 New Scotland Ave MC 28 Albany Medical Center Albany NY 12208 3478 The 518 262 5079 e y Foundation 800 776 OLEY www oley org 800 776 OLEY www oley org2. diet with a dietitian Ask if the food has anything that could cause Ask your doctor if you need a pancreatic enzyme replacement lactase enzyme or diarrhea Possibilities include foods with lactose or high amounts of sugar or fat a probiotic Tube Displacement DESCRIPTION Tube has come out of body or has moved out of place see measuring tips on page 2 Choking difficulty breathing Nausea vomiting abdominal pain diarrhea IMMEDIATE ACTION Discontinue feeding Ifyou have an NG or NJ tube and the tube is curled in the back of your throat pull it completely out Ifyou have a G J or G J tube do not remove the tube in your abdomen Call your doctor e Ifyou have a G J or G J tube and the tube has fallen out call your doctor or go to the emergency room to have the tube replaced as soon as possible Depending on the type of tube you may be able to replace it yourself but this needs to be discussed with your doctor ahead of time CAUSES AND PREVENTION These symptoms can be caused by several things Frequent vomiting e See Nausea and Vomiting page 3 The tube is not adequately secured Accidental or excessive pulling of the tube Your stomach may see your tube as a piece of food It may act to pull the tube inside your stomach or intestine Balloon deflates or bursts Use a tube attachment device such as a tube holder Carefully tape the tube to your abdomen nose or cheek Take a
3. LEY FOUNDATION TUBE FEEDING TROUBLESHOOTING GUIDE Gastrointestinal Bleeding GI DESCRIPTION Bright red blood on outside of stool or around the rectum Black tarry stool or diarrhea Black brown blood in vomit looks like coffee grounds Vomiting bright red blood Bright red blood coming from and or around tube IMMEDIATE ACTION Discuss all GI bleeding with your doctor CAUSES AND PREVENTION These symptons can be caused by several things Bright red blood on outside of stool or around the rectum is likely caused by irritated hemorrhoids fissure or an anal tear These conditions are commonly linked to excessive diarrhea or constipation Reduce diarrhea see Diarrhea page 4 or avoid constipation see Constipation page 7 Discuss symptoms with your doctor Black tarry stool or diarrhea black brown blood in vomit or gt 1 Tablespoon bright red blood in vomit likely indicates upper GI bleeding Ask your doctor about medicines that block acid production Frequent vomiting that may come with small amounts less than 1 tablespoon bright red blood is likely caused by burst blood vessel in throat Reduce vomiting see Nausea Vomiting page 3 Discuss symptoms with your doctor If large amount of blood is present call your doctor immediately You may need to call 911 Bright red blood coming from tube or around the tube may be caused by Gastric stomach ulcer irritation Eros
4. SN Kerry 43 New Scotland Ave MC 28 Stone MS RD CNSC Albany Medical Center Albany NY 12208 3478 And to the sponsors www oley org Daniel F and Ada L Rice Foundation info oley org 800 776 OLEY toll free in US and Canada updated 12 13 518 262 5079 calls from Europe and elsewhere 518 262 5528 fax Going Home with Tube Feedings WHEN YOU FIRST GET YOUR TUBE Ask for the packaging so you know the brand type G tube J tube G J tube and size the diameter is measured in French or Fr Note NG and NJ tubes that go through a person s nose are used for temporary not prolonged tube feedings Ask how your tube is held in place For example does it have a balloon a mushroom bumper or other internal device or does it rely on stitches Ifitis not a low profile device sometimes called a button ask the nurse if he she has tips on securing the dangling portion of the tube or see www oley org e Mark the feeding tube 1 inch from where it enters the body with a permanent marker Check the tube before each feeding If it has moved in or out more than 1 inch call your doctor Before going home you should be taught how to give liquid nutrition water and possibly medications through the tube If you are uncomfortable ask your doctor visiting nurse or home care company for more training Go to www oley org for a How to check list for feeding flushing and or giving medicines through a tube Ask what you shoul
5. The ey Foundation TUBE FEEDING TROUBLESHOOTING GUIDE TABLE OF CONTENTS This guide is a tool to assist you and Going Home with Tube FeedingS sscsssccssecssseesseseeesseneeees hould not replace your doctor s ae should P y Nausea and Vomiting sss ssssssssssssssesrssssssrtessseeessssssereeessseeesssseee advice We suggest you read the section related Diarrh d siisii to your symptoms and then discuss with your doctor Tube Displacement sss sssssssssesssssssssssseessssssrtessseeessssnsoresesssreessss whether you should follow the instructions on the guide Tube Obstruction Blockage sssssssssssssecsssescssessseecssscssseesssseesss General tips that will be especially helpful for new tube Site Irritation and or Tube Leaking ssssssssssssssessessessesssssssssnees feeders can be found on page 2 Recommendations from ASPINAUON cc cpaadanqeticnnnnsdackin sa mmnmlaREMdanRAN the guide may not apply to everyone Constipation nissin Gastrointestinal Bleeding Gl sessssssessssecceseecssseeceenseeeseneeees Pump or Power Failure sssssssssesssosssersnsessonsssersassssenssserancrssenses Hy Pell CEMA nc niencundimmounncku adamant Fy POGIYCENIA ccannatcetonmaumnnakunurdommanneammans Fluid or Electrolyte Imbalances covsssssossssscscsssssescorsnssseseesase 10 Special thanks to the authors and editors of this guide The Oley Foundation Pat Agre RN EdD Pat Brown RN CN
6. d do if the tube falls out If you ve been trained to replace your tube ask for an extra replacement tube should the need arise Showering bathing with your tube It is okay to get your tube insertion site wet in the shower 48 hours after the tube was inserted or as per your doctor s instructions Clean the site with warm water and a mild soap daily This can be done while showering Pat dry Apply skin ointment and dressing as needed see www oley org for ideas It is normal to have some crusty drainage around the tube If the drainage is foul smelling and or there is a large amount or the skin is red warm or tender consult your doctor e Cleaning and storing supplies Wash all equipment with hot soapy water after each use Rinse well making sure all the soap is rinsed away Allow to air dry It is best if you have at least two of every item so you can alternate their use Store clean feeding bags and tubing in a clean plastic bag or towel or container If desired store in the refrigerator Ask your clinician how many times the equipment can be washed and reused before it needs to be replaced e Don t forget your mouth Even if you are not eating you still need to brush your teeth gums and tongue with a soft toothbrush and gargle with mouthwash like Biotene twice each day see www oley org for Managing the Symptoms of Dry Mouth Parents of infants toddlers young children consult with your child s doctor about sa
7. e with water every six to eight hours if you are on continuous feeds Site Irritation and or Tube Leaking DESCRIPTION Burning pain Foul odor or local infection Irritated skin or rash around tube NG NJ tube users may have developed sinus or ear infection Granulation or extra tissue built up around the insertion site It may appear shiny and pink and bleed easily Visible leakage from tube or around tube Multiple soaked dressings that require changing more than twice per day IMMEDIATE ACTION If possible clamp the tube above the problem area Stop feeding Wash skin with warm water and a mild soap pat dry and apply a dry dressing CAUSES AND PREVENTION These symptoms can be caused by several things Poorly fitting tube Tube diameter is too small for tube tract Stem of button is too long Internal bumper is too short too loose or too tight against the inside stomach wall The external disc is too tight or too loose The balloon is overinflated or underinflated The disc was not adjusted after weight loss or gain NG NJ tube may be too big or too loose Check the tube to see if it has moved out of position see measuring tips on page 2 or if there is an obvious source of leakage Ask your doctor or nurse about the tube size manufacturer and lot number Ask your doctor or nurse to give you tips to keep the tube fitting snuggly to avoid skin infection Tube
8. ear tube Chemotherapy Steroids Leaking may occur due to chemotherapy This will decrease with recovery from the effects of chemotherapy See skin care suggestions above 6 OLEY FOUNDATION 7UBE FEEDING TROUBLESHOOTING GUIDE Aspiration DESCRIPTION Vomiting heartburn Coughing or choking with difficulty breathing Chest pain Possible fever shortness of breath pneumonia IMMEDIATE ACTION Stop feeding Open clamp to drain stomach contents if possible Some tubes have valves such as buttons which make drainage difficult If unable to drain button call your doctor to discuss decompression tubes or devices all doctor immediately and go to the emergency room CAUSES AND PREVENTION These symptoms can be caused by several things Diminished gag reflex gastroesophageal reflux also known as GERD this is when stomach fluids back up into your lower esophagus swallowing disorder silent aspiration esophageal narrowing or decreased movement motility of the esophagus and or stomach Put head of the bed on 6 blocks for night time feedings e Have head of bed elevated 30 to 45 angle or sit up during feeds Do not lay flat for at least 30 minutes to one hour post feeding Do not feed if stomach feels full or distended or if individual is vomiting Take prescribed medication for GERD Ask doctor about having a swallowing study done Constipation DESCRIPTION IMMEDIATE ACTION Increase flu
9. fe ways to stimulate your child s ability to suck swallow and taste This will help prepare for the day when your child will no longer need tube feedings see www oley org for more information on feeding or weaning a tube fed child GET CONNECTED TO INFORMATION AND OTHER TUBE FEEDERS Get connected to the Oley Foundation for more information www oley org Oley has written materials as well as DVDs on a range of topics of interest to tube feeders including how to feed tips on skin care and special products Feeling depressed or overwhelmed This is a common experience for people new to tube feeding Oley can connect you with other patients and families on tube feeding through its volunteer network and online forum Oley can also provide you a booklet on coping with tube feeding If your needs are more extensive or immediate ask your physician for a referral to a psychologist counselor or go to the ER e Other things Oley can help with include Travel tips Advice on swimming Finding formula or supplies through the Equipment Supply Exchange LIVE BETTER Keep in mind that there are many different types of tubes formula pumps and other supplies available There are also different ways of feeding e g bolus feeding vs gravity feeding vs pump assisted feedings and feeding schedules e g overnight vs during the day Changing one or more of these variables can improve your quality of life You are encouraged to speak with
10. h cold formula You or the tube are not positioned correctly for tube feeding The tube may not be in the correct position Check the tube to see if it has dislodged or moved see Tube Displacement page 4 You are not in the correct position for tube feeding Put head of the bed on 6 blocks for night tube feedings Have head of bed elevated 30 to 45 degree angle or sit up during feeds Do not lie flat for at least 30 minutes to one hour after the feeding ends 800 776 OLEY www oley org Your stomach may not be emptying well Stomach contents may be flowing back into your esophagus GERD or Gastroesophageal Reflux Disorder You may have an ulcer Ask your doctor if you have any of these conditions and if medication is needed Take any medicines that your doctor prescribes lt Your bowel may be obstructed Something may be blocking the formula so it cannot pass through your bowels Your doctor will need to examine you and possibly do some tests e You may be constipated see Constipation page 7 Other possible causes e Medication or other treatments such as chemotherapy radiation may make you feel ill Check with your doctor to see if these symptoms could be side effects of a medicine you are taking Ask if there are other medicines that might have fewer side effects Also ask if you can have a prescription for anti nausea medicine If your doctor prescribes it take it at least 30 to 60 minutes before
11. hat may be used to clear clogs caused by formula see suggested protocol on right or the Clog Zapper Corpak MedSystems a mixture designed to clear any type of clog Viokace is available by prescription only and must be administered by a clinician It is recommended that the first time you try the Clog Zapper you do so under the supervision of a clinician e Note A mechanical device TubeClear Actuated Medical Inc is in clinical trials and may be another option available to your clinician More information about tube clearing devices is available at www oley org CAUSES AND PREVENTION These symptoms can be caused by several things Medicine not given properly Ask your pharmacist doctor or nurse to review medications and how to give medications via tube e Give each medicine by itself Flush before and after it is administered Do not mix any medicine with formula Use liquid medicines when possible Dilute them with 30 mL of water Ifyou cannot get the medicine in a liquid form completely dissolve crushed medicines in 30 mL of water Time release medicines may need special attention for example the drug Prevacid e Go to www oley org for a handout on giving medications by tube Tube not flushed properly Flush tube well with water before and after putting formula medication or anything else in your tube Ask your doctor how much fluid you should use Flush tube every 4 6 hours if on con
12. id intake Use stool softener laxative or enema as instructed by doctor CAUSES AND PREVENTION These symptoms can be caused by several things You may not be getting enough liquids or fiber Ask your doctor how much liquid to take between feedings Ask about taking a fiber enhanced formula or adding a fiber product to your daily regimen Side effect of medication Ask your doctor if your medications can cause constipation Your bowels may be blocked obstructed Call your doctor if you think your bowel is blocked or obstructed Delayed gastric stomach emptying Take prescribed medication to help empty stomach for dysmotility Do not feed if stomach feels full or distended Do not feed if individual is vomiting or constipated Tube has moved migrated out of place Read suggestions in Tube Displacement section on page 4 Infrequent and or hard stool Liquid stool may leak around impacted or stuck stool Bloating gas cramping or pain Call doctor or go to ER if you ve had no bowel movement in two days you are vomiting you have abdominal swelling or severe cramping You are not active enough Increase your activity as able Walking is a good form of exercise Check with your doctor before you start to make sure it is safe for you Your bowels may not work normally dysmotility Ask your doctor if you need to take medication for this condition Tests may be necessary Te O
13. ion of stomach lining from excessive tube movement External granulation tissue Ask your doctor if you should be examined Secure the tube with a tube holder see Tube Displacement page 4 Discuss granulation tissue with the wound care stoma therapist nurse or doctor see Site Irritation page 6 Pump or Power Failure Excess formula left in the bag after recommended feeding time is complete DESCRIPTION Unable to start pump Repeated alarms without obvious cause IMMEDIATE ACTION Check to see if pump is plugged into wall and that wall socket is functioning or that battery is charged Stop pump Check the pump user manual trouble shooting section for possible cause Call home care company for replacement These symptoms can be caused by several things If pump will not work and replacement pump is not available convert to gravity drip and administer at same or lower rate If tube is located in the jejunum gravity drip should not exceed prescribed amount on pump to avoid dumping syndrome If there is excessive formula in bag call home care provider for pump change CAUSES AND PREVENTION Power failure low battery Pump charger parts aren t fully connected Pump not plugged into wall outlet Check electrical outlet and or replace battery Notify local power company of durable medical equipment at home for emergency power outages Keep pump plugged into electrical source wheneve
14. nausea subsides Slowly increase the rate over 2 to 4 hours and then resume the amount to the previous level as tolerated If this doesn t work talk to your doctor The formula may be too concentrated for you or you may not tolerate some of the ingredients in the formula Ask your doctor if you should switch to a different formula Note before switching you should check whether your insurance will cover the new formula The formula may have become contaminated spoiled Use good hand washing and clean technique when handling tube feeding formula and equipment Wash all equipment with hot water and mild detergent each time you use it Rinse well Change the pump bags every 24 hours to ensure the proper amount of formula is given If cost is a concern you can use a gravity bag more than once a day if you clean it well After cleaning a used bag allow to dry well and put it in a clean re closable baggie or plastic storage container If desired store it in the refrigerator Do not store or wash equipment in the bathroom Do not use formula past its expiration date Do not use formula from cans that have dents or bulges Put the date and time on cans when you open them Cover them and store in the refrigerator Discard an open can after 24 hours Formula should not be given at room temperature for more than eight to 12 hours If you need to run your formula for longer than 12 hours put ice packs around the formula bag or start wit
15. piece of tape about 7 inches long Fold the ends about 144 worth on either end back on themselves Wrap the tape around the tube the non sticky ends should extend out about 1 inches Pin the ends to your clothing making sure you allow for adequate movement See www oley org for under garments and other products tips to help secure tubes e Be sure the balloon under your skin is intact You can check by using a syringe to draw out a few cc s of water Replace the water in the balloon after checking Also the tube will be easy to pull out if the balloon has burst Ifthe balloon has burst use tape to keep the tube in place Call your doctor or go to the emergency room to get a new tube Depending on the type of tube you may be able to replace it yourself but this needs to be discussed with your doctor ahead of time OLEY FOUNDATION TUBE FEEDING TROUBLESHOOTING GUIDE Tube Obstruction Blockage DESCRIPTION Inability to flush with water infuse tube feeding or administer medication Bulging of tube when feeding or flushing IMMEDIATE ACTION Make sure the tube clamp is open Do not force formula or medication into a clogged tube Try to flush the tube with a syringe filled with warm water Pull the plunger back on syringe Try flushing again with warm water If flushing doesn t work call your doctor to discuss alternative options Some options include Viokace Aptalis Pharma a pancreatic enzyme t
16. r possible to conserve battery charge Pump malfunction Follow manufacturer home care company recommendation for routine service maintenance Change pump bag every 24 hours 800 776 OLEY www oley org RARE COMPLICATIONS Hyperglycemia DESCRIPTION Frequent urination Excessive thirst and or hunger Unexplained weight loss Fatigue weakness drowsiness Numbness Sores that are slow to heal Increased number of infections Glucose levels above 110 mg dL when fasting or above 150 180 mg dL when feeding or other level set by your doctor IMMEDIATE ACTION e Call your doctor immediately for specific instructions CAUSES AND PREVENTION These symptoms can be caused by several things Diabetes or strong family history of diabetes Ask your doctor how to manage your diabetes e Take your tube feedings in the amount and at the rate your doctor prescribed Body under stress due to illness medications steroids etc Seek advice from your doctor Hypoglycemia DESCRIPTION Anxiety Blurred vision Feeling cold Fatigue weakness drowsiness Headache Hunger Irritability Pounding heart Restless sleep Sweating Trembling or shaking Blood sugar below 70 mg dL orlevel setby your doctor IMMEDIATE ACTION Put 2 to 4 ounces of orange juice or sugar water 1 tablespoon sugar to 4 ounces water through feeding tube Ifyou are able to swallow you can place hard candy or cake decorating gel under your tongue You can al
17. so let 1 to 2 teaspoons of sugar dissolve in your mouth all doctor immediately for specific instructions CAUSES AND PREVENTION These symptoms can be caused by several things Diabetes or strong family history of diabetes Ask your doctor how to manage your diabetes e Take your tube feedings in the amount and at the rate your doctor prescribed Stopping a feeding suddenly for patients on insulin Avoid interruptions in your feeding schedules If interruption is necessary consult with your doctor Medicines like Levaquin an antibiotic Discuss all medicines with pharmacist doctor OLEY FOUNDATION TUBE FEEDING TROUBLESHOOTING GUIDE Fluid or Electrolyte Imbalances DESCRIPTION Rapid weight loss or weight gain Thirst Weakness Swelling Shortness of breath Shakiness Fine tremors Muscle cramping Numbness Tingling of hands or around mouth Palpitations Fatigue Taste changes Skin changes Loss of coordination IMMEDIATE ACTION Ifyou think you have taken too much fluid or are extremely short of breath stop tube feedings and call your doctor immediately all your doctor if you are experiencing any of the signs and symptoms listed above Describe any change in weight fluid intake or urine stool output Your doctor may recommend taking more or less fluid through your feeding tube CAUSES AND PREVENTION These symptoms can be caused by several things Increased loss of fluid and or electrolytes from vomiting
18. tes see Fluid or Electrolyte Imbalance page 10 have black stools are having severe abdominal pain CAUSES AND PREVENTION These symptoms can be caused by several things Side effects of medicines Bowels not functioning properly Ifyou are on antibiotics you may experience diarrhea due to the antibiotics or possible bacterial overgrowth Consult with your doctor You may need a stool culture Ask your pharmacist if any of your medicines have sorbitol magnesium or phosphorus If so discuss proper dosage or an alternative with your doctor Take the dose of medicine your doctor has prescribed Tell your doctor if you are taking over the counter medicines herbals or supplements Short bowel syndrome your working small intestine is less than 100 cm Ask your doctor if medication to slow your bowel such as lomotil or tincture of opium or medication to decrease stomach acid secretions such as Pepcid or Protonix may be helpful for you Bacterial Overgrowth Tell your doctor if you are on or have taken any antibiotics recently Consult with your doctor You may need a stool culture Bowel inflammation You do not tolerate the formula See Nausea and Vomiting page 3 Ask your doctor how to control bowel inflammation Ask your doctor if adding fiber to your diet or taking a fiber enhanced formula can help your diarrhea Not tolerating food or drink taken by mouth e Review your
19. tinuous feedings Flush tube at least once a day if not in use Putting soda through the tube Do not put soda or other carbonated beverages in the tube They can interact with formula or medication and cause clogging Ask your doctor before putting fruit juice in the tube 800 776 OLEY www oley org Suggested Protocol for Administering Viokace Wearing gloves and a mask crush one Viokace tablet 10 440 USP units of lipase and one 375 mg sodium bicarbonate tablet and mix in 5 mL of water Introduce the mixture into the clogged tube clamp and let dwell for at least 30 minutes The mixture can be introduced with a syringe or if the clog is further down the tube it can be introduced with a small bore PVC tube inserted into the feeding tube Attempt to flush the tube with warm water Ifthe clog is not cleared remove the old Viokace mixture and repeat with a new batch Use caution when clearing small bore tubes as tablet fragments may further complicate the clog Putting in items that are too thick sticky or large to pass through tube Thoroughly blend powdered formula and non formula foods before putting them through the tube A pump may be needed when using a formula that is thick or concentrated Tube clamp is closed Make sure tube clamp is open when flushing feeding giving medicine Infusion rate is too slow Ask your doctor about increasing the rate Flush the tub
20. tugging at exit site Excessive movement or tension at exit site causing enlargement of tube tract irritation ulceration Buried bumper syndrome when an internal or external bolster migrates into the tube tract stoma See suggestions for securing tube in Tube Displacement on page 4 Vv Call the doctor or home care nurse Apply zinc oxide or other ointment to protect skin see www oley org for suggestions Improper skin care How to care for skin around stoma Remove dressing Wash skin with warm water and a mild soap daily can be done while showering Pat dry Apply skin ointment and dressing as needed see www oley org for ideas Change dressings when wet or soiled Wash per instructions above before applying a new dressing It is normal to have some crusty drainage around the tube If the drainage is foul smelling and or there is a large amount or the skin is red warm or tender consult your doctor Consult a wound care nurse stoma therapist or your doctor for advice on persistent skin care issues Ask about silver nitrate if granulation tissue is a problem See www oley org for additional suggestions for granulation tissue Broken tubing cap or anti reflux valve Ask your doctor if any part of the tubing should be replaced Repeat clamping at same site accidental cutting of the tube Move clamp to a different site daily Do not use scissors or sharp objects n
21. you begin tube feedings e You may feel uncomfortable or anxious about feeding by tube Ask your doctor nurse or home care company for more training Visit www oley org for videos and brochures that cover how to tube feed Try stress reduction or relaxation techniques Try yoga or exercise before feeding Ask your doctor about anti anxiety medicine Seek out support and encouragement from other tube feeders through the Oley Foundation at www oley org You may be bothered by the sight or smell of food or something else in your house Remove or move yourself away from offensive sights or odor causing objects while feeding Examples are bedpans commodes cooking smells etc e Coughing post nasal drip upper respiratory infection sore throat See your doctor if you have a persistent cough nasal drip sinus infection or sore throat The foods you are eating by mouth Possibilities include foods with lactose or high amounts of sugar or fat Review your diet with a dietitian Ask for a list of foods you may tolerate better Diarrhea DESCRIPTION Abdominal pain or cramping with frequent loose and or watery stool IMMEDIATE ACTION Decrease the volume or rate of tube feeding Call your doctor immediately if you Call your doctor if you experience a noticeable change in bowel movements for see bright red blood in the stool 24 or more hours The doctor can tell you how to avoid losing too much fluid and electroly
22. your physician your home care company or an Oley volunteer staff member to learn more about your options OLEY FOUNDATION TUBE FEEDING TROUBLESHOOTING GUIDE Nausea and Vomiting DESCRIPTION Abdominal distress distention feeling bloated cramping Vomiting dry heaves retching cold sweat IMMEDIATE ACTION Stop feeding Ifyou continue to vomit call your doctor for advice on how to avoid becoming Following instructions from your doctor drain the formula and or food from your dehydrated see Fluid Electrolyte Depletion page 10 stomach by unclamping tube If nothing comes out flush the tube with water Note Early morning nausea and vomiting may happen when first starting tube to make sure the tube is not blocked Some tubes have valves such as buttons feeds It may take time for your body to adjust to the formula feeding schedule and or which make them difficult to drain If the tube is blocked and or you are unable to constipation drain the stomach or vent out gas call your doctor to discuss decompression tubes or devices CAUSES AND PREVENTION These symptoms can be caused by several things You do not tolerate the formula Your stomach and or bowel isn t working normally The formula may be going in too fast Begin feedings at a low rate then increase the feeding rate and amount slowly Ask your doctor what rates and amounts he she recommends you work up to If you become nauseous decrease the rate until
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