Problems and Solutions by Subject

During tube feeding, bowel movements may be less frequent than usual due to lack of water, lack of fiber in the formula, or inactivity. Constipation—meaning difficult-to-pass and very infrequent bowel movements—can sometimes occur on a home tube feeding program.

Probable causes:

• Not enough water is being given with your feedings
• No fiber, or not enough fiber, in your formula
• Unable to be mobile or engage in enough physical activity
• Medication side effects

Important Guidelines:

• Provide additional water through your feeding tube as instructed by your healthcare professional.
• Check with your registered dietitian nutritionist or doctor to see if you should change to a formula that contains adequate fiber.
• If it is permitted, and you are able, increase your physical activity.
• Ask your healthcare professional to review your medications to see if any may cause constipation or discuss a bowel regimen.

Diarrhea—frequent loose and watery stools—can sometimes occur on a home tube feeding program.

Probable causes:

• Medication side effects
• Formula is too cold
• Feeding pump rate is too high
• No fiber, or not enough fiber, in your formula
• Formula is being fed too fast by syringe or gravity feeding
• Formula may be spoiled or contaminated by bacteria
• Formula intolerance

Important guidelines:

• Because emotions can affect digestion, try to relax during the feeding.
• Remove the formula from the refrigerator at least 30 minutes prior to feeding, allowing it to warm to room temperature.
• Wash your hands thoroughly with soap and water and wipe the top of the formula container with a clean wet paper towel before you handle the formula and tubing.
• Unopened formula should be stored in a cool, dry place.
• Opened containers of formula should be reclosed or tightly covered and stored in the refrigerator for up to 24 hours.
• Discard formula that has been opened and left in the refrigerator for longer than 24 hours.
• Do not exceed the recommended hang time.
• Replace your feeding container and tubing as directed by your home care supplier

You may be receiving too little fluid or you are losing too much fluid.

Probable causes:

• Formula is too concentrated
• Frequent diarrhea
• Prolonged fever
• Not taking enough water before or after feedings
• Wound is draining large amounts of fluid
• Perspiring heavily
• Increased secretions (such as drooling)

Important guidelines:

• Take the prescribed amount of water every day before and after your feedings.

If you are experiencing fever, diarrhea, excessive wound drainage or heavy sweating, consult your healthcare professional to determine how much more water you need.

You may be receiving too much fluid or you are retaining too much fluid.

Probable causes:

• Taking too much water before or after feedings
• Feeding rate is too high
• Fluid volume is too high due to diluted formula

Important guidelines:

• Consult with your healthcare professional to determine if you should decrease the amount of water you take before or after feedings.
• Use the prescribed volume and strength of the feeding formula.
• Do not dilute the formula with water unless your healthcare professional has told you to.
• Ask your healthcare professional to re-evaluate your formula. You may need to switch to a formula that has more calories in less volume.

An uncomfortable feeling of nausea, bloating or gas pain may sometimes result from home tube feedings. Occasionally, belching or vomiting can also occur.

Probable causes:

• Formula is being fed too fast
• Formula is too cold
• Formula is left open at room temperature or in feeding bag for too long
• Formula is too concentrated
• Too much formula given in a short amount of time
• Lying flat during or immediately after receiving your feeding
• Constipation
• Medication side effect
• Exercising or engaging in too much activity right after a feeding
• Intolerance to the formula

Important guidelines:

• Remove the formula from the refrigerator at least 30 minutes prior to the feeding, allowing it to warm to room temperature.
• Make sure you are following the directions for the prescribed amount of formula and/or correct flow rate.
• Do not allow formula to sit at room temperature or hang longer than the recommended time.
• Do not lie flat during or just after a feeding. Sit or lie at a 30-degree angle (about the height of two pillows) during the feeding and for 30 to 60 minutes after the feeding.
• If directed by your healthcare professional, check the stomach residual before re-starting the next feeding. Do not start a feeding if the residual is over the fluid ounces or mL as instructed by your healthcare professional.
• Ask your healthcare professional to re-evaluate your formula. You may need to switch to a formula that has more calories in less volume or to a special formula that contains ingredients that are easier to digest and absorb.
• Review medications or bowel regimen with your healthcare provider.

Probable causes:

• Kink or bend in your feeding tube
• Dried formula or medication is blocking your feeding tube
• Inadequate or inconsistent flushing

Important guidelines:

• Check to make sure there are no kinks or bends in your feeding tube.
• Flush your tube before and after each feeding with at least 30 mL of lukewarm water or the amount directed by your healthcare professional.
• When taking medications, dissolve them thoroughly in warm water before administering them through your feeding tube (see page 18).
• Flush your tube with warm water before and after administering your medications.
• Flush your tube with at least 15 mL of lukewarm water before and after administering your medications or the amount directed by your healthcare professional.
• If tube is blocked, do not try to remove the blockage yourself. Consult with your healthcare professional for directions on how to proceed.

Aspiration refers to formula that enters the lungs and usually results in coughing, gagging and difficulty breathing. Consult your healthcare professional immediately if symptoms develop.

Probable causes:

• Improper feeding tube placement
• Formula has backed up or been inhaled into your lungs
• Lying flat during feeding

Important guidelines:

• Check that your tube is properly positioned (see page 10).
• Sit or lie at a 30-degree angle (about the height of two pillows) during your feeding.
• Remain sitting up, standing or walking for at least 30 to 60 minutes after your feeding.
• If you are taking your feeding at night, use two or three pillows to elevate your head, or put wooden blocks on the floor to elevate the head of the bed.
• If you feel bloated, full or have been vomiting, do not begin a feeding.
• Consult your healthcare professional immediately if symptoms develop. If directed by your healthcare professional, check the stomach (gastric) residual before re-starting the next feeding.
• Do not start a feeding if the residual is over the fluid ounces or mL as instructed by your healthcare professional.