Non-ENFit^®

Everyone has their own feeding routine. Be sure to plan your feeding routine with your doctor.

Bolus feedings can happen at the same time as regularly scheduled mealtimes, or, more often, throughout the day. Continuous feeding can happen throughout the entire day or night, including during your normal daily routine.

Note: Always use the feeding method and schedule that your doctor recommends.

You can feed wherever you feel most comfortable and relaxed.

With your head at a 30° angle or more, choose one of these positions:

• Sit on a chair or a couch.
• Sit up in bed.
• Stand up or walk around.

Note: Do not lie down while feeding or within one hour after feeding, as you may upset your stomach or vomit.

Liquid food is food in liquid form that can be taken in through your feeding tube. There are three types of liquid food:

• Ready-to-use formula: This is the most common type of liquid food. You can buy it in bags for gravity feeding or pump feeding, or you can buy it in a bottle or in a can. You must pour bottled or canned formula into a syringe before you can use it.
• Powdered formula: You must mix powdered formula with liquid in order to use it in your feeding tube.
• Home-blended food: Some people like to prepare their own blended food. Before you prepare your own food, talk to your doctor and a dietitian.

Note: Do not put solid or thick food through your feeding tube. Solid or thick food can clog or damage the tube. Be sure to record the type of liquid food you should use when you receive your feeding tube from your doctor. Don’t change your liquid food or feeding schedule without talking to your doctor first.

After your doctor places your Entuit BR feeding tube, you will need a few devices that will help you use your feeding tube.

If your doctor has prescribed bolus feeding, you’ll need a large volume syringe. If your doctor has prescribed continuous feeding, you’ll need a continuous feeding set and a feeding pump. If your doctor has prescribed gravity feeding, you’ll need a gravity feeding set.

The following guidelines are recommended by the Oley Foundation. For more information, visit www.oley.org.

Follow these general guidelines to ensure a safe and healthy feeding:

• Wash your hands with soap and water before you prepare your liquid food and before you touch your Entuit BR feeding tube.
• The Entuit BR feeding tube is marked in centimeters. Always check these marks before you feed in order to make sure that the tube has not moved.

Note: If your feeding tube is out of place, do not feed. Call your doctor right away.

Stop feeding and call your doctor if you experience weakness, cramping, dizziness, heavy sweating, or a rapid heartbeat.

• If possible, sit up straight while you feed and for one hour afterward. If you can’t sit up straight, raise your head at least 30 degrees during feeding. Do not lie down flat.
• Do not pull on your feeding tube. Pulling on your feeding tube may damage tissue or may cause your feeding tube to come out or to stop working.
• Contact your doctor if you see fluid leaking around your feeding tube or around your stoma.

The feeding port is the opening in your feeding tube where you put liquid food. Before and after each feeding, use a catheter-tipped syringe that is filled with 30–50 mL of water to flush the feeding tube through the feeding port (unless your doctor tells you otherwise).

Note: Always be sure to use the correct port for feeding. If you put liquid food into the balloon port, your balloon may break, or your feeding tube may fail.

Instructions for bolus (syringe) feeding

Use these supplies for bolus (syringe) feeding:

• Two 60 mL catheter-tipped syringes
• Liquid food prescribed by your doctor
• Water

Steps

1. Consult your feeding plan for the kind of liquid food you should use, the amount you should take, and your feeding rate as recommended by your doctor.
2. Flush your feeding tube with one 60 mL catheter-tipped syringe, using the amount of water and the method that your doctor has prescribed.
3. Fill the syringe with the prescribed amount of liquid food and attach it firmly to the feeding port of your feeding tube.
4. Use the syringe to inject the liquid food into your feeding tube.
5. When you finish feeding, use a clean catheter-tipped syringe filled with 30–50 mL of water to flush the feeding tube through the feeding port.
6. Rinse the syringes with warm water and allow them to air dry.

Instructions for continuous feeding

Use these supplies for continuous feeding:

• 60 mL catheter-tipped syringe
• Pump feeding set or gravity feeding set
• Liquid food prescribed by your doctor
• Water

Steps

1. Consult your feeding plan for the kind of liquid food that you should use, the amount that you should take, and your feeding rate as recommended by your doctor.
2. Flush your feeding tube with the 60 mL catheter-tipped syringe, using the amount of water and the method that your doctor has prescribed.
3. Fill the pump feeding set or the gravity feeding set with the prescribed amount of liquid food, and insert the tip into the feeding port of the feeding tube.
4. Ensure that the feeding set is properly connected to the feeding pump or gravity bag and that the clamp on the feeding set is open.
5. For pump feeding, follow the pump manufacturer’s instructions to set the pump rate. Follow any special instructions recorded in your feeding plan.
6. Close the clamp on the feeding set when the pump or bag is almost empty. Put the amount of water prescribed for you in the pump or bag.
   Note: Do not allow the liquid food to completely run out before you add water.
7. Open the clamp on the feeding set. Recheck the pump rate to make sure that it is set at the prescribed rate.
8. Flush the feeding tube with the prescribed amount of water. If you are feeding continuously for long periods of time, flush the feeding tube with the prescribed amount of water every 4–6 hours.
9. When you finish flushing, close the clamp on the feeding set. If you’re using a pump, turn off the pump.
10. Disconnect the feeding set from the feeding port of your feeding tube.
11. Rinse the syringe and feeding set with warm water and allow them to air dry.

Taking medicine

Most medicine that can be taken through your mouth can be taken through your Entuit BR feeding tube as long as the medicine is in liquid form. Always follow the instructions that were included with your medicine, and follow any special instructions that your doctor or pharmacist gives you.

Note: You should only take medicine through your feeding tube if your doctor has instructed you to do so, and you should follow your doctor’s instructions. Check with your doctor if you have questions about your medicine at any time.

Note: Solid medicine may be crushed into a fine powder and dissolved with water before being inserted. Do not crush medication that has an enteric (polymer) coating or attempt to mix medication with feeding formula. Check with your doctor before crushing your medicine.
If you take multiple medicines, take each medicine separately. After you take each medicine, flush your feeding tube with the amount of warm water that your doctor recommends.

Use these supplies when taking medicine through your feeding tube:

• Two 60 mL catheter-tipped syringes
• Medicine prescribed by your doctor
• Water

Steps

1. Flush the feeding tube with the prescribed amount of water using one 60 mL catheter-tipped syringe.
   Note: Before taking medicine through your feeding tube, make sure that nothing is blocking the feeding tube and that it is properly placed
2. Remove the plug from the medicine port adapter.
3. Insert the medicine into the medicine port using a clean catheter-tipped syringe.
   Note: Do not attempt to mix medicine with feeding formula.
4. After you’ve finished taking your medicine through your feeding tube, flush the medicine port with the prescribed amount of water using your original catheter-tipped syringe.

Your doctor may tell you to check your stomach for leftover liquid food before each feeding to make sure that your stomach is getting rid of food from your previous feedings.

Use these supplies to check for leftover liquid food:

• A catheter-tipped syringe
• Water

Follow these steps to check for leftover liquid food:

1. Wash your hands with soap and water.
2. Push the plunger on the catheter-tipped syringe all the way down.
3. Attach the syringe to the feeding port of your feeding tube and pull back on the plunger. You may see some stomach fluid enter the syringe.
4. Pull back very gently on the plunger until you don’t see any stomach fluid entering the syringe.
5. lf the syringe becomes full, empty it into a clean container and repeat steps 2 and 3 until no more fluid comes out. Stop pulling back on the plunger immediately after fluid stops coming out.
6. When no more fluid comes out, complete the steps that your doctor recommends.

Note: Always follow your doctor’s instructions when you check for leftover liquid food, and call your doctor if you see an unusual amount of liquid food. If the amount of liquid food is too great, your stomach may have problems. Your doctor may also give you special instructions to not use your feeding tube if you collect a certain amount of stomach fluid. Record your doctor’s instructions when you receive your feeding tube, and refer to them as needed.

• Clean your work area before each feeding or cleaning.
• Wash your hands before doing anything with your feeding tube or supplies.
• For a clean and healthy stoma, properly clean your feeding tube once a day, or as often as recommended by your doctor.

Clean and disinfect your stoma once a day. Do not routinely use antimicrobial ointments on or around your stoma. Follow your doctor’s instructions for a cleaning routine.

Steps

1. Wash your hands before and after you gather your cleaning supplies.
2. Clean the skin around your stoma with a clean cloth, soap, and water. Work in circles outward from your stoma.
3. Clean under the bolster and hubs of your feeding tube with cotton swabs, soap, and water.
4. Rinse the area around your stoma with warm water and let it air dry.
5. Always check the area for signs of infection. Call your doctor immediately if you see drainage, swelling, or redness, or if you notice unusual tenderness.

Flushing your feeding tube regularly with water will help prevent clogs and will keep your tube clean for your regular feedings. Regular flushing can also make your feeding tube last longer and may prevent other problems.

Steps

1. Check your stomach for leftover liquid food as instructed by your doctor.
2. Attach the 60 mL catheter-tipped syringe to the feeding port of your feeding tube.
3. Flush the feeding tube with the amount of water that your doctor has prescribed.
4. Remove the syringe when you finish flushing.

Store any unused liquid food in a clean, sealed container according to the manufacturer’s instructions. Read and carefully follow the manufacturer’s instructions that come with your liquid food.

Even though you are not usually eating with your mouth, you still need to take care of your teeth and gums to prevent bacteria and germs from building up.

• Brush your teeth, gums, and tongue every day.
• Keep your lips and mouth moist per your doctor’s instructions. This is important. When you don’t eat or drink with your mouth, your skin gets dry more easily.
• Call your doctor about anything unusual about your mouth, such as bleeding gums.

You may get an upset stomach if too much liquid food is taken in or if you feed too quickly. Do not feed if your stomach is upset.

• If your stomach is upset, wait about an hour, or until the feeling goes away, before trying to feed.
• Check with your doctor to see if you can add more water to your liquid food. You can also ask your doctor if you can take smaller, more frequent feedings.
• Stop feeding if you vomit. Wait about an hour and then try feeding again. If you vomit again, stop feeding.
• Call your doctor if, for more than 24 hours, you feel too sick to continue your regular feedings.

You may accidentally get liquid food in your lungs. Liquid food can get into your lungs if you burp up small amounts of liquid food, or if you vomit.

• Stop feeding immediately if you choke or have trouble breathing.
• Call your doctor.

Having a feeding tube can be a big change, but you can still do most of the things that you did before you got your feeding tube.

You can walk and exercise regularly. Be sure to notify your doctor before you make any big changes to your lifestyle or your exercise routine.

For a short time after you get your first feeding tube, your doctor may ask you to limit bathing, swimming, and showering. In many cases, these limitations are temporary. Ask your doctor about the precautions that you need to take when bathing.

After your doctor places your first feeding tube, you may have a dressing over it. Be sure to keep the dressing dry by covering it in a watertight wrap before you bathe.

Your doctor will help advise you on what your diet should be. Pay attention to any changes to your diet and weight. If you see changes, tell your doctor. Your doctor may recommend that you change your feeding plan.

• Weigh yourself at least once a week or as often as your doctor recommends.
• Write down any changes in your weight and report them to your doctor.
• If you often have an upset stomach, talk to your doctor about your feeding plan.