Tube feedings have come a long way.  20 years ago, when I was studying to become a dietitian, I remember making our own formulas at the hospital I was working in.  This was the main option, as at that time, only a few companies had started to develop adult formulas.

Since then, the market has been bombarded with formulas; the general formula that is both a tube feeding and a nutritional supplement, formulas with extra fiber and protein, to the more advanced diabetic, and renal (kidney) formulas.  We have formulas that are broken down into its most easily digestible form where the body just absorbs it (called elemental formulas) to a formula that takes a little extra work to digest as if the body was absorbing regular food.

So, which formula do you use?  This is generally determined while your family member is in the hospital, and sometimes dictated by your insurance...that is, if your insurance company will cover it.  Some insurance companies stopped covering home tube feedings.  Some companies will only cover certain ones if a specialty formula is recommended and if it is covered, it is only after all other less expensive formulas have been tried.

When starting the administration of a formula, you want to be sure that the tube is flushed with water.  This does two things: it makes sure that the tube is not clogged and also provides extra water since the general formulas are only 80% water.  Usually an ounce of water given with a gentle push through a device called a syringe (without needle) is used.  You should receive one with instruction by the home health specialist or the dietitian prior to discharge from the hospital.

If the formula is to be given around the clock (ATC), the head of the bed must be elevated AT ALL TIMES.  There should be degree markings on the hospital bed if you have one at home.  If you have a home health specialist, they can help you determine what this level is.  Generally, the head of the bed should be elevated 30-60 degrees.

If the formula is to be given by gravity drip or bolus infusion, the person receiving the formula should be in a sitting postion (90 degrees) for up to 60 minutes after the end of the feeding.  This will help prevent a condition called "Aspiration Pneumonia" which can be caused by formula running back up through the esophagus into the lungs.

As with starting any formula, infusing plain tap water after each feeding is also important, again to wash out the tube to prevent clogging and again to provide a little extra water to prevent dehydration.  Your dietitian will provide you with a feeding and flush schedule that meets the needs of the individual receiving the formula.  Extra vitamins and minerals are not necessary, unless prescribed by the primary care physician, because the formulas are created to provide all the necessary nutrients that the body requires.  Water is also needed if you have to put medication through the tube, to help rinse the tube of any particles.  If proper rinsing isn't done, bacteria and fungi can grow, and the tube can become blocked which may require hospitalization to have the tube replaced.

Your home health specialist will teach you how to check for proper placement of the tube before infusion of the formula. 

Over the next few weeks, please look for more articles regarding nutritional home care of an elderly family member.  If you have any specific questions, please email them to me at teresaulrich@yahoo.com so that I may be able to address them on line as others may have similar questions.