Friday, August 9, 2013

A Taping Technique You May Love

A common issue with tube feeding is snagging: door knobs, chairs, and otuer humans have been my top three culprits for sometimes a rather rough tug. And no. It does not feel very good.

There are a lot of people who use the "button" style tubes as either their G and/or J tubes because of the tube being low-profle, but in my experience, the button style tubes are superior in design and function. Even when accessed, these tubes aren't as bulky and easier to conceal (which is good for those of us on continuous feeds). The extension tubing used to access the tubes are disposable, which is beneficial in respects to keeping things as sanitary as possible and in best functioning order. Extension tubing also has a clamp so there is only free flow of content when one is too absent minded to forget to squeeze the clamp shut and pump alarms are also as easy to fix as releasing the clamp (those are moments when you shake your head and say out loud to yourself "Really?").

Here is another benefit of the button style tubes: variety of taping techniques. With feeding tubes medical tape is just part of the package deal (figuratively and literally. I get Medipore tape for every day use and Tegederm for my pain patch...or when my skin needs a break from taking tape off every single day). It is wise to use tape to stabilize the tube in order to prevent development of a sore, red blister called granulation tissue (it gives a slight burning sensation that at times is just enough to be distracting and will bleed on your shirt depending on activity and how big the granuloma is). Also, taping can potentially reduce snagging the tube and reduce the discomfort of that sharl tug. If caught unawares one can yelp or mutter and obscenity depending on how your day is going.

If I had to take away just one positive from my time on TPN at home (there weren't many positives at all. A medical intervention that almost killed me when the goal was to keep me from dying doesn't count as positive in my opinion) is that my Hickman line and IV tubing came from my chest and not from under my shirt, thereby almost completely eliminating snagging.

When I got my AMT Mini ONE Capsule Non-ballon buttons (plural at the time and singular right now, as my J tract was lost and are still doing this trial of G tube feedings instead), I was sort of looking at the different extensions I had from my DME (MIC-KEY extensions and AMT extensions), I noticed my G button had rotated (which is what you're supposed to do with a simple G button, not a G/J button and for the love of Pete please don't attempt to rotate a button in the jejunum or anywhere that is not the stomach...). I locked the extension into place and the tubing had hit at about where my collar bone sits...and near where the scar is from my old Hickman line.

Ladies and gentlemen,  we have a winner.

I highly doubt I am the only person who has ever experimented with this type of set up, but for those who would like to try this with a G tube (or if your G/J or J tube is in a good spot for trying this), here is how I construct this:

Photo 1: Extension tube of your choice. I am loving AMT's right angle straight port extension. I am on continuous feeds and meds go through my G tube as well, and I disconnect each time now (I cap the adapter from the bag and wash the extension with soap and water before hooking back up for feeds to decrease infection risk).

Photo 2 and 3: Prime formula through extension. You don't want a bunch of air in your stomach or small intestine. It hurts! Thread it through the sleeve of a T-shirt or the collar of a long sleeved shirt or tank top. Photo three shows where the adapter from the feeding bag and opening of the extension will lay. I recommend keeping white clamp closer to the tip of the extension so it's easier to reach.

Photo 4: There needs to be some extra length of the tubing that goes past the button since you will need to rotate the extension. Don't rotate the tube instead. The whole point is to keep everything stabilized and excessive rotation is a good way to irritate the stoma (typically you don't want to do that. I wouldn't he making this entry if stoma irritation weren't uncomfortable enough to need to avoid doing so).

Photo 5: Black lines need to meet in order to access tube. The flange is on the LEFT side since the extension will be rotated three quarters to lock into place.

Photo 6: See what I mean?

Photo 7: This is what it looks like from my view. Extension is now locked and makes a small loop. Give it enough length so that it won't kink. Otherwise that pump will start screeching at the most inopportune times.

Photo 8: To stabilize the feeding line and tube, tape at where the line from the feeding bag is, NOT the extension. Tape residue won't come off the stupid thing and it's wise to preserve each extension as long as possible. Unless you are paying out of pocket, insurance doesn't allow but a few extensions per month and gunking it up with tape residue isn't the best way to prolong the life of your extension. However, you will change the bag at least every 24 hours. So residue on that side is iust fine.

Photo 9: Side view of the finished technique.  Only some of the feeding line is even visable, and if looped carefully will make it very much less like likely that it will be yanked on by errant furniture, another person, or curious tubies themselves.

Photo 10: What tube? ;) Nothing coming from under my shirt amd the straps of the backpack conceal the line. Collar of shirt helps hide extension and line from the bag. Exceptions being for tank tops and long sleeved shirts.

This eliminates the need to cut holes in clothing. I would like to strongly caution parents/caregivers, if they would like to try this, to take extra care so the risk of the feeding bag line does not accidentally wind around the neck.

And there you are! Hoping this is helpful to someone out there.

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