Why Does the Feed Bag Port Push Out of My Feeding Tube
Advice needed! Back pressure in PEG tube!
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Hello Everyone,
Firstly, let me apologize for this extremely wordy post, for which I could probably set some sort of record! :) So here's our long story, and I pray you can spare the time to bear with me......... I am new to the community, and act as caregiver and assistant to my dear 88yo mother, who lives with us. She had a brain stem stroke this past July, resulting in the loss of her swallow, and has a PEG tube, through which we gravity-feed her Jevity 1.5 4 times daily 4 hours apart, using a 70cc syringe barrel. Her routine is to begin her feeding with about 40cc of warm water, followed by repeatedly filling the syringe barrel with Jevity topped off with water until using up her 8oz can, ending with the last of the 8 oz. of warm water. However, I have been desperately trying to find help with intermittent malfunctioning of her tube.
For the first 6 weeks or so of tube feeding, Mom had no problem with independently feeding herself. When her routine works well, she finishes her feeding inside of a few minutes. However, over the past month or so, we've been totally confounded by the most exasperating problem! - On some occasions, (seemingly random, intermittent and inconsistent) when she inserts the barrel of the syringe into the adaptor port of her uncapped, unclamped tube, the syringe is forcefully popped out of the tube! This sometimes happens repeatedly during that particular feeding, yet if we keep a death grip to hold the barrel into the tube, her water and Jevity will actually go down fine. But of course this back pressure pushing the barrel out of the tube causes her great distress, as needing literally 3 hands to complete the feeding threatens her ability to independently feed herself. This pressure or gas or whatever is happening, might occur for an hour, or might subside after a few tries of placing the syringe barrel into the tube. Then the next time she feeds herself she may have the issue again, or have the feeding go fine. We've tried using the plunger to push in warm water and having Mom slightly reposition herself, but neither of those tactics seem to matter.
Here are the providers I've tried to consult with regarding our issue:
- On 4 occasions, I have contacted nurses from the rehab/nursing home where Mom spent 5 days post-hospital to learn to use her tube. Their collective suggestions included mostly to try to flush the tube with warm water before beginning feeding.
(By the way, I do not have access to our Visiting Nurse Association nurses as a resource, since Mom was determined ineligible for in-home service of any sort due to her level of independent functioning.)
- I've taken her to our local hospital's GEU, where the gastro doc working that day could find no problem when he checked Mom's tube. Mom's tube was placed while she was hospitalized by one of other docs from his practice. He suggested that if we think there's a clog, to push a syringe full of diet Coke to unclog it, although we've never tried that since everything still goes down the tube - even when the syringe barrel is getting pushed out.
- I've called the hospital GEU nurse as well, and she had no solid suggestions for us.
- Upon the advice of our family doc, we consulted with a general surgeon that performs gastrostomies, who once again, could not find any problem on the afternoon we saw him, after having the pressure problem earlier in the day. He did change out the y-port adapter on the end of Mom's tube, suggesting the perhaps the syringe barrel was slipping out of the tube due to the wear on the adapter itself. His only other comment was that we cannot control normal variations in intra-abdominal pressure, not to worry, and just keep trying to get the feeding done. I have also spoken on the phone with this doctor on 2 other occasions, trying to discuss same pressure issue. But what seems to be no big deal to him, is quite the cause for distress to Mom and me!
- I've spoken at great length to the nurse who works for the pharmacy that delivers Mom's supplies. She encouraged me to take Mom to the surgeon or gastro doc to have the tube removed/examined, and either reinserted or replaced with a new one, thinking that my story of this back pressure problem could be due to something be wrong with the balloon/part of the tube inside Mom's stomach.
- Another issue, possibly related, or maybe not, has happened twice since Mom has had the PEG tube. Upon trying to initiate her feeding, after uncapping the end of the tube and unclamping it, stomach contents in the form of curdled bits have come pushing out of the tube, creating quite an unpleasant mess, to say the least. When that happened, I cleared out the syringe barrel to the best of my ability, and pushed in warm water with the syringe plunger, which did seem to get things flowing in the right direction - allowing us to proceed with the feeding.
The issue with the pressure has occurred on numerous occasions over the past 10 days or so, frequently enough for me to become even more determined to seek some answers as to why it's happening and how to deal with it! Not one of the nurses I have spoken to seemed to believe that these occurrences of pressure and pushing out of the syringe barrel is the norm or to be expected, so we feel like we're grasping at straws trying to come up with a solution. My mom's mental health is being further threatened, as she has not come to acceptance regarding her inability to eat or drink by mouth, let alone having to deal with the malfunctioning PEG tube! We need help, and any suggestions or explanations would be greatly appreciated!! I would be more than happy to share personal contact info if anyone would be up for more direct communication.
If you've managed to read my "book", I thank you for your interest and would be so grateful to receive some member responses. Sincerely, Judy
Source: https://www.inspire.com/groups/oley-foundation/discussion/advice-needed-back-pressure-in-peg-tube/