G-Tube Extension Tubes

When feeding via g-tube for medical reasons, extension tubes are used to connect the syringe or IV tubing to the actual g-tube button. Extension tubes are a bit expensive.  I endeavor to make mine last as long as possible.  There are two keys I have found to be important in this effort:

• keeping the extension tube dry
• only having one extension tube in use (or at most 2) at a time

After feeding Little Miss, I clean the extension tube and syringe and put them in a basket lined with a cloth napkin in my cabinet until the next use.

Extension tubes degrade when exposed to water and air.  They become stiff rather than flexible.  I keep the clamp open, so as not to stress the plastic.

When an extension tube is creased by the clamp and I have to squeeze that crease or crimp with my fingers to open it, I know the tube is done for.

Reference Article on Digestive Enzymes

Here is

a good article about digestive enzymes.  I am not an expert and offer my experiences and research only as a parent who has found helpful information.  The article at the link gives what I believe is excellent information about enzymes.  It is more than digestion!

Why Do I Need a 60cc Syringe?

For many medical situations, G-Tubes or Gastrostomy Tubes, or N-G tubes (naso-gastric which means starting in your nose and ending in your stomach), j-g tubes (starting AFTER your stomach) are life saving!

While feeding blended meals via g-tube requires the use of syringes since pumps cannot process the thicker food, G-Tube fed people who stick with formula and pumps need to have some large syringes on hand. 60 cc or 2 ounce syringes come in very handy.  In our situation we can use either a luer lock or catheter tip syringe – both work on the extension tube ports for “Little Miss”.  Sometimes a luer lock seems better because it doesn’t pop out or leak as easily.  We use 10 cc (2 teaspoons) syringes for giving medicine.

The larger syringes – either 35 cc or 60 cc – work well for giving water or Pedialyte.  We give either or both when Little Miss has been sick.  We had to give up on the pumps because our girlie-girl moves around so much all day AND all night.

Another reason to have a large syringe on hand is to deal with clogged  g-tubes. Reverse pressure with a large syringe is much higher pressure than with a small syringe.  By reverse pressure, I mean attaching an empty syringe to the extension tube and pulling BACK on the syringe plunger in order to pull out whatever is clogging things up.  This has worked very well in our experience.

Additionally, if the power goes out and you do not have adequate batteries, being able to feed via syringe is a great help!  Your durable medical goods supplier will be the place to contact for 60 cc syringes.

Storing Food Prepared for G-Tube Feeding

When preparing food for g-tube feeding, I am particularly careful to avoid contamination.  My system is what I am comfortable with to prevent spoilage. Any recipes I make include carefully cleaned vegetables, thoroughly cooked proteins, clean containers, etc.

After preparing the foods, they go immediately into a clean container, are covered and stored in refrigerator or freezer. I never use a container of food that has been refrigerated for more than 3 days. First of all, I do not want any bacteria to proliferate and make my daughter sick. Three days may seem a very short time and overly cautious, but it is what I am comfortable with.

I have a freezer in my garage to store containers of food.  I date them with labels and a permanent marker so that I know how long they’ve been in there.  If I found one that was older than 6 months, I’d probably discard it.  Note:  permanent marker can be removed from labels or container lids (in my experience) with an ink eraser.

My freezer is NOT a frost free freezer.  I have to defrost it once a year and clean it.  The reason for NOT getting a self-defrosting freezer?  The temperature varies too much for my comfort level.  The way a freezer stays frost free is by turning on a heating coil to melt ice off the freezer coils.  This puts the food in the freezer through temperature changes and although there may be many sources saying this is completely safe, I opted for a freezer without this feature.   (A standard freezer also costs less to operate.)

The Vacation

Dear Hubby is off to the Eastern region of the country.  After a visit to some relatives in Virginia, he has undertaken the truly amazing:  

Little Miss at a campground.  

This is the exact reason I did NOT go along. We tried this once before and that was enough too much for me.  Last time was tent camping at Disneyworld.  It is very clean and that helped, but I had my fill then.

Anything smelly or obviously dirty is beyond the coping abilities of Little Miss. Although they are in a log cabin, there are no bathrooms inside. When she tried the available facilities, they did not pass her inspection and she came running out, promptly having an accident.   If I had been there, I could have MAYBE gotten her in there to sit down and avoid the accident but it would have been SO much work. Trips with her are like that and very non-vacation-ish to me! I am so glad I am missing out on this.  Dear Hubby doesn’t live it everyday the same way I do, so he has a little more stored up energy, I think, for this type of adventure.  

Besides:  He. Likes. Camping. (That just does not compute for me.)

One more week and they’ll be back home.  If they all survive! I can’t wait to hear the reports from Big Brother.  He’ll have his own unique perspective on it all!  Little Miss will have plenty to say.  Some of which will be made up.  Most definitely!

And NO. My husband is not available on a rental basis.

G-tubes and Lubrication of Syringe

When feeding my daughter using a g-tube, I make blended meals for her and feed them to her by bolus feeds using a large syringe.

Syringes can be reused and the cleaning and storage instructions for them will be posted here soon.

When a syringe is reused, the rubber end of the plunger frequently begins to oxidize or become tacky. This makes using the syringe a test of muscle strength and very frustrating. A very simple and effective solution for this problem is to lubricate the syringe.

Here’s how I do it: I take my spray oil (the kind used for cooking) and spray lightly on the rubber, on a couple sides of it. Using just a few drops from an oil bottle, like olive oil, works well also. Then I reinsert the plunger into the syringe, turning it and pulling it out and reinserting again to make sure the oil is evenly distributed. That’s it. Mission accomplished!

This is necessary with each use of the syringe. If the oiling is not effective, the rubber has oxidized beyond help and the syringe should be discarded.

I need another forearm

Me:  Brother, go clean your closet.

He pauses. Maybe even delays.  

Little Miss:  I’ll pull you there.  (grunting and pulling with one hand)

 

Mom! I need another forearm!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I'll push you.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Get on. I'll carry you like a horse.

 

 

 

 

 

 

 

 

 

 

Little Miss: (refusing to give up) I know. I’ll throw you in a box and push you that way. 

Nothing ever came of that, but he IS in his room cleaning out his closet!

G-Tube Recipes – What NOT to Include

When feeding blended meals via g-tube for medical reasons, there are some foods to avoid. I have found that cruciferous vegetables are not storage friendly. This includes broccoli, brussel sprouts, cabbage, kale, bok choy, and turnip greens. Onions and beans are also trouble makers, in my experience. 

Cruciferous vegetables tend to produce gas due to the indigestible sugar found in them called raffinose. Beans have even MORE raffinose than cruciferous vegetables. My best guess as to why these vegetables cause gas so quickly in my daughter is that by blending the recipes, the enzymes in the various foods catalyze the breakdown of the foods. If I store a blended meal in the refrigerator for only ONE day, she feels gas pains by the second or third syringe of food. So my practice is to only include these foods when I am going to blend and immediately feed. 

These cruciferous vegetables are very nutritious and as such are good to feed your child. Bacteria in the colon that produce methane feed on raffinose and release gas in the process. So if you regularly feed your child buttermilk or yogurt it may increase the friendly bacteria in the colon and reduce this effect.  Probiotic supplements can also be very helpful, as can Beano.  Beano is a plant-derived enzyme that breaks down raffinose before it enters the colon, reducing gas. It can be purchased in many grocery stores. 

If I am planning to store blended meals, I do not include these gas-producing foods.  If I am cooking for the family and use that food for Little Miss right away, then I DO include them.

G-Tube Avocado Recipe

When feeding via g-tube for medical reasons, there are so many options!  Providing nutritious meals is an opportunity to reach beyond medicine and doctors and into what is available to all of us for health. 

Avocados are a nutrient dense food. Here’s what I’ve discovered about avocados:

• good source of potassium, which helps guard against circulatory diseases
• good source of folate which is important for heart health
• rich source of monounsaturated fatty acids: oleic acid (so although a typical avocado contains 30 grams of fat, 20 of them are health promoting, especially oleic acid)
• increases absorption of carotenoids from vegetables
• good source of vitamin K, fiber, vitamin B6, vitamin C, and copper

Note:  According to numerous sources, for people with a latex allergy there may be an allergic reaction to avocados, bananas and chestnuts as they contain substances called chitinases  that are associated with the latex-fruit allergy syndrome. 

To provide a vegetarian g-tube recipe using avocadoes:

Gently heat 2 large sliced tomatoes in a pan

• (cooking tomatoes breaks down cell walls releasing carotenoids which are thought to protect cells, provide vitamin A, enhance immune system function, help reproductive system function properly)

Peel and remove pit from 4 – 6 avocadoes and place in blender

Add large handful of parsley

1/2 pound of spinach

13 – 15 walnut halves

the tomatoes 

enough water to facilitate blending – 2 cups or more depending on size of avocadoes and tomatoes

Blend until smooth.  Refrigerate.

1 cup of avocado = 235 calories so it is also possible to blend avocado alone with water for a high calorie meal when that is needed.

Another G-Tube Recipe (Eggs)

For people with the medical need to be fed by g-tube, there is another recipe that works well and is VERY easy.

Scramble 4 – 6 eggs, blend well and feed.  You may need to add oil or milk to gain the right consistency.  Other ingredients can be added if desired.

Useful info:

• Each egg contains roughly 70 – 100 calories, so this is a nice and simple way to get a high calorie meal.
• Regarding cholesterol in eggs:  there is still not a determination that shows a link between the cholesterol we eat and the blood cholesterol in our bodies.  (Our body manufactures that cholesterol.)
• Eggs are NOT high in saturated or trans fats. One egg has about 5g of fat of which only 1.5g is saturated.
• Eggs are very nutrient rich including iron, folate, phosphorous, riboflavin, vitamins A, D, E and B-12, and zinc.

NOTE:  Egg allergy is fairly common.  DO NOT FEED EGGS TO  KIDS UNDER 2 YEARS OF AGE. This may help avoid developing an egg allergy.  There is some evidence that indicates many kids “outgrow” egg allergy by age 4 or 5.  Check with your doctor.