Dear LITRE
Frequently Asked Questions
I have recently been started on home enteral feeding, but I am still having lots of pain and vomiting when I feed, and my consultant has mentioned that I might need TPN. I have heard of TPN, but I don't really know what it means. Please can you explain?
TPN is an acronym which stands for total parenteral nutrition. The parenteral word means into the blood stream or intravenously. So TPN means supplying all the nutrition that a person needs via the blood stream. Many people on TPN are able to absorb some of their nutrition via their gut (by eating and drinking or via a feeding tube into the gut) so many specialists like to use the term PN or parenteral nutrition.
I have a PEG which I use for feeding at home. I've always wondered why my tube is called a PEG - Please can you explain?
The term PEG is an acronym which stands for percutaneous endoscopic gastrostomy. The easiest way to explain PEG is to explain each of these 3 words. Percutaneous means through the skin (rather than through an existing opening into the gut such as the nose or mouth). Endoscopic explains the way the tube was put in (a long flexible tube with a camera at one end allowing the doctor to see inside the stomach and upper intestine). Gastrostomy means an opening into the stomach. So if you put all that together you have a tube put in to the stomach through the skin using an instrument called an endoscope - no wonder people prefer to call them PEG's!
I have a gastrostomy tube, and have a recurrent problem with over-granulation at the exit site. Do you have any suggestions as to how to deal with this problem?
Over-granulation is a harmless extra growth of skin, often found with gastrostomy tubes as the movement of the tube stimulates growth. Some skin is more sensitive or susceptible than others. It does not have a nerve supply so is not usually painful, but can look unsightly. Treatment with topical creams such as Sofradex (Florizel) or Terra-Cortril (Pfizer) can often cure it, or at least reduce it in size, but it may recur, and occasionally requires treatment with application of silver nitrate sticks, which effectively burns down the affected skin.
I have PN overnight at home, and have occasionally had a problem with the filter apparently blocking up. Can you suggest any way that this can be avoided?
Filters are often used as an added protection against potential infection for patients on PN. They prevent micro-organisms and particulate matter from progressing along the tube into the system. Those used with PN containing fat are 1.2 microns, to allow the fat droplets to pass through. If the PN mixture is made properly, there should not be a problem, however the stability of the mixture should be checked. If the mixture become too warm, the fat content might "clump" slightly which could clog the filter, which is why it important to keep the bag refrigerated prior to putting it up. It is worth checking the room temperature during the night - if it is too warm, you could try attaching a freezer pack to the outside of the PN bag to cool it during the night. Priming the filter with saline before attaching it to the giving set may also prevent any clogging.
Please can you advise me on what types of dressings are available for my Hickman line? I currently use a white Primapore 8.3cm x 6cm and wondered if there were any smaller, skin-tone ones that I could use?
The question of skin-tone dressings was something that LITRE looked into a short while ago. The manufacturers of dressings were contacted, but unfortunately all felt there was insufficient demand, and that the cost would be prohibitive. There is a paediatric skin-tone stoma bag available, which is a small square shape, and the line could possibly be curled up inside the bag; this may be something worth trying.
I need to take my pump when I go on holiday and was concerned about insurance. Should I take out cover for it?
It will depend where you are going on holiday. For travel in the UK most homecare company's will say your covered, but if your going abroad they may not. It is always best to check with your homecare company first to what is covered by them and where the cover extends to. If they don't cover your pump where your going you may have to take out your own insurance, also check if its covered on your holiday insurance.
My wife had a J-Tube placed approximately 3 weeks ago and the tube has been leaking around the incision site. The doctor seems to think this is somewhat normal, but a serious complication has arisen. The gastric juices are burning her skin, and she is in extreme pain from the burn. I have been trying to keep the area clear and dry, but it is physically impossible for me to keep cleaning the area every 30 minutes 24 hours per day. Even with all of this attention, it seems I have not been able to halt the progress of this burn. Is there any method you know of to dress this site to keep the leakage from burning her skin? Standard dressings just hold leakage to the skin, exacerbating the problem. I tried a large adhesive ostomy pad, with the same results. The leakage went under the pad.
We are currently using a Lanacane/Silvacaine cream to treat the area, but the analgesic effect is minimal. I am desperate to find a solution to ease my wife's pain.
If there are any stoma nurses or tissue viability nurses attached to the hospital, they may be able to offer some help with this situation. Cavilon cream or spray (3M Healthcare) or Lotriderm cream (Dominion) are often very effective with this kind of excoriation, used in conjunction with a foam dressing such as Lyofoam (SSL). If the exudate is very acidic, an antacid such as Ranitidine may reduce this acidity which in turn should relieve some of the pain.