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Feeding through an Ostomy Bag Using a Universal Catheter Access Port
Some time ago we published a tip on how to adapt an ostomy bag to allow a feeding tube to pass through it without leakage (LifelineLetter, July/August 2002). We recently shared that tip with Oley member Emily Convery, who adapted the suggested procedure a little and sent us wonderful photos, along with some updated information. The article below reflects much of the original, with Emily’s photos and updates.
Please discuss this idea with your physician before you try it.
Most physicians see important advantages to a patient using his or her gastrointestinal tract, even if accessing it is somewhat complicated. For example, tube feeding is sometimes done through a small bowel ostomy that is the site of some secretions and requires an ostomy bag. This might happen if the patient has a loop small bowel ostomy and feeding into the more distal segment of the bowel is desirable, or if the patient has a Roux-en-Y feeding jejunostomy.
The ostomy bag is essential so the secretions from the proximal bowel do not irritate the skin, so the challenge is to insert the feeding tube through the ostomy bag and into the distal segment for feeding. This can be achieved by gluing a universal catheter access port (a soft plastic cone) into the ostomy bag. The directions below take you through this process with some helpful hints by Emily.
Emily uses a two-piece ostomy system: “The barrier (also know as a wafer or base plate) stays on my skin around the stoma and the bags fit onto it. This is crucial for protecting the skin around my stoma because the base only gets changed every three to five days.” The adapted bags, she says, “have worked wonderfully! I am now able to go to school and work and function just fine with the tube hooked up and hardly anyone notices.” When she doesn’t need to use a feeding tube, Emily applies a regular bag or a stoma cap to the barrier.
Gluing the port into the ostomy bag:
1. Put the outer ring on the port (soft white cone) and place them tip down into the hole in the wooden block (photo 5).
2. Put glue around the perimeter of the outer ring (photo 6).
3. Place the ostomy bag face (hole-side) up on top of the port on the block, centering the bag’s hole over the port (photo 7). Emily notes, “This makes the pointed part of the tube adapter face outward; I had tried having the adapter point inward, but my stoma was getting a little sore and actually bleeding a little bit if I had it going this way.”
4. Place the inside ring on the hard blue cone (photo 8), and carefully apply a small amount of glue to the exposed surface of the inside ring (photo 9).
5. Poke the blue cone (tip side down) through the opening on the ostomy bag, through the back of the ostomy bag, and into the white cone (photo 10). This will create a hole in the ostomy bag, and leave the port sandwiched between the inner and outer rings.
6. Hold in place until the glue sets (about 1 to 2 minutes). Remove the blue cone.
7. Snip the tip of the port carefully, making a hole just large enough to fit the feeding tube through. Emily notes, “The tip of the blue cone will make a hole in the bag large enough for the tube to fit through. I prefer not to completely cut the remaining bag out from the center of the hole because it prevents secretions/drainage from accumulating in the cone.”
8. After experimenting with the adapted bags, Emily added a step to glue the tube in place in the port. But note: you need to measure the length of the tube before you glue it. This way when you put the bag and tube in place, the tube will be situated appropriately in the distal bowel, as recommended by your physician. Emily says, “I put a thin layer of glue inside the cone after the tube has been put through to prevent the occasional leaking I had there, because the cone does not make a tight enough seal.”
9. To prepare for a feeding, insert the feeding tube that comes out of the port into the distal bowel and attach the ostomy bag to your body.
Emily prepares several bags of various sizes at once, so they are ready when she needs them (photo 4 with tubes, and photos 11–13, without tubes). Emily notes, “It is important to wait twelve to twenty-four hours before using the bags, to allow the glue time to dry—even if it is labeled ‘quick dry.’ I lay them all out on a trash bag or cheap plastic tablecloth while they dry in case any of the glue runs. (I had to cut one out of my carpet once.) I also recommend wearing gloves when dealing with the glue because it’s sometimes painful if you get it on your hands. Also, the bags can be used multiple times. I get special cleaners for ostomy appliances from my medical supply company to wash them when they are not in use.”
LifelineLetter, September/October 2010
An Alternative Using a Baby Bottle Nipple
Gail Waldby, MD, sent us a tip for adapting an ostomy bag using a baby bottle nipple, developed by Jarvis Haugeberg of Huron, SD. Step-by-step directions with photos for Jarvis’s design can be found online at generalsurgeonslinks.com. Questions can be directed to Dr. Waldby at firstname.lastname@example.org. If you don’t have Internet access and would like a copy of the directions, please call Oley at (800) 776-OLEY.
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Oley exhibit at A.S.P.E.N.'s Clinical Nutrition Week