Tube feeding for an ill patient

[pusskin]

When a very sick and confused patient pulls his feed tube out, and maybe do it again today --what is the next step for feeding him?
Answers much appreciated x

[anneasquith]

maybe intravenous ?

[pusskin]

thanks anneasquith, I didnt think of that. he has a drip for liquids, but tube through the nose for feeds

[bednobs]

intravenous food is very unlikely. If the pt is expected to live for some time and recover, they may consider a PEG feed (tube straight into stomach from the abdomen)

[rowanwitch]

They will probably try repassing the tube a few more times maybe looking at better ways of fixing it then as Bednobs suggested the next option would be a feeding tube directly into the gut.... but as this procedure is not without complications they will avoid it if they can. Intravenous feeding is very rarely used now.

[pusskin]

Hi bednobs, we cant see him recovering, as he has gone down hill so quickly and cant even take his 2nd lot of chemo this week, due to weakness and total confusion due to infection and now given strong antibiotics again. Been in hosp for 3 weeks. So feeding him through the stomach isnt recommended then?
We think that he just wants to give up now and cant eat or wont eat?

[pusskin]

Must go now to get ready for hospital and quick shopping. Will get back on again later.

cant thank you all enough for replies, many thanks x

[bednobs]

if he is not expected to survive, it may be that they decide not to put him through more trauma of passing the tube. When you are very ill you have a much reduced need for calories as you aren't using as many up. It also may be that by refusing to eat and pulling the tube up he is trying to have control in the only way he can.
People (relatives/friends) tend to get very hung up on food, but if he is that ill, it will probably be a secondary consideration to keeping him comfy. Sorry if i've read the situation wrong

[Sqad]

I agree with bednobs/rowan as what you describe his condition and prognosis it is either a gastrostomy (tube straight into the stomach) OR let him go.

[pusskin]

sorry delay in popping back in --shopping, hospital, cooking, washing up.

I visited my brother today and he still hasnt got the the feeding tube put back in which is for the best. He hated it , and has made an effort to DRINK more too.
His ramblings are weird , saying strange things, but he seems today to be better than y/day (bit better) So there's no mention of force feeding at all and will find out much more info tomorrow when all the doctors are around!
They did say couple of days ago, that their thinking of moving him to more comfy and homely surroundings which could only mean one thing. --hospice?
Whatever is better for him, is better for us too to save him any suffering.
He isnt on morphine and hasnt pain,only in his back while being moved about.

[Rosetta]

It may be that the infection is making his confusion worse, in which case the antibiotics will help. If he is calmer he might not as inclined to pull out his feeding tube. Was he confused before he went into hospital?

[pusskin]

They said y/day that they'd put him on more antibiocs because of an infection going on inside him, but they havent given him any today --yet. He was put on antidrepressants a few days ago, and he seems fairly calm today. Doctors said that they cant quite make out yet , why he is so confused and y/day he spoke in riddles and he couldnt be understood.
Cant thank you enough for listening, it makes me feel that I can cope a bit better knowing I can get it off my chest xx pusskins

[Rosetta]

Obviously I dont know how poorly he was prior to admission, his cancer prognosis isnt mentioned and that will determine medical and family decisions. But in acute cases of confusion (maybe from infections) this can be usually treated, (but no guarantees).Long term decisions depends on quality of life issues, sometimes these are heart rending, othertimes they are obvious. I dont envy you but am sure that the right thing will happen

[pusskin]

he was very poorly and could hardly walk when admitted to hosp 3 weeks ago.
He came across as quite well in july and even enjoyed a family get together, but has gone down hill so quickly. We hope for more info about his condition by the end of the day after his wife has spoken to the doctors.
Thanks again for all your replies, much appreciated x pusskins

[whiskeryron]

So sorry pusskin. When you say he is rambling he may very well be talking to others that you cannot see. When my darling wife was dying she was talking to all sorts of people that I was not aware of & I got the impression that she knew who she was chatting to.Please be prepared for your brother to soon be joining those that have gone before & be happy for him. God bless.

Ron.♥

[pusskin]

Hi whiskeryron, you know how sad it is to sit there and listen to ramblings! Sometimes he makes us laugh, as he really sees these images, and they come across as quite comical. Whats a choker is when he asks " When is mum coming in to see me" I have prepared myself mentally even though its really tough as he is such a lovely bruv and I love him to bits. I feel for you too Ron x

[Mamyalynne]

Pusskin, everyone is so right in their advice they have offered. Bruv may be nearing end stage and often as the brain starts to shut down, ramblings and confusion can occur, very distressing for the loved ones to bear.

If Hospice care is offered it may be a more pleasant place for him and indeed for you. I send you my thoughts at this difficult time.

Mamya ♥

[pusskin]

thank you mamy. Everyone here have been so good on replying to me. His wife wants him home but cant cope with nightimes, and so Hospice is the very best place for him when the time comes. When? no one knows!
I pray for a miracle but thats not going to happen xx

My other bruv is in remission with Myloma, so thats been tough too

[pusskin]

Just a little update for my lovely bruv.

last night I was told that they are with holding any more feeding by tube etc.
He is quite comfy and not in pain, and he will be leaving maybe on Friday to return home, and not go to a hospice at this present time. They are going to put together a package so he can rest and be comfy at home with night time carers coming in to help him and his wife. I feel very sad but relieved this morning to know just whats happening now.

Take care every one and keep well. many thanks to each and everyone xx

[RATTER15]

Im assuming the Macmillan Nurses are going to be involved, talk to them and your GP about the "Gold Standards Framework" this is the new standard in palliative care, they will ensure all things are in place to aid your brother and his entire family. check it out here.

http://www.rcpa.org.u...20the%20Community.pdf

[Mamyalynne]

Pusskin with the right framework around them, care at home will be the best thing. I nursed my husband at home (it was his wish and I would never deny him anything) I had minimal help, by choice and to be honest it was a very special time in our long and happy marriage. I must also add that the care and support I got on here helped me immeasurably to cope in the long dark nights.

I send you my best thoughts

Mamya ♥