Patient Education: Laryngectomy Appointments



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Patient Education:

Laryngectomy


Appointments

Doctor:_____________________

Date:_________ Time:________

Location:___________________

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Phone:_____________________


Doctor:_____________________

Date:_________ Time:________

Location:___________________

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Phone:_____________________


Doctor:_____________________

Date:_________ Time:________

Location:___________________

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Phone:_____________________


Doctor:_____________________

Date:_________ Time:________

Location:___________________

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Phone:_____________________


Doctor:_____________________

Date:_________ Time:________

Location:___________________

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Phone:_____________________


Doctor:_____________________

Date:_________ Time:________

Location:___________________

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Phone:_____________________


Doctor:_____________________

Date:_________ Time:________

Location:___________________

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Phone:_____________________


Doctor:_____________________

Date:_________ Time:________

Location:___________________

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Phone:_____________________





Medication Record

Medication Dose Frequency Start Date Stop Date

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Health Professionals:

I am a laryngectomee (no vocal cords). I am a total neck breather. I speak via a voice prosthesis. In the event that I stop breathing, expose my entire neck. Keep my neck opening clear and protected from liquids. Resuscitate with air or oxygen to neck opening, or use mouth-to-neck breathing.



Personal Information


Name:___________________________________

Address:_________________________________

________________________________________

________________________________________

Date of Birth: _____/______/______

Telephone Numbers


Home:_________________________________

Cell:___________________________________

Work:__________________________________

Other:__________________________________


Emergency Contact 1


Name:___________________________________

Address:_________________________________

________________________________________

________________________________________


Telephone Numbers


Home:_________________________________

Cell:___________________________________

Work:__________________________________

Other:__________________________________


Emergency Contact 2


Name:____________________________________

Address:__________________________________

_________________________________________

_________________________________________


Telephone Numbers


Home:_________________________________

Cell:___________________________________

Work:__________________________________

Other:__________________________________


Primary Physician


Name:___________________________________

Address:_________________________________

Phone Number:____________________________

Head and Neck Surgeon


Name:___________________________________

Address:_________________________________

Phone Number:____________________________


Preferred Local Hospital:_________________________________________________

Medical Insurance Carrier

Name:_______________________________________________ Phone Number:_______________________

Medic-Alert ID Number:___________________________________________________

Medications


___________________________________________ ___________________________________________

___________________________________________

___________________________________________ ___________________________________________

___________________________________________




Contents:

Pages


6-8 Laryngectomy Timeline

9-12 Glossary

13 Parts of the Mouth

14 Parts of the Throat and Neck

15-16 Laryngectomy

17-18 Radical Neck Dissection


19-20 General Information for the Laryngectomee

21 Incision Care


22 Stoma Care

23-24 Suctioning

25-26 Reinsertion of Laryngectomy Tube

27 Mouth and Skin Care

28 Checking Residual

29 Flushing Your Feeding Tube

30 Tube Feeding

31 Medication Administration

Support Groups and Resources



Laryngectomy Timeline

Pre-Operation


1st Visit with:



  • An Ear, Nose, Throat (ENT) physician

  • Cancer Care Coordinator (this person will set-up diagnostic tests)

2nd Visit with:



  • ENT Physician’s Assistant (PA)

  • Anesthesia

  • Speech Therapy

  • Cancer Care Coordinator

  • Other physicians



Operation

Pre-Operation preparations:



  • The anesthesiologist will talk with you about anesthesia

  • Your vital signs (blood pressure, pulse, respirations, temperature, oxygen saturation) will be taken

  • An intravenous (IV) catheter will be inserted in your vein (usually the hand or arm) for fluid and medication administration before, during, and after surgery

  • Blood may be drawn before surgery

Length of Operation:



  • Approximately 8 hours

Recovery Room:



  • You will be in the recovery room for approximately 4 hours.

  • During your recovery room stay, your vital signs and pain level will be monitored.

  • When you are determined stable, you may be transferred to the Intensive Care Unit (ICU).

Post-Operation


Intensive Care Unit (ICU):



  • You will be carefully monitored in the ICU for at least one day (longer for complicated cases) after surgery to make sure your body tolerated surgery

  • When your are determined to be stable, you will be transferred to a medical/surgical nursing floor

Medical/Surgical Nursing Floor:



  • Upon arrival to the medical surgical floor, your nurse will teach you how to:

    • Care for your laryngectomy and incisions

    • Suction your laryngectomy stoma

    • Feed and give medications through your feeding tube (if applicable)

    • Reinsert the laryngectomy tube if it becomes dislodged

  • You and your family will be expected to demonstrate the above skills by discharge

Discharge:



  • Approximately 7-9 days after surgery

  • Nurse will have you sign discharge paperwork

  • You will be sent home with (including but not limited to):

    • Suction equipment from an outside agency

    • Obturator for your laryngectomy tube (if applicable)

    • An extra laryngectomy tube (if applicable)

    • Alkalol spray

    • Humidity


Follow-up


1st Visit:



  • Approximately 1 week after discharge

  • Meet with an ENT physician for suture, staple, and nasal gastric (NG) tube removal. May have swallow test.

  • Esophagram to evaluate for possible leak

  • Make arrangements for meeting with radiation oncologist, if indicated. Radiation treatment should begin within 6 weeks of surgery.

2nd Visit:



  • Approximately one month after surgery

  • Meet with the ENT physician

  • Set-up appointment or meet with the Speech Therapist



Long-term Follow-up Care





  • Evaluation by your ENT staff surgeon on a regular schedule for cancer surveillance

    • Years 1-2: Every 6-8 weeks

    • Year 3: Every 3 months

    • Year 4: Every 4 months

    • Year 5: Every year


If you would like more information or have questions, please contact The University

of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.


Glossary



Anesthesia: Medication used to produce a loss of sensation or feeling.
Anesthesiologist: A medical doctor that administers anesthesia.
Cancer: Abnormal cells that multiply without control. They can spread through the bloodstream and the lymphatic system to other parts of the body.
Carcinoma: Cancer that begins in the lining or covering of an organ.
Cartilage: Firm, rubbery tissue that cushions bones at joints.
Chemotherapy: Anticancer drugs used to treat cancer.
Clinical Trials: Studies of new cancer treatments. Results from clinical trials determine future cancer treatments.
Electrolarynx: A battery operated instrument that makes a humming sound to help laryngectomees talk.
Epiglottis: The flap that covers the trachea during swallowing so that food does not enter the lungs.
Esophageal Speech: Speech produced with air trapped in the esophagus and forced out again.
Esophagus: The tube through which food passes from the throat to the stomach.
Glottis: The middle part of the larynx where the vocal cords are located.
Humidifier: A machine that puts moisture in the air.

Laryngectomee: A person who has their voice box removed.
Laryngectomy: An operation to remove all or part of the larynx.
Larynx: An organ in the throat used in breathing, swallowing, and talking. It is made of cartilage and muscle and is lined by a mucous membrane similar to the lining of the mouth. It is also called the voicebox. The larynx has three parts: the supraglottis, the glottis, and the subglottis.
Lymph Nodes: Small, bean-shaped organs located along the lymphatic system. Nodes filter bacteria or cancer cells from the lymph fluid.
Malignant: Cancer that has the ability to spread to other parts of the body.
Metastasis: Cancer cells that spread to other parts of the body. These cells have the same appearance or characteristics of original tumor or mass.
Neck Breather: A term used for a person who has had a laryngectomy. The laryngectomee breathes from the neck because the trachea is diverted from the mouth and nose to the neck.
Obturator: A device with a curved tip used in the insertion, or reinsertion, of a laryngectomy or tracheostomy tube.
Oncologist: A doctor who specializes in the treatment of cancer.
Otolaryngologist: A doctor who specializes in the treatment of diseases of the ear, nose and throat. Also known as an ENT or Head and Neck surgeon.
Pathologist: A doctor who identifies diseases by studying cells and tissues under a microscope.
Pneumatic Larynx: A device that uses air to produce sound to help a laryngectomee talk.
Prognosis: The probable outcome or course of a disease; the chance of recovery.
Radiation Therapy: Treatment of cancer cells with high energy beams from x-rays or other sources to kill these cells.
Remission: Disappearance of the sign and symptoms of cancer; can be temporary or permanent.
Risk Factors: Something that increases a person’s chance of getting a particular type of cancer.
Speech Pathologist: A specialist who evaluates and treats people with communication and swallowing problems.
Staging: Doing exams and tests to learn the extent of the cancer; whether it has spread to any other areas of the body.
Stoma: The opening into the windpipe made by the surgeon. Laryngectomees breathe through this opening.
Subglottis: The lowest part of the larynx, just below the vocal cords down to the top of the trachea.
Supraglottis: The upper part of the larynx, above the vocal cords; including the epiglottis.
Systemic Therapy: Therapy that reaches and affects cells all over the body.
Trachea: The airway that connects the larynx to the lungs; the windpipe.
Tracheoesophageal Puncture: A small opening made by the surgeon, between the esophagus and the trachea. A valve keeps food out of the trachea but lets air into the esophagus for esophageal speech.
Tracheostomy: Surgery to create an opening in the windpipe.
Tracheostomy Button: A ½ to 1½ inch long plastic tube placed in the stoma to keep it open.
Tracheostomy Tube: A 2-3 inch long metal or plastic tube that keeps the stoma and trachea open.
Tumor: An abnormal mass of tissue.
Vocal Cords: Two small bands of muscle within the larynx that closes to prevent food from getting into the lungs and they vibrate to produce voice.


If you would like more information or have questions, please contact The University

of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.





Parts of the Mouth

Your mouth allows you to speak, breathe, and chew. Listed below are specific parts of the mouth and where they are located.


© 2005 The StayWell Company, 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your health care provider's instructions.



Parts of the Throat and Neck
Your throat allows you to swallow, breathe, and speak. Parts of the neck help you fight infection. Listed below are specific parts of the throat and neck and where they are located.

© 2005 The StayWell Company, 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your health care provider's instructions.



Laryngectomy

A laryngectomy is an operation to remove the larynx. The larynx, or voice box, is the organ that produces the sound that allows us to speak. It also prevents food from entering the air passage.


Who is a candidate for the procedure?

A person with cancer of the larynx is a candidate for this procedure.


How is the procedure performed?

A laryngectomy is done through an incision in the neck. The larynx is removed. Air can no longer pass from the lungs into the mouth, because the connection between the mouth and the windpipe no longer exists. So a new opening for air to enter the lungs must be made in the front of the neck.


The upper portion of the trachea, or windpipe, is brought out to the front of the neck to create a permanent opening. This opening is called a “stoma.” A laryngectomy tube may be placed in the stoma to keep it open until it heals.
Often, an operation called a neck dissection is done at the same time as a laryngectomy. This is done to remove the lymph nodes in the neck, to which cancer may have spread.
What happens right after the procedure?

After the laryngectomy surgery, the person will be taken to the surgery recovery room to be watched closely for a short time. Vital signs, blood pressure, pulse, and breathing will be checked frequently. A small mask with humidified air will be placed over the stoma. This helps to keep the secretions thin and prevent blockage of the airway. The head of the bed will be elevated to promote drainage from the surgical site. Suction drains may have been placed under the skin to catch any fluid that collects at the incision. The nose, mouth, and the laryngectomy tube will be suctioned gently.



What happens later?

The person usually spends a few nights in the intensive care unit after a laryngectomy. Fluids are given through an intravenous line. A stomach tube may be inserted in the nose into the stomach to supply nutrition until the throat has healed. You will not be able to eat by mouth for 7-14 days. The total hospital stay after a laryngectomy is usually about a week.


Before discharge, the person is taught how to care for the stoma. It is very important that the person and the family understand stoma care. The stoma is the person's only airway. It must be kept free of fluids, mucus, and anything else that can block the flow of air. Any blockage of the stoma can be very serious.
The person will need to learn a new way of speaking. Speech therapy can help to provide alternative ways of speaking. These alternative ways to speak include using artificial voice aids, esophageal speech, and voice prosthesis. It may be helpful to talk with someone who has undergone this procedure. The International Association of Laryngectomees can help provide support.
What are the potential complications after the procedure?

Surgery carries the risk of bleeding, infection, wound healing problems including a salivary fistula (an opening into the throat), and allergic reactions to anesthesia. As with any major surgery, there is a slight risk of heart attack, stroke, or death. Keeping the new airway open is essential to prevent airway complications.




If you would like more information or have questions, please contact The University

of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.





Adapted from: Hendrickson, Gail. Laryngectomy. Retrieved from: http://health.discovery.com/encyclopedias/3208.html
Radical or Modified Radical Neck Dissection
A radical neck dissection is a procedure used to remove cancerous tumors from one side of the neck or upper airway. Almost all the lymph nodes and some of the muscles, tissues, veins, and nerves in this area may be removed as well.
Who is a candidate for the procedure?

A person who has a cancerous tumor in the lymph nodes in the neck and upper airway is a candidate for this procedure.


How is the procedure performed?

The procedure is done under general anesthesia. This means that the person will be put to sleep with medications. An incision, or cut, is made under the chin towards the ear. Another incision is made down to the bottom of the neck. A third incision is made down the middle of the neck. Other incisions may also be made so the surgeon has a full view of the structures inside the neck. The skin is then spread open and the tissues underneath the skin are pulled away from the skin. The surgeon then removes the lymph glands from the neck and oral cavity.


In addition to the lymph nodes, there are three main structures that may be removed from the neck area if they are involved by cancer. These are: the internal jugular vein, the accessory nerve, and the sternocleidomastoid muscle.
Any other veins, nerves, or muscles that are involved with the cancer are also removed. If the cancer has spread, it may be necessary to remove sections of the jaw, tongue, or voice box. At times, it is also necessary to perform a tracheostomy. A tracheostomy is a surgically created opening through the neck into the trachea, or windpipe. The incision is closed with sutures, staples, or skin clips.

What happens right after the procedure?

Usually after a radical neck dissection, a person will be in the surgery recovery room for a few hours for close monitoring. Oxygen will be given through a facemask or nasal prongs. Pain medication will be given as needed. A person cannot eat or drink anything at first. Then later in the day, the person can start taking small sips of fluid. There may be a few tubes that are left near the incision to drain fluids and blood. These tubes will be removed once the draining stops.


For the next few days the person will be encouraged to do deep breathing. This helps to clear the lungs and prevent pneumonia. The day after surgery the person will be encouraged to get out of bed and walk around. This helps to lower the risk of blood clots.
If a tracheostomy was done, the person (and family members) will be given special training in caring for the tracheostomy site.
What happens later at home?

The person will be in the hospital from 4 to 14 days depending if other operations have also been performed with the neck dissection. Activity at home will be based on how the person is recovering. Usually a small amount of activity is recommended on the first day or two after getting home. The person can increase the activity level if he or she feels ready. Sutures, staples, or clips are usually taken out 7 to 10 days after surgery. A person is advised not to drive or participate in strenuous activity for several weeks.


What are the potential complications after the procedure?

After a radical neck dissection a person may have bleeding at the surgery site, infection, pain, and scarring. There is also a chance for injury to the veins and nerves in the neck. This can cause bleeding or numbness. This procedure may also cause a deformity of the neck and face.




If you would like more information or have questions, please contact The University

of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.



Adapted from: McLaughlin, Eileen. Radical Neck Dissection. Retrieved from: http://health.discovery.com/encyclopedias/3212.html

Patient Education:


General Information for the Laryngectomee
Activities of Daily Living:


  • Plan regular rest periods during the day.




  • Exercise lightly as tolerated, such as walking. Increase your level of exercise on a daily basis but not to the point of exhaustion or pain.




  • Maintain your diet as ordered by your physician. Food will taste dull and it will have no odor, however, you must eat and keep your weight up in order to heal and get well.




  • Drink plenty of fluid; at least 8-10 glasses of water a day. Drinking the recommend amount of fluids will decrease your chance of getting constipated.




  • You may drink any other fluids in addition as long as they do not contain alcohol. Alcohol will dehydrate your body.




  • You may shower 24 hours after your drains have been removed.




  • When showering, you will need to cover your stoma/incision with a shield or cover with your hand. Avoid getting soap lather in your stoma because it will make you cough. Pat area dry with towel.




  • Shave with an electric razor or safety razor.



Communication:


  • Wear a medical alert bracelet that says “Neck Breather”.




  • Notify your physician of the following conditions:

    • Severe pain and swelling, redness or drainage from the incision area.

    • Prolonged fever of 101.5 degrees Fahrenheit for over 24 hours.

    • Persistent cough

    • Respiratory distress, difficulty breathing, or a feeling of being short of breath.




  • Contact 911 or your local EMS when you have trouble removing dried or thick secretions from your stoma or difficulty breathing from your stoma.



Other:


  • Avoid smoking or being in the room where others are smoking. The smoke fume may irritate your throat and will induce coughing.




  • Avoid persons with respiratory tract infections, especially colds. You will be more susceptible to these infections for the first several months after surgery.




  • Contact the doctor’s office if you have any questions at (913) 588-6700.




  • To contact one of our hospital ENT nurses, please call (913) 588-9350.


Patient Education:

Incision Care





  • Wash your hands with soap and water.

  • Pour equal amounts of hydrogen peroxide and water in a cup.

  • Dip one swab into the hydrogen peroxide mixture. Clean around stoma and incision. Do this one swab at a time and remove any dried crust or mucus.

  • Rinse off any hydrogen peroxide mixture with a swab or gauze that is dipped in plain water.

  • Gently dry your skin with a dry cloth.

  • A
    Source: http://devweb3.vip.

    ohio-state.edu/patedu.htm ate.edu/patedu.htm
    pply a thin layer of triple antibiotic ointment to stoma and incision with a cotton swab for the first 10 days after surgery (if ordered by your physician).

  • Clean stoma and incision 2 times a day and as needed until healed.

  • Look at your incision. If it is red or hurts, repeat stoma care more than 2 times a day.

  • Wash your hands with soap and water.


If you would like more information or have questions, please contact The University

of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.




Adapted from: Ohio State University Medical Center. Laryngectomy Stoma Care. Retrieved from: http://devweb3.vip.ohio-state.edu/patedu.htm
Patient Education:

Stoma Care




  • Spray the stoma with alkalol spray (diluted one part alkalol to two parts of water) every 1-2 hours while awake. This will help keep the secretions moist and prevent crusts from forming. It will also make it easier for you to cough the secretions out. The diluting water may be plain tap water.




  • Remove dried secretions from stoma with tweezers as needed. You may need to use alkalol to loosen the crust.




  • Blood specks in the sputum occur in the winter. Increased moisture helps prevent crusting and subsequent blood specks.




  • I
    Source: http://devweb3.vip.ohio-state.edu/patedu.htm
    t is important that you cover the stoma when you cough. Your secretions are now coming from your stoma instead of your mouth.




  • Keep you stoma covered at all times with either the stoma cover or other collars of your choice. This will keep dirt and debris out of your stoma. This will also help you keep from coughing in an embarrassing manner. You may want to wear clothing with high necklines or scarves so that the area is covered and looks attractive during cold weather when the air is dry, you will need to place extra covering over your stoma so that the air will condense on the cover and freeze.




If you would like more information or have questions, please contact The University

of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.



Adapted from: Ohio State University Medical Center. Laryngectomy Stoma Care. Retrieved from: http://devweb3.vip.ohio-state.edu/patedu.htm
Patient Education:

Suctioning

  • Suctioning keeps your stoma clear of excess mucus


  • Suction when unable to clear your secretions or you are having trouble breathing.

Suctioning Procedure:



  1. Collect your supplies

    • Suction machine

    • Catheter

    • Small bowl of distilled water

    • Disposable powder-free gloves




  1. Wash your hands with soap and warm water. Then put on clean, disposable, powder-free gloves.




  1. Prepare to suction

    • Turn the suction machine to 80-120 mmHg

    • Attach the suction catheter to the suction machine. Dip the catheter tip into the distilled water to assure the suction is working.

    • Do the following if your secretions are thick: Spray small amount of alkalol, 2-3 times in your stoma as you inhale. This will help loosen mucus.


Source: http://devweb3.vip.ohio-state.edu/patedu.htm



Patient Education:


Suctioning (continued)




  1. Insert the Catheter

    • Take a few deep breaths to fill your lungs with oxygen.

    • G
      Source: http://www.cpem.org/gif/55.gif
      ently insert the catheter into your tracheotomy tube. While you insert the catheter, do not suction. Stop inserting the catheter when you start to cough or meet resistance (usually 3-4 inches).




  1. Suction

    • Apply suction by intermittently covering the suction hole with your thumb. At this time, slowly pull the catheter out of your trach tube. Move the catheter tip in a circle as you pull the catheter out.

    • The catheter should be out of your stoma within 5-10 seconds.

    • If you need to suction more, relax and breathe before you start again. Repeat suctioning process until airway is clear.

    • Discard the catheter, water and gloves. Rinse the suction connecting tube with water until it is clear of mucus.

    • Turn off the suction machine. Wash your hands.


If you would like more information or have questions, please contact The University

of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.



Adapted from: Ohio State University Medical Center. Laryngectomy Suctioning. Retrieved from: http://devweb3.vip.ohio-state.edu/patedu.htm


Patient Education:

Reinsertion of Tracheostomy Tube


  1. Remain calm. Call 911.



  1. Remove the inner cannula.






  1. I

    Outer Cannula

    nsert the obturator into the laryngectomy tube. You will know the obturator is in place when you see the round tip protrude out of the cannula.

Obturator




  1. H
    Stoma
    old the obturator in place with your thumb and grasp the outer cannula under the faceplate with the index and middle fingers, and insert the new tube following the track of the dislodged tube.




  1. Guide tube into trachea, gently with tip toward your toes. If you have difficulty inserting the cannula, lift your chin up to better align the stoma with the hole in the trachea.



Patient Education:

Reinsertion of Laryngectomy Tube (Continued)


  1. Immediately remove the obturator.



  1. Reinsert the inner cannula to reestablish the airway.



Inner Cannula



  1. Secure the tube with ties.



  1. If you are unable to reinsert the laryngectomy tube, try inserting suction catheter to maintain some airway and keep incision open until expert help arrives.


If you would like more information or have questions, please contact The University

of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.





Source: Ohio State University. Reinsertion of a Tracheostomy Tube. Retrieved from: http://devweb3.vip.ohio-state.edu/Materials/PDFDocs/procedure/tube-care/trach/reinsert.pdf.

Patient Education:

Mouth and Skin Care


You need to keep the skin around the feeding tube dry and clean. This helps prevent soreness and infection. The mouth also needs to be cleansed, even though food isn’t taken through it.

Caring for the Mouth

To keep the mouth clean, follow these steps:

  1. Brush the teeth or dentures at least twice daily with a soft toothbrush.

  2. If you have dentures, remove your dentures and wipe the inside of the mouth with a damp washcloth.

  3. Apply a lip balm to keep the lips moist.
Cleaning the Skin and Under the Bolster

G

Bolster

ently wash the skin around the feeding tube each day. Follow these steps:

  1. Wash your hands.

  2. Wet a soft cloth or gauze with warm, soapy water.

  3. Gently wipe the skin around the feeding tube. Also wipe the bolster and the base of the feeding tube.

  4. Gently lift the bolster just enough to get the cloth or gauze under it. Be careful not to pull on the feeding tube.

  5. Check for redness, swelling, bleeding, or leakage around the opening.

  6. Clean under the bolster with the soapy cloth or gauze.

  7. Rinse well with clear, warm water. (This can be done in the shower.)

  8. Pat dry with a soft cloth.

  9. Apply a protective skin barrier or antibacterial ointment if your health care provider tells you to.

  10. Gently push the bolster back against the skin.

  11. Give the feeding tube a gentle 1/4 turn. This helps keep the tube from sticking to the inside of the stomach.

  12. Wash your hands.


If you would like more information or have questions, please contact The University

of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.




Source: The StayWell Company (2004). Tube Feeding: Skin and mouth care. Retrieved from www.kramesondemand.com.

Patient Education:

Checking Residual



Residual is the fluid in the stomach that is left over from the previous feeding.

Always check residual before using tube for feedings.


  1. Gather supplies: feeding syringe, empty cup.

  2. Clamp feeding tube in-between fingers to prevent contents in tube from leaking out.

  3. Open the cap of the feeding tube.

  4. Put the tip of the feeding syringe in the feeding tube.

  5. Pull back gastric contents into syringe with plunger.

  6. Measure amount of gastric contents in syringe. You may need to empty the gastric contents in to a cup and continue to draw back gastric contents with syringe.



If residual is less than 100ml:

  1. Replace all gastric contents back into the stomach.

  2. Flush the tubing according to instructions below.

If residual is greater than

100ml:

  1. Replace all gastric contents back into the stomach.

  2. Flush the tubing according to instructions below.

  3. Recheck residual in one hour




If you would like more information or have questions, please contact The University

of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.




Source: The StayWell Company (2004). Feeding Tube Care: Flushing. Retrieved from www.kramesondemand.com.



Patient Education:

Flushing Your Feeding Tube


With tube feeding, you need to keep the tube from getting clogged by flushing it with warm water before and after each feeding and before and after giving any medications.



  1. Fill a clean bowl with warm water.

  2. Put the tip of the syringe in the water.

  3. Draw up 50 cc of water.

  4. Clamp feeding tube in-between fingers to prevent contents in tube from leaking out.

  5. Open the cap on the feeding port.

  6. Put the tip of the syringe in the feeding port.

  7. Push down on the plunger. Let the water run through the tube.

  8. Clamp feeding tube in-between fingers to prevent contents in tube from leaking out.

  9. Close the cap.

  10. Tape the tube to the skin with medical tape.





If you would like more information or have questions, please contact The University

of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.




Source: The StayWell Company (2004). Feeding Tube Care: Flushing. Retrieved from www.kramesondemand.com.
Patient Education:

Tube Feeding


People who can have a normal amount of food at one time can be fed by bolus feeding. Feedings are most often given every 4 to 6 hours during waking hours. They are only given in the stomach. When starting a feeding, open and use only the prescribed amount of liquid food (formula).

Tube Feeding Solution:______________________

Tube feeding amount:_________________cans/day

Water:________________________ml/day

  1. Pull the plunger out of the syringe.

  2. Clamp feeding tube in-between fingers to prevent contents in tube from leaking out.

  3. Open the cap on the feeding port.

  4. Put the tip of the syringe in the feeding port.

  5. Pour the formula into the syringe.

  6. Fill syringe only half-full.

  7. Hold the syringe straight up and let the formula run through the tube by gravity.

  8. If the formula is not going in by gravity, put the plunger back into the syringe. Then push down slowly on the plunger.

  9. Continue pouring tube feeding into the syringe until you have given the prescribed amount.

  10. After feeding, flush tube as instructed above.

  11. Remove the syringe and close the port cap.



If you would like more information or have questions, please contact The University

of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.




Source: The StayWell Company (2004). Bolus Tube Feeding. Retrieved from www.kramesondemand.com.

Patient Education:

Medication Administration via Feeding Tube


  1. Prepare liquid medications and set aside.

  2. If medications are in tablet form, crush medications and let them sit in warm water for 5 minutes prior to putting in the tube.

  3. Pull the plunger out of the syringe.

  4. Clamp feeding tube in-between fingers to prevent contents in tube from leaking out.

  5. Open the cap on the feeding port.

  6. Put the tip of the syringe in the feeding port.

  7. Pour the medications into the syringe.

  8. Fill syringe only half-full.

  9. Hold the syringe straight up and let the medications run through the tube by gravity.

  10. If the medication is not going in by gravity, put the plunger back into the syringe. Then push down slowly on the plunger.

  11. Continue pouring the medications into the syringe until you have given the prescribed amount.

  12. After all medications have been given, flush tube as instructed above.

  13. Remove the syringe and close the port cap.

**If tube feedings and medications are due at the same time, administer the medications half-way through the tube feeding.




If you would like more information or have questions, please contact The University

of Kansas Department of Otolaryngology Head and Neck Surgery at (913) 588-6701.





Source: The StayWell Company (2004). Bolus Tube Feeding. Retrieved from www.kramesondemand.com

Support Groups and Resources

Alcoholics Anonymous


Missouri

District 12 Office

24 Hr. Answering Service

P.O. Box 1673

Columbia, MO 65205

(573)442-4424


St. Louis County Intergroup Office Trades Center

394 Brooks Dr.

Hazelwood, MO 63042

(314) 731-4854



http://www.ncoaa.org
Jefferson City Answering Service

Jefferson City, MO 65101

(573) 659-6670
Kansas City Area Central Office

200 E. 18th Ave.

North Kansas City, MO 64116

24 Hour availability

(816) 471-7229

E-mail: kcacol@juno.com



http://www.kc-aa.org
Central Office

1031 E Battlefield St.

Suite 124C

Springfield, MO 65807

(417) 823-7125

Information Exchange Intergroup


P.O. Box 1256

St. Charles, MO 63302

(314) 946-1560

Central Services of A.A.

2683 S Big Bend Blvd. Room #4

St. Louis, MO 63143

(314) 647-3677

TDD (314) 647-3683



http://www.aastl.org/
Central Office of SW Missouri

102 A Webb Street

Webb City, MO 64870

(417)673-8591



Kansas


Kansas Area Assembly Central Office

P.O. Box 1773

Salina, KS 67402

(913)823-3058


Information & Service Center

Shawnee Mission, KS 66205

(913) 384-2770
Topeka Area Answering Service

Topeka, KS 66605

(785) 354-3888
United Service Intergroup

P.O. Box 702

Ulysses, KS 67880

(316) 356-3003


Central Office

2812 E. English


Wichita, KS 67211

(316) 684-3661

E-mail: wichitaaaco@aol.com


Support Groups and Resources (continued)

American Cancer Society

www.cancer.org

Cancer Action


Provides free service to cancer patients and their families in the Kansas City area.

www.canceractionkc.org



Cancer Center Patient Resource Center

(913) 588-0130



InHealth Speakers Club

Free membership provides: quarterly newsletter, new product announcements, product specials and promotions, and free one-year membership to MedicAlert ($35.00 value).


Email: speakersclub@inhealth.com

(800) 477-5969



The University of Kansas Health Resource Line

(913) 588-1227

National Institutes of Health


www.nih.gov

Nu-Voice Club


An organization of Laryngectomees, families, and friends. Sponsored by The American Cancer Society.

(816) 842-7111



Smoking Cessation Clinic


Kansas University Medical Center

(913) 588-1227



WebWhispers


Free Laryngectomee support via the Internet at www.webwhispers.org.



Laryngectomy Patient Education




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