How to Care for your Feeding Tube
Improving health through education
Patient Education
A guide for patients
Please visit the UHN Patient Education website for more health information: www.uhnpatienteducation.ca
© 2010 University Health Network. All rights reserved.
This information is to be used for informational purposes only and is not intended as a substitute for professional
medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific
medical condition. A single copy of these materials may be reprinted for non-commercial personal use only.
Author: James Smith, Jennifer Deering, Tammy Fansabedian, Maurene McQuestion
Created: 10/2010
Form: D-5685
C034-D
You had a feeding tube put in to maintain your nutrition and fluid needs. This booklet will guide you
through the things you need to do and know to take care of yourself while you have a Feeding Tube.
At first, you may be scared or unsure about using your Feeding Tube. This is normal. With practice you
will feel more comfortable and will be able to go through the steps more quickly.
This booklet has been divided into five sections with information you will need to know about how to use
and care for your Feeding Tube and how to deal with side effects you may experience. If you have any
questions at all you can contact your nurse at Princess Margaret Hospital using the important numbers on
the last page of this booklet.
Table of Contents
SECTION A
Page 3
How to Use your Feeding Tube: A Step By Step Guide Using the Gravity Method
Learn the steps and supplies you need to use your Feeding Tube at home.
SECTION B Page 13
Caring for Your Feeding Tube Security Dressing
Learn what to look for, how to keep your tube in place and where to go to have your dressing changed.
SECTION C
Page 17
How To Prevent Your Feeding Tube from Becoming Blocked
Learn tips and things you can do to prevent your Feeding Tube from becoming blocked.
SECTION D
Page 20
Possible Side Effects Related to Your Feeding Tube
Learn how to spot and deal with side effects you may experience while you have your Feeding Tube.
SECTION E
Important Phone Numbers
Find all the numbers you will need to contact your health care team for help or questions.
2
Page 25
SECTION A
How to Use your Feeding Tube
A step-by-step guide using the gravity method
This section will teach you how to:
• • • • Gather supplies for your feeding
Flush your feeding tube
Feed yourself
Clean up after the feeding
Key points to remember for safety!
• Do not put blended or pureed food into the feeding bag. You should only use store-bought formula
that your dietitian has approved.
• Make sure to clean your work surface before gathering your supplies.
• Wash your hands very carefully before you begin your feeding.
• Always stay in a sitting position during your feeding – do not lay down.
• After your feeding you should continue to sit up, or you may take a walk. You should not lie flat for
1 hour after your feeding is finished. This is because there is a risk that if you lie flat the feeding formula
could ‘back up’ into your stomach and then into your throat. From there the feeding formula could ‘go
down the wrong way’ and end up in your lungs. This also sometimes called "aspirating".
• You should use a new feeding bag at least every 7 days or if you find that it is getting dirty with
old formula.
Get comfortable
Using your Feeding Tube will be more pleasant if you are comfortable and entertained during the process.
It can take a long time to finish your feeding so it is important to be prepared and plan ahead. Use some or
all of these tips to make your feeding more comfortable:
• Pick a room that is bright and cheerful to have your feeding.
• Gather some personal items like books or crossword puzzles to keep you entertained.
• Position yourself near a TV to watch your favourite programs or movies.
• Put on some relaxing music.
• Invite a friend or family member to keep you company.
• Sit in a comfortable chair or sit up in bed using lots of pillows to prop you up.
3
Your Feeding Tube and its Parts
Security Dressing
Exit Site
Clamp
Cap
Feeding Tube
Step 1: Gathering your supplies
The first step to feeding yourself is to gather your supplies. Here is a checklist of supplies that you need to
gather before you begin:
Formula
Formula is liquid food that usually comes in a can or a tetra pak box. The formula
has all of the nutrients and minerals you need in your body to stay healthy. There are
many different types of formula you can buy. Some examples are Nutren® 1.5 or
Isosource®. Formula should always be stored at room temperature.
Feeding Bag
Drip Chamber
Tubing
Feeding bag with tubing
The Feeding bag is the plastic bag that you will pour the formula into. The formula
will flow through the tubing and into your Feeding Tube. You will be given 2 bags at
the hospital and you may purchase more bags from the PMH pharmacy.
The parts of the bag and tube are:
• A plastic bag to hold the formula.
• A drip chamber that will connect the bag to the tubing and let you see how fast
the formula is flowing through the tube.
• A roller clamp to control the rate the feeding formula drips at.
• A plastic tube with a tip that will connect the feeding bag tubing to the
Roller Clamp feeding tube in your body.
4
Catheter-tip syringe (60 ml, equal to 2 ounces)
A plastic syringe that has a 1-2 inch tip on it. You will need to make sure that your
syringe holds 60 ml of liquid. You will be given two 60 ml syringes by the nurses.
Glass of room temperature water
Room temperature water is used to flush your Feeding Tube to make sure it is
working properly. Cold water could cause you to have pain or cramps in your
abdomen (belly area).
Clean paper towels
(Preferably without any dye or print on them) to protect your clothes from stains
and spills.
Something to hang your feeding bag from
There are many things you may have in your home that you can use to hang
your feeding bag from:
• A coat stand
• A hook in the wall or ceiling
• A clothes hanger over a door
• A laundry hook over a door
• An IV stand
5
Step 2: Wash your hands
After gathering your items:
• Wash your hands with soap that has no perfume in it
(unscented soap).
• Dry your hands very carefully using a clean towel.
Step 3: Put the formula in the feeding bag
A. Make sure the roller clamp on
your feeding bag is closed so
that the formula stays in the
bag and doesn’t flow through
the tube.
B. Shake the can of formula and
open it.
C. Using one hand hold the bag
and the end of the tube in a
vertical upright position so that
the tube makes a “U” shape.
D. Close the lid on the feeding bag.
E. Keep the can because you will use it later.
Open the top of the feeding
bag and pour the formula in.
6
Step 4: Hang the feeding bag
Hang the bag so that it is:
• Very stable, not wobbling or slipping
• Above the level of your shoulder when you are seated
Step 5: Let the formula flow through the tubing
Once the bag is hung up properly you can let the formula flow through the tubing.
open
A. Squeeze and release the drip
chamber until it is half full
with formula.
B. Remove the cap of the
feeding bag tubing, and
place the end into the empty
formula can that you saved.
D. Let the formula run through the tube to push out any extra air.
7
C. Slowly open the roller clamp.
closed
E. Close the roller clamp when
the liquid gets to the end of
your tube.
F. Put the cap back on the end
of the feeding bag tubing.
Step 6: Flush Your Feeding Tube
Once your feeding bag is ready you need to flush your Feeding Tube with water to make sure it is working
well and is not blocked.
A. Remove the cap of your
syringe.
B. Place the tip below the
waterline to make sure no air
goes into the syringe. Fill the
syringe with 60 ml of room
temperature water.
8
C. Put the tip of the syringe in
the air and squeeze a tiny
bit of water out of the tip to
make sure there is no air left
in the syringe.
closed
D. Close the clamp on your
Feeding Tube.
E. Remove the cap on your
Feeding Tube.
F. Insert the tip of the syringe
filled with water in the end of
your Feeding Tube.
closed
open
G. Open the clamp on your
Feeding Tube.
H. Push the plunger on the
syringe so that the water from
the syringe goes into your
Feeding Tube to flush it.
I. Close the clamp on your
Feeding Tube.
J. Remove the syringe and place the caps back on both the Feeding Tube and the syringe.
9
Step 7: Connect the feeding bag tubing to your Feeding Tube
Once you have flushed the Feeding Tube to make sure it is working you are ready to connect the feeding
bag tubing to your Feeding Tube on your body.
open
A. Remove the cap of the
feeding bag tubing and the
cap of your Feeding Tube.
B. Put the tip of the feeding bag
tubing into your Feeding
Tube.
D. Adjust the roller clamp on the feeding bag tubing so the feeding
formula drips at a steady rate. You may find it most comfortable to
keep the roller clamp at about mid-range allowing for at least 1.5
hours for each can of feed. Keep an eye of the flow of the formula
from time to time. Usually, it should be a slow-steady drip of about
one drip per second.
• You may adjust the speed to go slower or faster depending on your
comfort and how your body reacts to the feeds.
C. Open the clamp on your
Feeding Tube.
Open
(faster)
Closed
(slower)
Note: Moving the roller clamp up will make the drip faster; moving the roller clamp
down will make the formula drip slower.
Your nurse or dietitian will give you this information when you meet with them after you have your tube
put in. If you aren’t sure, please call one of the numbers on the last page of this booklet.
Things to remember during your feeding:
• Stay in an upright sitting position either in bed or in a comfortable chair.
• Keep the feeding bag above your shoulder level when you are sitting. As long as you keep the feeding
bag over your shoulder level you can do light activities such as playing cards, reading or light arm stretches.
• When you move, be sure there are no kinks in the tubing that may cause the formula to stop flowing
through the tube.
10
Step 8: Finish your Feeding
When the feeding bag is empty of all of the formula you can disconnect the feeding bag tubing.
closed
A. Close the roller clamp on the
feeding bag tubing.
B. Close the clamp on your
Feeding Tube.
C. Pull out the tip of the feeding
bag tubing and replace the
caps on both your Feeding
Tube and the feeding bag
tubing.
Step 9: Flush your Feeding Tube Repeat Step 6 (page 8-9).
Step 10: Cleaning your feeding bag
For this step, you will need to use a sink. After each feeding, the feeding bag needs to be rinsed with water
so no formula is left in the tubing.
A. Take the bag down from where you hung it.
B. Open the top and pour 1 cup of water into
the bag. Remove the tip cover and open the
roller clamp so the water runs through.
C. Be sure to hold the tip of the
feeding bag tubing over the sink.
11
Repeat the flushing until there is no formula in the feeding bag tubing.
Cleaning Tips:
In the hospital, you will get a new feeding bag each day. At home, you can use one feeding bag for up to
seven days as long as there is no build up of formula inside the feeding bag and tubing:
To clean your feeding bag and tubing:
• Clean the feeding bag and tubing at the end of each day by adding a little dish soap or detergent to the
water. Try squeezing the drip chamber and holding the bag of water above your head to get water to run
through the tubing.
• Rinse the tubing well to make sure all the soap is removed
• Hang the feeding bag and tubing to dry
• Your feeding bag and tubing are ready to use the next day.
A video is available for patients to go through the steps of using a Feeding Tube at home
How to use your Feeding Tube at home: A step-by-step demonstration
You can view this video:
1.
By borrowing a DVD copy from the Patient & Family Library on the main floor
at PMH for 3 weeks
2.
By going on the internet at:
www.uhn.ca/Patients_&_Visitors/health_info/videos/videos.asp
3.
By going on the internet and using a search engine like www.google.ca and typing
“How to use your feeding tube at home: a step-by-step demonstration”
If you have any questions about this video, please ask your nurse or dietitian.
12
SECTION B
Security Dressings for Feeding Tubes:
Caring for and Changing the Dressing
This section has instructions on how to safely care for your Feeding Tube security dressing.
What is a security dressing?
The type of dressing used to keep your tube in place is called a “Security Dressing”. To keep the tube in
place, it is important that you care for the dressing properly.
The transparent security dressing needs very little day–to–day care. These dressings can sometimes last for
2-3 weeks. The dressing is to secure the tube only. It should not cover the site on the skin of your abdomen
where the tube comes out (called the ‘exit site’).
After the tube is inserted there will be a gauze dressing covering the exit site, this should be removed the
next day. There is no need for a gauze dressing. It is better if the exit site is left open to the air.
Showering with a Feeding Tube
Do not take a bath because having the tube and dressing soaked in water
will loosen the dressing and could lead to your tube coming out.
Security Dressing
Exit Site
Plastic Covering
for showering
You can take a shower with your Feeding Tube when you have a security
dressing on your tube.
You will need to cover the whole area including the ‘exit site’ and the
security dressing with a plastic waterproof covering such as a plastic
sandwich bag and secure this cover with hospital tape. You will be given hospital tape at the hospital, or you can buy it from a drug store.
Cleaning the ‘exit site’
Clean the skin around the ‘exit site (where your tube comes out)’
A gentle patting with a clean damp cloth and a little mild soap and water is
enough. Use a clean towel to pat dry the exit site and surrounding skin.
13
Checking your Feeding Tube exit site
Everyday, look at the exit site of your feeding tube to make sure it is all right, do this while you are
cleaning the exit site.
Things you should look for:
1. Any redness, pus or discharge.
• If you see any pus or discharge or if your feeding tube exit site looks red
and is tender, tell your R.N. Case Manager or call the Radiation Nursing
Clinic (located on level 2B at PMH). See page 25 for phone numbers.
• If you notice redness or pus discharge at the tube site in the evening or on
weekends, or after you have completed your treatments you should go to
your local emergency room (ER).
• If you live in Toronto, the Toronto General Hospital or the Toronto Western
Hospital are recommended (both are apart of University Health Network
along with PMH).
2. Check that your Feeding Tube security dressing is okay.
• Check if there is any loosening of the dressing around the tube or at the
edges next to your skin.
• If the dressing appears loose you should secure the tube and dressing with
hospital tape.
• Once you have secured the tube you can continue with your feeds as usual,
but have your nurse check it as soon as possible. Call the hospital for
further instructions (see page 25 for phone numbers).
3. Check that the tube has not moved.
• If the tube has moved, you will see more of your Feeding Tube than
before, and it may be dark green or brown in colour. This colour is because
of the effects of your stomach acids on the tube, it does not mean the tube
is damaged.
• DO NOT use the feeding tube and DO NOT try to put it back in yourself.
Tape the feeding tube where it is to stop it from coming out more.
• Call the hospital for further instructions (see page 25 for important
phone numbers).
14
4. If your tube has come out completely you should cover the exit site with gauze. Call the hospital
for further instructions (see page 25 for important phone numbers).
• If you notice that your tube has moved or come out in the evening or at weekends, or after you have
completed your treatments you should go to your local ER.
• If you live in Toronto, the Toronto General Hospital or the Toronto Western Hospital are
recommended (both are apart of University Health Network along with PMH).
How to have your dressing changed
A nurse can change your dressing for you:
• While you are on treatment:
Come to the PMH Radiation Nurses Clinic on level 2B between 9am to 5pm, Monday to Friday.
No appointment is necessary.
• After your treatment is completed:
Ask your home care or CCAC nurse to change your dressing and give them the instructions labelled
for “Instructions for Home Care Nurse” below
Please note: Dressing changes will not be done in the Radiation Nursing Clinic. They will be done at
home or at an outside clinic. Extension tubes (about $1) and red caps (about $7) should be purchased
in the PMH Pharmacy.
The following section is for the home care or hospital nurse ONLY.
Instructions for Home Care or Hospital Nurse: How to Change the Security Dressing
What the nurse will need to change the dressing
• 2 transparent dressings (e.g. 10cm x 12 cm Tagaderm®)
• Dry Gauze
• 2 Cavilon Swabs, to help the dressings stick to the skin, and to each other.
• 2 x 2 gauze and paper tape if your tube is still draining from the insertion site.
Remove the old dressing by gently pulling the edges to lift it off. Secure the tube while pulling off the old
dressing. There are two layers to the dressing, if you can, pull each layer off separately.
1. Clean the skin around the tube insertion site with soap and water.
2. Dry this area with the gauze.
3. Wipe the skin below the exit site where you are going to put the new
dressing with one of the cavilon swabs, allow the Cavilon to dry, 10-15
seconds.
15
4. Apply 1 transparent dressing to the skin just below where the tube exits
the skin, on the area you wiped with the cavilon.
5. Wipe this transparent dressing with the second Cavilon swab, to make
it sticky.
6. Gently place the tube onto the sticky transparent dressing.
7. Put the second transparent dressing over the first to sandwich the tube
in place.
8. Press gently to secure.
9. If there is drainage around the tube at your insertion site, put the 2 x 2
gauze on to cover the insertion site and secure the gauze with paper
tape.
NOTE: The transparent dressing breathes. When you apply it to healthy
skin, it can stay on for a long time. We have patients who have had it on
for 1 month at a time.
SECTION C
16
SECTION C
How to Prevent Your Feeding Tube from
Becoming Blocked
It is important that you are able to use your Feeding Tube when you need it. This section will give you a
few simple tips and things you can do to prevent your Feeding Tube from becoming blocked.
The holes or openings at the end of the Feeding Tube are very small.
Small amounts of formula (residue) or medication can build up and block
the holes in your Feeding Tube. This image shows the small holes that are
on the end of the feeding tube inside your abdomen (belly area).
How should I clean my Feeding Tube?
Flush your Feeding Tube with 60 ml of room temperature water using a
syringe twice a day, once in the morning and once in the evening.
Your feeding tube has small
holes that are at the end of the
tube inside your abdomen
(belly area).
Doing this keeps the holes at the end of the tube clear of residue that can
build up, even if you are eating normally and not using your Feeding Tube.
What can I do to lower the chances of my Feeding Tube becoming blocked?
You can lower the chances of your Feeding Tube becoming blocked by taking these steps:
1. Shake the can of formula well before pouring it into the bag. Do this to make sure that it is mixed well
(especially if your formula contains fiber) and will not clump in the bag.
2. Flush the tube with 60 ml of room temperature water before and right after you finish a feeding.
3. If you are taking formula feeds for a number of hours at a time, stop the feed every 4 hours and flush the
tube with 60mL of room temperature water.
4. Flush the Feeding Tube with 60 ml of water between each can of formula feeding if you are using one
can immediately after another.
17
Here are a few things to remember when you are using your Feeding Tube to give
yourself medications:
1. Talk to your doctor, pharmacist or R.N. Case Manager about any medications you are taking. They can
help show you how to put medications through your Feeding Tube.
2. Not all medications are safe to crush. Ask your health care team if you are not sure.
3. Ask if the medications you are taking are available in a liquid form. Some medications, like the most
common painkillers and anti-nausea medications are available in liquid form.
4. Crush pills that are safe to crush into a fine powder. Mix the powdered medication with 30 ml water and
put through the Feeding Tube using a syringe.
5. Take different medications one at a time. If you are taking more than one medication, flush the Feeding
Tube with 30 ml of room temperature water between each medication. Do not mix the different
medications.
6. Flush the tube well with 60 ml of room temperature water after you have finished taking all your
medications.
What should I do if my Feeding Tube becomes blocked?
If your Feeding Tube becomes blocked, or if the flow is slower than usual, first try to flush the tube a few
times with room temperature water using gentle pressure.
If this does not unblock the tube contact your RN Case Manager or doctor at PMH or your homecare
nurse.
If you are not able to come to PMH, give the instructions below to your Home Care nurse or Emergency
Room (ER) staff to unblock the tube.
18
The following section is for the home care nurse or ER staff ONLY.
Instructions for Home Care Nurse or ER staff:
Preferred Method for Unblocking Feeding Tubes
1. You will need: One cotazyme capsule and one 500mg sodium bicarbonate tablet.
2. Open the Cotazyme capsule and mix with the 500mg tablet of crushed sodium bicarbonate.
3. Add 10 ml of water to the mix and stir to make ‘slurry’.
4. Draw the mixture into a syringe, and inject into the Feeding Tube.
5. Allow for 20 minutes letting the mix take effect and then try to flush the tube with 60ml of water.
19
SECTION D
Possible Side Effects Related to your
Feeding Tube
This section will give you information about how to deal with possible common side effects that you may
experience after your Feeding Tube is put in.
During your treatment, you may have some of the following symptoms:
• Nausea and/or Vomiting
• Diarrhea
• Constipation (hard stool or no stool)
These symptoms can happen for many reasons, whether you are using your Feeding Tube or not. They can
be mild or severe.
Using your Feeding Tube should not add to your feeling of nausea and it should not affect your bowel
movements. If you feel that it is doing either of the above, contact a member of your health team so they
can help you feel better.
Here are a few things you can do to deal with these symptoms:
Nausea and Vomiting
Nausea and vomiting are unpleasant side effects that can occur with cancer treatments, including radiation
therapy and chemotherapy. They can also be related to your tube feeding.
Open
(faster)
Closed
(slower)
The best way for you to prevent your feeds from causing nausea and
vomiting is to give yourself your formula at the rate suggested by your
dietitian. If you are doing this and still have nausea, it may be that this
rate is too fast for you. You should slow the rate of your feeds by rolling
down the ‘roller clamp’ on the tubing slightly to allow for a slower drip.
If you continue to have nausea you should call your dietitian or R.N. case
manager.
20
What to watch out for
If you feel you are experiencing nausea or vomiting whether you are using your Feeding Tube or not, your
symptoms may not be related to your Feeding Tube. Call or visit the hospital. See page 25 for important
phone numbers and who to call.
How to avoid dehydration (not having enough fluid in your body)
You can easily get dehydrated when you are vomiting, or not eating or drinking, or taking fluids through
your tube because of nausea. The average person needs about 8 cups (2 litres) of fluid a day. This can
include all fluids such as: juice, milk, soups, ice cream, tea, coffee, formulas, and water. Four 60ml
syringes equal only 1 cup of water.
If you are unable to eat or take formula through your tube you should increase the amount of water you
give yourself through your tube.
You should see your health care team right away if:
1. You haven’t been able to drink fluids by mouth or you use your Feeding Tube for more than 6 hours.
2. You do not have anti-nausea medications or the one you have is not working.
3. You are becoming dehydrated, and feel symptoms like:
• feeling weak and dizzy when you get up from bed or a chair.
• passing less urine and the urine is darker in colour.
If you feel you are becoming dehydrated, call or visit the hospital. See page 25 for important phone
numbers and who to call.
Diarrhea
There can be many causes of diarrhea. The best way to prevent diarrhea that may be caused by your
Feeding Tube is to run the formula at the rate suggested by your dietitian. If you are doing this and still
have loose bowel movements after your feeds, you can try to run the feed a little slower, by rolling the
clamp down slightly to lessen the rate that the formula drips at.
What to watch out for
It is very easy to become dehydrated when you have diarrhea. It is important to contact you RN case
manager and/or dietitian if you are having diarrhea. You should replace the fluids lost from the diarrhea by
drinking more fluids or putting extra water through your Feeding Tube (remember that four 60mL syringes
equal only 1 cup of water).
Do not use anti-diarrhea medications like Imodium without talking to your doctor or nurse first.
21
You should see your health care team right away if:
• You have blood or mucus in your stool.
• You have 3 or more loose bowel movements a day.
• You have severe cramping.
• You are not able to take enough fluids (8 cups) a day either drinking or through your Feeding Tube.
If you have any of these symptoms call or visit the hospital. See page 25 for important phone numbers and
who to call.
Constipation
Like the other symptoms mentioned above, constipation can be caused by many factors. The most likely
reasons why you may be constipated during your treatment are:
• Constipation as a side-effect of your pain control medications.
• Constipation related to taking in less fluids (either fluids taken by mouth or fluids taken through your
Feeding Tube)
If your constipation is caused by the pain medications that your doctor recommended it is important that
you follow the ‘bowel routine’ at the end of this section.
Here are a few suggestions to follow if your pain medications are making you constipated. Following these
steps and the bowel routine will help to stop the constipation before it becomes a problem:
• Increase the amount of laxatives you need to have a daily bowel movement, or until reach your normal or usual bowel movement routine.
• If you start taking pain killers 3 or more times a day, take a stool softener and a laxative.
• If you are still constipated, start the bowel routine below.
NOTE: If your pain medications are making you constipated, adding more fibre in your diet may not be
enough to help relieve your constipation. Taking in more fluid and/or doing more water flushes through
your tube may help. If taking more fibre and fluids are not enough, you may need to begin the bowel routine that appears below.
What to watch out for
If you have not had a bowel movement in 2-3 days, call or visit the hospital. See page 25 for important
phone numbers and who to call. Nausea can also be caused by constipation. If you have been given a
prescription for laxatives and/or stool softeners by your doctor or nurse please follow the instructions for
their use. If you have not been given a prescription for stool softeners and laxatives please ask your R.N.
case manager or doctor for one.
22
Bowel Routine While Taking Pain Medications
This bowel routine uses two medications which can be bought in any pharmacy without a prescription in
both liquid and tablet or capsule form. Following this routine can help stop constipation before it becomes
a problem.
These medications are:
• Docusate Sodium (also called Colace) which is a Stool Softener (keeps the stool soft so you don’t
strain or push to expel the stool)
• Senokot which is a laxative (helps move the stool through the bowel)
Converting Medications in Pill Form to Liquids:
Medication
Colace
Senekot
Form
Capsule
Tablet
Dose
100 mg (1 capsule)
8.6 mg (1 tablet)
Liquid Amount
25 ml (5 teaspoons)
5 ml (1 teaspoon)
Begin this routine on the first day you start your pain medication:
STEP 1: Take 1 Colace (25 ml or 5 teaspoons) and 1 Senokot (5 ml or 1 teaspoon) in the morning.
Repeat at bedtime.
The next steps can be used to increase the doses until you have regular bowel movements.
Moving up from each step can be done every 24 hours.
STEP 2: Take 2 Colace (50 ml or 10 teaspoons) and 2 Senokot (10 ml or 2 teaspoons) in the morning.
Repeat at bedtime.
STEP 3: Take 2 Colace (50 ml) and 3 Senokot (15 ml or 3 teaspoons) in the morning. Repeat at bedtime.
STEP 4: Take 2 Colace (50 ml) and 4 Senokot (20 ml or 4 teaspoons) in the morning. Repeat at bedtime.
STEP 5: Speak to your doctor or nurse. He/she can review what you are taking and make changes or
suggest other things you can do. Other medications may be added to your routine (such as lactulose).
• If you are already taking other laxatives, tell your nurse and follow any instructions for changing the
doses.
• It is important to have a regular bowel pattern while taking pain medications. If it’s normal for you
to have a bowel movement every day, you should still have a bowel movement at least every 2-3
days while taking pain medications.
• If you do not have a bowel movement within 3 days, please call your nurse to go over what you are
taking and make changes to your bowel routine.
23
• If you start to have diarrhea or loose stools, do not stop bowel routine medications. Tell your nurse,
and go back one step in the bowel routine. The step system lets you change the steps to meet your
needs (e.g. helps with the side effects of medications and what you eat to keep a regular bowel
pattern).
• If you begin to take chemotherapy (like Cisplatin), and your bowel routine is working, you will need
to increase by 1 step on the day you receive your chemotherapy and/or will be taking Kytril (an anti
nausea medication that is constipating). Example: If you are on step 2, increase to step 3 on the day
you receive chemotherapy.
24
SECTION E
Important phone numbers
This section has important contact information for your health care team at PMH that you can call if you
need help while you are on treatment or after your treatment is completed.
• While you are on treatment:
Weekdays (Monday-Friday) 9am to 5pm
Call or go to the Radiation Nursing Clinic, level 2B at PMH
416-946-4501 ext 6558
On evenings (after 5pm), weekends and holidays
Call the Nursing Coordinator at 416-946-4501 ext 5134
• After your treatment is complete:
Call your Registered Nurse Case Manager
Name:______________________________
Phone number: 416 946 4501 ext_________
If at anytime you need help in an emergency, go to your nearest Hospital Emergency Department.
Other important numbers:
Dietitian: 416-946-4501 ext. 5266
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
25
Notes:
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________