This is part of the article series in Tube Feeding due to Alzheimer's/dementia/dysphagia Resource page.
The nasogastric tube or nose tube is secured to the patient via a tape. In Alzheimer or dementia folks, we face the huge challenge as they would attempt to pull the tube out in all ways possible.
They wanna pull the tube? Of course you bet they would. No worries, doctors adviced to have their hands restrained.
But even when we restraint them or put a special hand mitten over their hands, they would still try to reach their face with their hands and rub off the tubes.
So we gotta secure the tube with a tape to their nose and have the tape changed often. If you secure the tape properly and had it changed often (at least once a day), it would help to keep the tube in place. With the help of hand restraints, of course.
Some tips when it comes to securing the tape on the nose tube:
1. Use porous tapes so that it will minimize rashes, itchness and irritation on the skin. I recommend the Fixomull stretch tape that comes with guided boxes at the back for easy cutting. The tape is easier to come off compared to the 3M nose tape but Fixomull is less irritating on my mom’s skin. I notice it does not cause skin peeling or rashes if I change it frequently.
Whereas for 3M tape, it is more sticky. So hard to pull off but painful for my mom when I remove it. Also it caused a little redness on her skin. However, as I do not tie her hands to the railings (but still cover her hands with the special hand mittens), I will add the 3M tape on the other side of her nose to make sure she does not rub off the tape. I will remove the 3M tape next day and change the Fixomull tape if need be.
How to attach the nose tape
I could not find any video in English where a micro porous tape is used to secure the nose tube. I managed to find a video in Thai language that demonstate how to change the nose tape or plaster:
You can fast forward to 3.52 min to see her demonstration how to do it, kinda creative way of showing clearly.
Note: My Thai language is still weak but below is the understanding I have of what she said.
Prior to that, she explained the precautions such as clean the nose first as there may be dust, sweat and oil on the skin surface. Also she said we always need to remember the black marking (how many strokes) is outside. If you worry you cannot remember, she adviced to snap a picture when the nurse doing the insertion. This is so if the person happened to drag out the tube, or the nose tape came off (which will make the tube move out easily) you would know by how much from seeing the distance of the black stroke marking on the tube. She warned if pull out too much and you secure the tape not knowing this, the tip of the tube may end up in the lungs and you can endanger the life of the patient because when you feed, the food will go straight to the lungs! Always bring the patient back to hospital if unsure (if out of office hours then you would need to visit ER).
From 3.52 min, she demonstrates how to secure the tube. You may notice she cut vertically on one part of the plaster so the plaster split into ‘2 legs’. She secured the uncut part on the nose while the cut part is on the tube.
I wish to say that I do the opposite. Meaning, I would twirl the uncut part on the tube, then the ‘2 legs’ I will stick on the nose. I find it easier to remove the tape that way. Also, with 2 ‘legs’ if my mom happened to rub off one ‘leg’, there is another left.
Overcome your fear and learn to change the tape on your own
Important: As mentioned above, if the tape came completely off for sometime, chances are the tube has moved outwards. If you are not sure of the original length, please get it checked and replaced by a healthcare professional.
Initially I did not really know how to do it even I saw the nurses doing it. But I made myself learn it. At first, I did not know how to dislodge the old tape and few times my mom yelped in pain as I tried to pull the tape out.
With time, I learned to trial and error. I would pacify her, then remove the tape first from her nose. Then I hold on to the tube near the tape and pull it out. You need to pinch and keep the tube from moving as you try to yank the old tape off.
If you are the main caregiver, I strongly advise you to learn to do it on your own. It is not convenient to take to the clinic to change. What happens if it is 3am in the morning and you already seen the tape become not so sticky or going to come off?
If you know how to change yourself, you would not be anxious or frightened each time you see the tape coming off.
I also learned on my own because I had no choice. Because once the tape comes off, it is easy for them to drag the tube out.
Honestly, initially I used to be terrified each time I had to change the nose tape that secures the tube. Because I was so afraid of hurting my mom. But I always reminded myself that she cannot survive without the nose tube hence it is crucial not to let it come off.
With determination, preserverance and practice, it will get easier and easier. At first it took me 20 minutes and few times trials to secure the tape. Now, it takes me below 5 minutes to remove the old tape and secure the new one. It would be the same for you too.