Having a PEG fitted

That depends on how quick you can feed. I can manage 160ml an hour. So it is 1000 divided by 160, that is how many hours I feed usually at night. 

Thanks for the heads up

Thanks for the feedback 

Thanks Gill but I think I will get what is available 

Thanks that’s encouraging 

Good evening Micheal, i have 7 ensures a day and start off with two Ensure Compact delivered by a syringe in the morning, two at dinner time and two at tea time. After each feed, i syringe one syringe full of cold boiled water through the peg this is to stop the tube from getting blocked and also for extra fluid, if you cannot swallow thin liquids like water then you have to increase your water intake via the PEG. I would not exceed having two ensures or equivalent in one session as it will bloat you and can cause sickness, the seventh Ensure i take sort of supper time or if you are feeling hungry during the day. I dont know what the feeding regime is if you are pump-fed as i have always used a syringe (bolus feeding). All the best.

                                                                          Chris 

Dear .......

Thank you for your email, I am really happy to hear that you are finding the Monarch Tube to be so beneficial and sharing that experience.

We work very closely with our NHS Trusts and share information about our Feeding products through different forms of communications. I am sorry that it appears your clinicians do not know about the Monarch tube. Do you have a Nutrition Nurse involved in you care? They tend to be the people who explore a variety of tubes and will often recommend the Monarch as an alternative. The Monarch tube is a replacement tube and often if your initial tube has been for example a balloon retained device this is continued unless you experience issues and initiation of a Monarch will only then be explored.

In terms of getting your replacement Monarch Tube I can assure you that the Nutrition Nurses at ......... are familiar with this tube and should be able to assist in getting a replacement with the Clinical Team you see.

In London there are many hospitals using the Monarch Tube, below I have listed a few;

Royal London Hospital

St Barts Hospital

Whipps Cross

Guys and St Thomas Hospital

Northwick Park

Charing Cross Hospital

St Mary’s Hospital

Hammersmith Hospital

Lewisham Hospital

Queens hospital

Whittington Hospital

Royal Free Hospital

UCLH

St Georges Hospital

Kingston Hospital

If you have any other questions please contact me.

Dear .....

The Monarch tube is a replacement gastrostomy tube. This means that it is a tube which is used a replacement (should that decision be made) to any other feeding tube which was used to create the stoma (hole through the skin into the stomach) and ensure the stomach wall has been formed a secure attachment to the inner skin. In most cases the initial tube is often a balloon retained tube which can be referred to as RIG as these tend to be a temporary tube which requires replacing frequently. The balloon retained tube keeps the feeding tube anchored wall of the stomach or in your case small bowel (jejunum). To do this you inflate the balloon so it is anchored and will not come out of the stoma. The insertion and removal of a balloon tube is fairly easy. The tube comes already prepared and in most cases slides easily into the tract and the balloon is inflated anchored and secured at the skin.

The monarch tube differs in that it is retained or anchored in the stomach by a small flange (disk like). When it is inserted the tip of the tube is flat and the flange is in a capsule. When inserted in the stoma and advanced into the stomach, the string at the end of the tube is pulled to release the flange and the guidewire in the tube removed. The clamp will then be placed over the tube and the end connected. The advised removal is traction/pull the tube out.

In relation to knowledge around the Monarch tube, the information is available for clinicians however the balloon tubes have been around a lot longer and people are more familiar with them. A monarch tube is also considered a short to long term feeding tube and what this means is that if the Clinician thinks that you will only need a tube temporarily they will often opt for a balloon retained tube as they expect you may not need for longer than maybe 6-9months. If it is considered you may need a feeding tube for longer then they may look for other options such as a Monarch. There are many reasons why a clinician may choose to place a certain type of feeding tube a maybe for some patients a Monarch may not be appropriate.

Because the Monarch isn’t licensed for placement in the jejunum it can be very hard to offer advice as to why you are having issues, as the tube has been tested for placement in the stomach.