Enteral Tube Feedings

Enteral Tube Feedings- Enteral nutrition, also known as tube feeding, is a way of delivering nutrition directly to your stomach or small intestine.

Gastric Access-

  •  Nasogastric tube (NGT)
  • Oral
  • Percutaneous endoscopic gastrostomy (PEG)
  •  Nasoduodenal tube (NDT)
  •  Low-profile gastrostomy device (LPGD)

Small Bowel Access-

  •  Nasal-jejunal tube (NJT)
  •  Percutaneous endoscopic jejunostomy (PEJ)

Types of Tube Feedings-

  • Intermittent or bolus feedings- A set volume of formula is delivered at specified times.
  • Continuous feedings-A set rate of formula is delivered over a period of time.
  • Cyclic feedings- Similar to a continuous feeding but the infusion is stopped for a specified time within a 24-hour period, usually 6–10 hours.

Checking Tube Placement-

  • Aspirate gastric contents and check pH.
  •  Gastric aspirate pH 1–4 but may be as high as 6 if patient is on medication to reduce gastric acid (famotidine, ranitidine, pantoprazole).
  •  Small intestine aspirate pH >6.
  •  Obtain chest x-ray.
  •  Inject 20–30 mL of air into the tube while auscultating over the epigastrium. Air in the stomach can be heard via a swooshing sound.

Feeding Tube Complications-

Mechanical Complications
Nasopharyngeal discomfort  Reposition tube.
Esophageal ulceration or bleeding esophageal varices Consider PEG or PEJ tube.
Clogged tube Flush with lukewarm water after every feeding. Hosp. Protocol
Tube displacemen  Reposition tube.
Extubation
  • Insert new tube.
  •  Consider PEG or PEJ tube
Stomal leak or infection  Keep area around stoma clean and dry. 
Nonmechanical Complications Interventions
Nausea, vomiting, cramps,bloating, abdominal distention
  • Withhold or decrease amount, rate, and frequency of feedings.
  • Change to low-fat formula.
Diarrhea  Withhold or decrease amount, rate, and frequency of feedings. 
Aspiration
  • Hold feedings. Check residuals.
  • Keep HOB elevated 30°–45° during feedings and 1 hr. after bolus feedings.
Gastric reflux
  •  Hold feedings. Check residuals.
  • Keep HOB elevated 30°–45°. 
   

Dumping syndrome: nausea,vomiting, diarrhea, cramps,pallor, sweating, high HR 

 Withhold or decrease amount, rate, and  frequency of feedings.
   

Checking for Residuals

  •  Assess every 4–6 hrs for continuous feeding and prior to bolus feeding.
  • Using a 30- to 60-mL syringe, withdraw gastric contents from the feeding tube. Note volume of formula.

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