3.3.3. Enteral Nutrition

Nutrition Support

The delivery of formulated enteral or parenteral nutrients appropriate to patients for the purpose of maintaining or restoring nutritional status.

Enteral Nutrition

The provision of nutrients both orally and via any tube in the gastrointestinal tract (GI).

Enteral Nutrition

The preferred route of feeding because it is safer, economical, and maintains gastrointestinal function.

Enteral Nutrition

The preferred route for providing nutrition when the gastrointestinal tract is functioning.

Functioning GIT

The most important consideration before administering enteral feeding, indicating that the digestive tract is able to receive and process nutrients.

Length of feeding

A consideration for enteral feeding involving the expected period during which the patient will require nutritional support.

Risk of aspiration

A major risk that should be considered before initiating enteral feeding because formula may enter the respiratory tract.

Enteral Nutrition

Patients with a functional gastrointestinal tract but who are unable to orally ingest adequate nutrients to meet nutritional requirements can benefit from this type of feeding.

Enteral Nutrition

Protein-calorie malnutrition with inadequate oral intake of nutrients for the previous five (5) days or normal nutritional status but inadequate oral intake for the previous seven (7) to ten (10) days is an indication for this feeding method.

Central nervous system

Disorders such as comatose patients, cerebrovascular accident (CVA), and Parkinson's disease may require enteral feeding because they affect this body system.

Enteral Nutrition

Gastrointestinal diseases such as Crohn's disease, gastroparesis, short bowel syndrome, and chronic pancreatitis may be indications for this feeding method.

Psychiatric disorders

Severe depression and anorexia nervosa are examples of conditions under this category that may indicate enteral feeding.

Enteral Nutrition

Enteral nutrition is preferred over parenteral nutrition because it is safer, economical, and maintains gastrointestinal function.

Nasogastric, nasoduodenal/nasojejunal, jejunostomy, percutaneous endoscopic gastrostomy, or multiple lumen tubes

Routes of access that may be used for enteral nutrition depending on considerations such as nutritional assessment.

Complete intestinal or colonic obstruction

A condition involving blockage of the small or large intestine that contraindicates enteral feeding.

Intractable vomiting

Persistent expulsion of stomach contents that contraindicates enteral feeding.

Active GI bleeding

A gastrointestinal condition involving active blood loss that contraindicates enteral feeding.

Shock

A severe circulatory condition associated with inadequate tissue perfusion that contraindicates enteral feeding.

Protein content or overall macronutrient composition

Enteral formulas are often classified according to these characteristics.

Nutritionally complete polymeric formula

A formula composed of protein, carbohydrate, and fat in high molecular weight form and therefore having lower osmolality.

Nutritionally complete polymeric formula

The formula that is generally lactose-free and gluten-free.

Chemically defined elemental formula

An enteral formula that has a low residue and uses free amino acids or peptides as a protein source, with simple carbohydrates and mostly medium-chain triglycerides.

Modular formulas

Enteral formulas that contain single nutrients such as carbohydrate, fat, or protein, which may be combined with standard enteral products.

Specialty formulas

Enteral formulas that are modified for a variety of clinical conditions including renal, respiratory, hepatic, inflammatory, malabsorptive states, and fat or carbohydrate malabsorption.

Blenderized tube feedings (BTF)

Enteral feedings that may be prepared by liquefying regular foods in a blender and administered through the tube.

Flexibility of formula

An advantage of blenderized tube feeding involving the use of ordinary foods and the ability to adjust the formula precisely according to the patient's requirements.

Health benefits from whole foods

A benefit of blenderized tube feeding involving the physiologic advantages associated with ordinary food ingredients.

Diagnosis and nutritional status

The patient's medical condition and associated problems that should be considered when selecting an enteral formula.

Digestive and absorptive ability

A consideration involving the patient's ability to digest and absorb nutrients, such as the presence of a specific nutrient intolerance.

Low-lactose or lactose-free formula

A patient with lactose intolerance may require this type of enteral formula.

GI tolerance

A consideration in formula selection involving possible gastrointestinal effects and the therapeutic use of an enteral formula.

Caloric and protein density

Characteristics of an enteral formula involving the amount of energy and protein provided per volume.

Ability of formula to meet nutritional requirements

A consideration determining whether an enteral product can adequately satisfy the individual's prescribed nutrient needs.

Na, K, Mg, and P

Nutrients specifically identified in the formula that should be considered when selecting enteral feeding.

Cost

A practical factor considered in enteral formula selection because specialty formulas are more expensive than standard isotonic formulas.

Blenderized tube feeding (BTF)

Enteral tube feeding is contraindicated for patients who are immunocompromised, for infusion through tubes smaller than 10 French, for continuous infusion, or when the formula hangs for more than 2 hours.

≥14 French

If blenderized tube feeding is used, this size of feeding tube is required.

The maximum hang time for blenderized tube feeding.

14 French

The minimum tube size required when blenderized tube feeding is used.

1 mL/kcal

The recommended daily water requirement in the absence of hepatic, renal, or cardiac disease.

75% water

The approximate percentage of water contained in a 1 kcal/mL formula.

2 - 2.5 L/day

Patients receiving a 1 kcal/mL formula should receive enough additional free water to provide at least this total daily amount.

Isotonic

An ideal enteral formula with a nutrient density of 1 kcal/mL has this characteristic related to osmotic concentration.

1 kcal/mL

The ideal nutrient density for adults.

0.67 kcal/mL

The ideal nutrient density for infants.

Osmolality

The number and size of nutrient particles in a solution, which determines the formula's concentration.

Osmolality

The formula characteristic that affects gastrointestinal tolerance, bacteriological safety, and ease of administration.

Monitoring

The process necessary to detect and prevent complications associated with enteral nutrition.

Confirm tube placement

Before initiating feeding, the placement of the feeding tube should first be verified.

Aspiration

During feeding, the patient's head and neck should be elevated 30–45 degrees to reduce this major complication.

30 - 45°

The recommended elevation of the patient's head and neck during enteral feeding.

Accurate intake and output records

Records that should be maintained to compare the prescribed feeding with the amount actually received by the patient.

3 times weekly

The patient's weight should be measured and recorded at least at this frequency during enteral nutrition.

Enteral feeding monitoring

Symptoms such as abdominal distention, pain, diarrhea, or dyspnea should be observed and managed during this process.

Mechanical complications

Enteral feeding complications caused by obstruction of the tube lumen or displacement of the tube.

Esophageal complications

Enteral feeding complications occurring when there is esophagitis or ulceration.

Nasopharyngeal complications

Complications that may be caused by nasal erosions and sloughing of nasal cartilage due to excessive pressure on the nasal cartilage.

Gastrointestinal complications

Enteral feeding complications such as abdominal distention, nausea, vomiting, or diarrhea, which may result from improper formula temperature, irregular or overly rapid administration, or bacterial contamination.

Metabolic complications

Complications including hypernatremia, hyponatremia, hyperglycemia, and azotemia, which may be prevented by proper monitoring of intake.

Bolus feeding

The rapid delivery of 240–400 mL of formula every 4–6 hours, usually approximating normal food intake in terms of gallbladder motility.

240 - 400 mL

The amount of formula generally administered during one bolus feeding.

Every 4 - 6 hours

The usual interval between bolus feedings.

Timed intermittent feeding

A feeding method involving provision of 100–400 mL of formula at intervals of 2–4 hours.

100 - 400 mL

The amount of formula administered during timed intermittent feeding.

Every 2 - 4 hours

The usual interval between timed intermittent feedings.

Continuous drip

A feeding method requiring infusion of the formula using a pump or gravity drip over a period of 16–24 hours.

16 - 24 hours

The usual duration of continuous drip feeding.

Cyclic administration

A feeding method that infuses the formula for 8–16 hours, usually overnight, using an infusion pump.

8 - 16 hours

The usual duration of cyclic administration.

Cyclic administration

The feeding method commonly administered overnight using an infusion pump.