Enteral feeding (9)

Enteral nutrition involves routes:

• Oral

• Tube feeding

  • Nasogastric, nasoduodenal, nasojejunum

  • Gastrostomy

  • Jejunostomy

For successful enteral feeding, GIT must be……………….and…………………….

accessible and functional

CI to enteral feeding:

1. Bowel ischemia or necrosis

2. Bowel obstruction

3. Short bowel diseases

4. Fistula in the small bowel

5. Paralytic ileus

6. Moderate or severe malabsorption

7. GI bleeding

When to start enteral feeding?

According to:

• Degree of illness

• Nutritional status

  • Early in burn patients (2-6 hrs)

  • Early in critically ill patients (24-48 hrs)

  • Hypocaloric enteral intake in early stages of critical illness to avoid hyperglycaemia risk.

EN delivery methods:

1. Bolus feeding

   • For ambulatory settings

   • 100 to 400 ml given over 5-10 minutes using syringe or bulb.

2. Intermittent feeding

   • For in-house feeding

   • For 8-16 hr periods overnight

3. Cyclic feeding

   • for patients in a semi-recumbent position.

   • For 8-16 hrs

4. Continuous feeding

   • for bedridden patients

   • over a 24-hr period

   • Head inclined at 45 degrees to prevent aspiration or regurgitation

Enteral feeding access sites.

1. Gastric feeding

   • Nasogastric tube

   • Gastrostomy tube (PEG tube)

2. Post-pyloric feeding

   • Nasoduodenal or nasojejunum tube

   • Jejunostomy

Nasogastric tube feeding is risky in patients with………………….

poor swallowing reflex or coordination.

Advantages and disadvantages of post-pyloric feeding.

Advantages:

• Bypasses problem of poor GER

• Lesser risk of aspiration

Disadvantages:

• intermittent and bolus feedings are intolerable.

Placement of nasoduodenal or nasojejunal feeding tube can be at……………………. or with………………………..

bedside or with fluoroscopy guidance.

What is a G-J tube?

It’s a PEG tube with an extension to the jejunum (PEGJ).

EN transition feeding (through gastric feeding only) steps.

Patients on continuous feeding will transition to intermittent feeding (several times a day for 30-45 minutes). Then bolus feeding (several times a day for 5-10 minutes).

This transition possible in gastric feeding because intermittent and bolus feeding intolerable in post-pyloric feeds.

General precautions when administering medication via enteral feeding tube.

• Never mix drug directly with enteral feeding formula

• Check site of tube delivery for max dissolution, absorption or efficacy (ex. antacids are delivered by gastric feeding tube, not duodenal)

• May need to discontinue tube feedings before and after drug administration temporarily to prevent reduced bioavailability (fluoroquinolones, phenytoin, warfarin, bisphosphonates)

• Shake suspensions well, don’t crush tablets that are coated, crushed tablets are irrigated with sterile water, flush tube with 20 ml water before and after drug administration.