March 5th

Gastrointestinal Complications and Management

Vomiting and Diarrhea

  • Patients with excessive vomiting or diarrhea need careful management.

  • Those with enteroputaneous fistulas (abnormal connections between the skin/intestine or stomach) require further assessment.

Tube Placement and Verification Methods

  • Ensure the feeding tube is correctly placed before administering feeds using various methods:

    • Aspirate with a syringe: Check for stomach contents.

    • pH checks: Some healthcare facilities allow checking pH as confirmation.

Medications for Gastric Motility

  • Patients may need motility drugs to assist with gastric movement.

  • Medications for GERD may also be prescribed to manage symptoms effectively.

Ongoing Patient Assessments

  • Bowel Sounds: Assess before feedings to determine gastrointestinal activity.

  • Weight Monitoring: Daily weight checks to monitor the patient's condition.

  • Intake & Output (I&O): Maintain accurate records of fluid intake and output.

  • Feeding Frequency: Change feeds every 24 hours.

  • Flushing Protocol: Flush the tube with 30 mL of free water before and after bolus feeding and drug administration as per doctor's order or institutional policy.

Preventing Misconnections and Complications

  • Check connections regularly to prevent misconnection issues.

  • Monitor for complications such as:

    • Excess residual leading to vomiting.

    • Need to slow down feeds if patient is intolerant.

  • Consider supplements for healing, including trace elements, minerals, and electrolytes.

Central Line Considerations

  • Once central line is inserted, it is generally not used for isotonic solutions without specific indication.

  • Be diligent about potential complications like refeeding syndrome and electrolyte imbalances.

Tubing Specifications

  • Special tubing with micron filters is utilized to ensure it meets safety standards (e.g., 1.2 micron filter).

Behavioral and Psychological Considerations

  • Pre-surgery evaluations should include psychological assessments to identify any disorders (e.g., binge eating, mood disorders) that may interfere with post-surgery dietary adherence.

  • Lifestyle changes must be supported through counseling and education.

Types of Surgical Interventions

Restrictive Surgery

  • Surgical options include adjustable bands that are provided and adjusted by the healthcare provider directly affixed to the small intestine, bypassing the upper stomach.

  • Complications post-surgery may include:

    • Leaks

    • Gallstones

    • Hernias

Postoperative Dietary Management

  • Patients are advised to:

    • Eat slowly and chew food thoroughly.

    • Wait at least 30 minutes after meals before consuming any liquids.

    • Avoid lying down for at least 30 minutes after eating to prevent reflux.

Neurotransmission Role

  • Nerve impulses from the brain to the stomach aid in sensation and satiety. This neurological link is vital for understanding hunger and fullness cues.