Enteral Feeding

Enteral Feeding Overview

  • Purpose:

    • To assist patients in meeting their calorie and macronutrient requirements when they cannot obtain these through conventional methods.

Formula Selection

  • Different Types of Formulas:

    • Formulas provide varying amounts of calories.

    • Key factors in selecting formulas:

    • Absorption Capacity:

      • Refers to how well the patient's body can absorb the nutrients from the formula.

    • May vary based on the patient's condition or digestive capabilities.

    • Important for optimizing nutrient intake.

    • Clinical judgement is essential in evaluating absorption capacity to select the appropriate formula.

    • Calorie Goals:

      • Determination of calorie intake targets based on patient's nutritional needs and health conditions.

      • The caloric density of each formula varies and must be matched to the needs of the patient.

    • Disease Specialties:

      • Selection may depend on the specific health issues of the patient (e.g., diabetes, renal issues).

      • Certain formulas are designed for patients with specific diseases or conditions, influencing nutritional content.

    • Recommendations from Nutritionists:

    • Guidelines provided by registered dietitians or nutrition specialists should be followed when selecting formulas.

    • Consider patient's personal history, dietary preferences, and nutritional requirements.

Feeding Schedule

  • Types of Feeding Schedules:

    • Continuous Feeding:

    • Administered at a constant rate over a specified period.

    • Usually requires a pump for regulation.

    • Intermittent Feeding:

    • Administers feed in intervals rather than continuously.

    • Cyclic Feeding:

    • Involves administering feed over a certain number of hours followed by a period of no feeding.

  • Administration Mechanisms:

    • Formulas administered through a feeding pump or syringe.

Administration Techniques

  • Verification:

    • Always verify the physician's order for:

    • The specific formula.

    • Rate of administration.

    • Frequency of feedings.

    • Need for flushes to maintain tube patency.

    • Confirm Route Placement:

    • Ensure the feeding tube is correctly positioned (e.g., post pyloric preferred).

  • Head of Bed Positioning:

    • Maintain the head of the bed elevated above 30 degrees to reduce the risk of aspiration.

  • Preferred Medical Formulation:

    • Liquid formulations or orally disintegrating tablets (ODT).

    • Ensuring that solid medications are finely crushed before administration is crucial to prevent clogging.

  • Residual:

    • Assessment of gastric residual volume (GRV) is important to prevent complications such as aspiration.

    • Techniques to check residual should be established as part of protocols.

Documentation Requirements

  • Documentation of Enteral Feeding:

    • Essential records include:

    • Date & Time of Feeding: Documenting start and finish times.

    • Formula Used: Specify type and brand.

    • Tube Length: Measurement of the feeding tube's length to confirm placement.

    • Volume Given: Track intake versus output (I/O).

    • Flushes or Residuals: Documentation of both flush amounts and any residual volumes observed should be included.

    • GI/Skin Assessment: Regular skin integrity checks and gastrointestinal symptoms to ensure patient well-being.

Reportable Gastrointestinal Symptoms

  • Gastrointestinal Symptoms to Report:

    • Vomiting: Potential sign of intolerance or complications.

    • Diarrhea: Could indicate formula issues or infections.

    • Route Issues:

    • Clogged tube: may require interventions.

    • Dislodged tube: needs immediate correction.

    • Skin Integrity:

    • Compromised skin can lead to further health complications.

SBAR Communication Framework

  • SBAR: A structured method for communicating critical information.

    • S - Situation:

    • Identify current clinical situation clearly and concisely.

    • B - Background:

    • Provide relevant patient history and context, including type of feeding and route.

    • A - Assessment:

    • Analyze the situation; for example:

      • Reporting residual gastric volume greater than 500 mL.

      • Client experiencing nausea and feeling bloated, leading to a need for potential intervention.

    • R - Recommendation:

    • Suggested actions based on assessment findings, such as adjusting feeding rate or administering medication (e.g., antiemetics).

    • Example Scenario:

    • A client who is receiving continuous enteral feeding via a nasogastric tube at a rate of 50 mL/hr, with noted issues like increasing gastric residual volumes. Recommendations include holding the feeding, assessing the client further, and considering future adjustments to therapy depending on the outcomes of assessments.

Enteral Nutrition Formulations

  • Kate Farms® Peptide:

    • A sole-source nutrition formula.

    • Composition:

      • 11 grams of protein

      • 40 calories per serving

    • Indications:

      • For patients needing critical illness support, protein-energy malnutrition, and protein deficiency.

      • Designed exclusively for tube feeding use.

  • Nutrition Features:

    • Fibersource HN by Nestlé:

    • High-nitrogen complete nutrition with a blend of casein and soy protein.

    • Cosmoline:

    • Another complete, balanced enteral nutrition option available for tube feeding.

    • Each formula and nutritional support should be assessed for appropriateness based on individual patient needs and clinical status.