2. Enteral Tube Feedings
• Enteral nutrition (EN) provides nutrients into the GI tract.
• Feedings are provided for patients who can not swallow and have a
functioning GI tract.
• Feedings can be delivered through a nasogastric (NGT), jejunal (JT)
or gastric tube (GT).
2
3. Enteral Tube Feedings
Procedure:
• Start at full strength
• Slow rate
• Increase every 8-12 hours as ordered
• Assess for signs of intolerance
• High gastric residuals, nausea, cramping, vomiting and
diarrhea
• Assess for complications
• Aspiration, Diarrhea, Bacterial contamination, Tube
occlusion, delayed gastric emptying
3
4. Tube Placement
• The most reliable method for verification of
placement of small-bore feeding tubes is x-ray film
examination.
• Check pH of gastric aspirate, < 4
• Observe aspirate color
• Do not use auscultation method
4
7. Nursing Diagnosis
Risk for Aspiration r/t NGT feeding
Outcome: Patient will maintain patent airway and clear lung sounds.
Nursing Interventions
1. Determine if patient is at high risk for aspiration:
coughing, hx of GERD, nasotracheal suction, an
artificial airway, decreased LOC, and lying flat.
2. Keep HOB up to 30-45 degrees at all times
3. Measure gastric residual volumes every 4-6 hrs.
1. 250 ml or more on 2 consecutive assessments: delayed
gastric emptying or if 500 ml on assessment
2. Discuss follow up with HCP
7
8. Nursing Diagnosis
Risk for Aspiration r/t NGT feeding
1. Stop feedings if aspiration occurs
2. Administer metoclopramide (Reglan) if
ordered
3. Monitor for nausea, vomiting, cramping and
diarrhea and tube occlusion.
4. Increase rate per order
8
9. Parenteral Nutrition
• Parenteral nutrition (PN) is a form of specialized nutrition
support in which nutrients are provided intravenously.
• A basic PN formula is a combination of amino acids,
hypertonic dextrose (10-50%), electrolytes, vitamins, and
trace elements.
• Fat emulsions: provides calories and fatty acids
– Delivered through
• Central venous catheter
• Peripheral line (rarely)
pg 1021 9
10. Parenteral Nutrition
• If using a CVC that has multiple lumens, use a
port that is exclusively dedicated for the TPN.
Label it!
• Verify the HCP’s order
• Inspect the solution for particulate matter
• Always use an infusion pump
• First 24-48 hrs: delivers 50% of estimated
needs and then rate has will be increased (run
at 40-50ml)
10
11. Parenteral Nutrition: Complications
• Catheter-related Problems
– Pneumonthorax
• Sudden sharp chest pain, dyspnea, and coughing
• Monitor for 24 hrs
– Air embolus
• Occurs during insertion of the catheter or when
changing the tubing or cap.
• Turn pt to left side and have pt perform a Valsalva
maneuver (hold breath and bear down during catheter
insertion to help prevent air embolus
• Keep IV system closed
11
12. Parenteral Nutrition: Complications
• Catheter-related Problems
– Catheter occlusion
• If sluggish or no flow, stop infusion and flush with NS or
heparin (per protocol).
• Attempt to aspirate clot or follow protocol for thrombolytic
agent (urokinase)
– Sepsis
• Fever, chills, or glucose intolerance and positive blood
culture
• Change tubing q 24 hrs
• Hang bag for only 24 hr; lipids 12 hrs
• Check to see if solution needs a filter
12
13. Parenteral Nutrition: Complications
• Metabolic alterations
– Electrolyte and mineral imbalances
– Hyperglycemia
• Thirst, HA, lethargy, increased urination.
• Monitor BS q 6 hrs
• Give insulin
– Hypoglycemia
• Diaphoresis, shakiness, confusion, loss of consciousness
• Do not abruptly discontinue TPN
• Taper rate
• Give IV bolus of dextrose
– Dehydration
13
Editor's Notes
When oral feeding assistance is inadequate in providing appropriate nutrition, enteral or parental feeding is required. EN is the preferred method of meeting nutritional needs if a patient is unable to swallow or take in nutrients orally, yet has a functioning GI tract.
[Box 44-11 on text p. 1019 lists indications for EN or PN.]
Patients at low risk for gastric reflux receive gastric feedings; however, if risk of gastric reflux, which leads to aspiration, is present, jejunal feeding is preferred.
Types of formulas include
Polymeric: milk-based, blenderized; the patient’s gastrointestinal tract needs to be able to absorb whole nutrients
Modular: single-macronutrient (protein, glucose, polymers, or lipids) formulas are added to other foods to meet patients’ needs
Elemental formulas: predigested nutrients, easier for partially dysfunctional gastrointestinal tract to absorb
Specialty formulas: designed to meet specific nutritional needs in certain illnesses
Before beginning a tube feeding, you will learn in the skills lab to flush the line with a small amount of water to ensure that the tube is clear and patent. Tube feedings typically are started at full strength at slow rates. Increase the hourly rate every 8 to 12 hours per health care provider’s order if no signs of intolerance appear.
Feeding by the enteral route reduces sepsis, minimizes the hypermetabolic response to trauma, decreases hospital mortality, and maintains intestinal structure and function.
Tubes are inserted through the nose (nasogastric or nasointestinal), surgically (gastrostomy or jejunostomy), or endoscopically (percutaneous endoscopic gastrostomy or jejunostomy).
If for less than 4 weeks total, nasogastric or nasojejunal feeding tubes may be used. Surgical or endoscopically placed tubes are preferred for long-term feeding.
A serious complication associated with enteral feedings is aspiration of formula into the tracheobronchial tree, which leads to infection.
[Review Box 44-12 on text p. 1019 Advancing the Rate of Tube Feeding.]
