1. Chapter 9 Enteral Nutrition

2. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.2 Enteral Tubes An enteral tube is a catheter, stoma, or tube –Used for delivering nutrients to the gastrointestinal tract

3. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.3 Enteral Tubes Enteral tubes are inserted into the stomach for: –Feeding –Inability to swallow –Risk for aspiration –Significant weight loss

4. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.4 Enteral Tubes Enteral tubes are inserted into the stomach for: –Collecting a specimen –Washing the stomach –Removing contents of the stomach

5. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.5 Tube Feeding Nasogastric tube –Threaded through the nose until it reaches the stomach –Short term use only Gastrostomy tube –Surgically inserted through the abdominal wall into the stomach

6. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.6 Tube Feeding Percutaneous endoscopic gastrostomy (PEG) tube –Surgically inserted by threading tube down the esophagus –Exiting through an incision in the abdomen

7. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.7 Tube Feeding Jejunostomy tube (J-tube) –Surgically inserted from the abdomen into the small bowel

8. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.8 Patient Care Keep the head of the bed elevated at least 30 to 45 degrees Monitor and care for the skin –Head elevation increases the risk of skin breakdown Provide frequent mouth and nose care

9. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.9 Patient Care Keep the tube fastened and positioned Know where the tube is –Avoid pulling it out Check tube placement before adding anything to the tube –Confirm initial placement with x-ray

10. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.10 Checking for Residual Check for residual stomach contents before adding formula to the tube Hold feeding if the residual exceeds 100 ml or more than one and a half times the hourly rate, or according to facility policy Never add food coloring to the tube feeding formula

11. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.11 Dehydration Patients with tube feedings can and do become dehydrated Most formulas contain about 15% solids Physician will order water flushes in addition to the formula Dietitian will calculate the patient’s daily fluid needs

12. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.12 Dehydration Nursing personnel ensure the patient’s fluid needs are met –Carefully record and evaluate the I&O sheet to ensure water intake is adequate

13. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.13 Tube Feeding Dietitian calculates the patient’s caloric and nutritional needs Physician orders the formula

14. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.14 Tube Feeding Most formulas contain one calorie per ml of fluid –Most patients need 1600 to 1800 calories a day for nutritional adequacy Flavored formulas (such as chocolate) are for oral use –Not used for tube feeding

15. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.15 Nutritional Adequacy ½ strength and ¾ strength formulas –Provide only half to three quarters the calories and nutrients of regular formula –Should be used on a temporary basis –Patient needs more calories and nutrients for long-term nutrition

16. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.16 Infection Control Enteral nutrition is a potential source of infection Complications may be caused by: –Substandard handling procedures for formula and nutrients –Contamination of dispensing system –Faulty method of administration

17. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.17 Infection Control Open systems should not hang more than 4 hours –Closed system may hang for 24 hours Never “top off” formula in a bag –Always rinse bag and tubing before adding formula

18. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.18 Preparing and Hanging the Tube Feeding Use good handwashing and aseptic technique Avoid administering expired formula Administer prescribed water Keep accurate I&O Always elevate head of the bed 30 to 45 degrees during and after feeding

19. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.19 Complications of Tube Feeding Choking, gagging, vomiting, and aspiration Diarrhea Constipation Skin breakdown due bed elevation Erosion of skin from tube pressure Tube inadvertently removed