[Fendamental] Enteral Tube Feeding

Nasoentric tubes are passed through the nares into the duodenum or jejunum when it is necessary to bypass the esophagus and stomach. Nasoenteric tubes have a decreased risk of aspiration compared with nasogastric tubes; however, a nasoenteric tube can become dislodged to the lungs, causing aspiration of enteral feedings.

 

If a client with a feeding tube develops signs of aspiration pneumonia(diminished or adventitious lung sounds (eg. crackles, wheezing) dyspnea, productive cough), the feedingshould be stopped immediately and tube placement checked. [eg.measure insertion depth, obtain x-ray, assess aspirate pH])

 

Some facilities use capnography(호기말 이산화탄소 분압 측정) to determine placement; if a sensor detects exhaled CO2 from the tube, it is in the client's airway and must be removed immediately. 

 

An inhaled bronchodilator may be prescribed to treat aspiration pneumonia, but the priority is to stop the feeding and check tube placement to prevent additional aspiration.

 

Enteral feeding

-provide nutrition to clients unable to eat or drink

-short term (<4 weeks)

:orogastic: mouth to stomach

:Nasogastric: nose to stomach

:Nasoduodenal: nose to duodenum

:Nasojejunal: nose to jejunum

-Long term (>4-6 weeks)

:gastrostomy tube

:jejunostomy tube

 

Type of feedings

-Bolus

Resembles normal meal feeding patterns

Administed over 30-60 mins every 3-6 hrs

Amount and frequency vary

-Continuous

Administered continuously over 24hrs

Infusion feeding pump regulates flow

-Cyclical

:administed continuously over 8-16 hours :Day or night

:provides breaks between feedings

 

Nursing interventions

Verify tube (ie, nasal, orgastric)

placement prior to initiaitng enteral feeds to prevent aspiration

-initial verification via x-ray

-mark tube should at the naris

-Later can see the marking on the tube and/or measure pH of aspirated gastric contects.(<3.5)

Warm feeding to room temperature

Aspiration precautions: continuous feeding: raise head of bed to >30-45 degrees, bolus feeding: high-fowler posiiton for 30-60min after feeding

Assess for gastrointestinal intolerance: Bowel sounds before feeding, Abdominal distention and pain, Monitor gastric residual only if there is an inotlerance or as per policy

Flush feeding tube to maintain tube patency: before and after for medications and bolus feeds, every 4 hours for continuous feeding, do not mix or add medications to formula, crush tablets if appropriate to find powder and dissolve in water.

 

Site Care!

 

Monitor for complications

-Aspiration: HOB)HEad of the bed) during feedings, tube placement

-Metabolic: refeeding syndrome, hyperglycemia:osmotic diuresis, electrolytes

-Diarrhea: slow feedings, Room temperature feedings, other cuases(C.diff or antibiotics), add fiber

-Vomitting: check gastric residuals, if >500 ml, stop feeding and reassess