Patient Nutrition By Enteral Feedings

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Maintaining good nutrition is of the up most importance for all patients. If a person is ill, recovering from surgery or has an unexplained weight loss, the body has to work extra hard to restore good health. The body needs protein, fat, carbohydrates, vitamins, minerals, and water, in order to maintain and build body tissue and provide energy for body functions.

The patient usually gets these nutrients from eating a balanced diet. However, because of special problems, the patient may require receiving this nutrition in a liquid form through a tube. If this happens, a formula is calculated specifically for the individual patient in order to maintain their nutritional needs.

A majority of patients have a naso-gastric enteric feeding tube placed through the nose, reaching the stomach or small intestine. There are different size tubes to accommodate the difference in the sizes of the patients. Wolf-Pak has pumps for the continuous feedings and syringes for the water flushes.

After insertion of the tube, the physician will order the feedings or will ask the dietician to consult on the feedings. There are two different methods of feeding that can be given to the patient through these tubes. Bolus feedings is when there is a large amount of formula administered over a 15-30 minute time. This feeding is repeated several times a day, according to the orders. The other method is to use a machine, such as a Kangaroo Pump, and give the formula over an 8-24 hour period.

A different method of receiving feedings, is through a gastrostomy feeding tube. This tube is inserted by the physician through the abdomen into the stomach. With this method, the tube bypasses the esophagus and mouth. The feedings can be given through the gastrostomy tube the same way, by bolus or by continous feedings.

In certain cases, the physician may feel that it is necessary to place a jejunostomy tube. This tube in placed through the abdomen also, but goes directly into the small intestine or the jejunum. Feedings done with this tube bypasses the esophagus, mouth, and the stomach. The feedings given through the jejunostomy tube are usually given by the continuous method.

Even though the tube feedings are given, there is also need for plain water flushes to be given with a syringe 6 times a day. The orders by the physician or the dietician should include the tube feeding and the water flush amount. To help prevent reflux, keep the head of the bed elevated 30 degrees or more.

The patient should always be checked for residual stomach contents before starting tube feedings, unless the feeding tube used does not allow for this. If the patient is on continuous feeding, it is suggested that they be checked every 8 hours for residual stomach content. Typically, if the residual content is less than 250 ml, put the fluid back into the feeding tube and resume the feeding as scheduled.

If the residual content is greater than 250 ml and less than 400 ml, put the fluid back into the feeding tube and resume the tube feeding and recheck after 4 hours. At that time, if the residual content is greater than 250 ml, stop the feeding and call the physician. If the residual content is greater than 400 ml at any time, stop the feeding immediately and call the physician. Do not put the feeding back into the feeding tube.

If a continuous feeding is being given be sure to keep the pump plugged into the wall outlet to keep the battery charged. The battery typically last for 18 hours. Make yourself familiar with the protocols and policies of the facility for the administration of the enteral tube feeding. The main concern is the safety and the nutritional status of the patient.

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Providing Nutrition With Enteral Feedings

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Malnourished patients should be considered for enteral feedings. If the patient cannot maintain an adequate intake, the enteral feedings can be a life-saving procedure. Critically ill patients, post-operative patients that can only take limited amounts, and patients with problems such as severe pancreatitis, may require some assistance with nutrition in order to get better. There are instances when the enteral feedings are given along with the parenteral nutrition. This is done in order to reduce the likeliness of cholestasis and to maintain the gut function. Different routes are available for achieving this feeding. Nasogastric tubes are the most common form of delivery and are easy to insert. These tubes must be checked routinely because all though they are easy to insert they are also easy to become displaced.

Peg tubes are more common with patients that have had a stroke, Parkinson’s disease, motor neurone disease or esophogeal cancer. These tubes are inserted surgically directly through the stomach wall. There is a form of this tube that is referred to as the percutaneous jejunostomy tube. This tube is inserted through the stomach into the jejunum, using a surgical technique.

After the tube is inserted and the orders are received by the physician, you will need a feeding set, in order to start the feedings. One type of this is the gravity feeding set. This set will hold 1200ml and comes with a drip chamber, roller clamp, hanger, and a top-fill opening. This bag is leak proof and cuts down on formula spills and also waste. They come 30/case. A different type of tubing is the EnteralLife Infinity set. It comes with a 500ml delivery set and is compatible with the EnteralLife pump. This set has a large top fill opening and is leak proof. These sets do require an enteral infusion pump to operate and come 30/case.

The type and amount of the enteral feeding is usually ordered by the physician or in some cases, the physician will order for the dietician to regulate the enteral feedings. Oral, enteral, or parenteral nutritional support should be considered for any patient that is malnourished or at risk or becoming malnourished. Potential swallowing problems should always be taken into consideration when making the determination as to the route of the nutrition.

One of the complications that can arise from these feedings is infection from contamination of the enteral feeding. The feeding sets and feeding should be discarded every 24 hours to minimize the risk of bacteria growing. Other complications can include the erosion or displacement of tubes, reflux, and aspiration. Enteral feedings can be highly beneficial to the malnourished patient. Assess the patient per protocol and monitor the feeding, so that the patient will receive the correct amount of feeding safely.