Chapter 36.2 - Enteral Tube Insertion and Feeding

Question 1

Oral Feeding Safety

Answer 1

Ensure gag reflex is functioning
Feed small amounts and ensure patients swallowed before more food given
HOB up 45-90 degrees during and 60 minutes following feeding
Diet will be ordered by physician or dietician

Question 2

Oral Feeding

Answer 2

Most important to maintain the dignity of the patient
Involve the patient as much as possible
“Which would you like first?” “Do you want ketchup?”
Use napkin, not bib, use straws
Ensure dentures and hearing aids are in
Have a conversation

Question 3

Indications for Enteral Nutrition

Answer 3

Cancer
Neurological or Muscular disorders
Gastrointestinal disorders
Prolonged intubation
Inadequate oral intake

Question 4

Enteral Nutrition - Short Term

Answer 4

+Short term (less than 6 weeks)

• Nasogastric tube through the nose into stomach
• **Stomach regulates amounts released into small intestine (high risk for aspiration)
• **Do not use NG if dysfunctional gag reflex or unable to elevate head
• Nasointestinal tube through the nose into the intestine
• **Minimal risk for aspiration
• **Higher risk for dumping syndrome (too much formula given quickly, causes overdistention, nausea, diarrhea, cramping and light headedness)

4-6 hours of hanging food maximum
Smaller tubes are harder to place and clog easier

Question 5

Enteral Nutrition - Long Term

Answer 5

+Tube placed surgically through an opening created in the

• stomach (gastrostomy- GT)
• jejunum (jejunostomy – JT)

+Percutaneous endoscopic Gastrostomy – “PEG”
-Requires intact, functional GI tract

Question 6

Inserting a Nasogastric Tube

Answer 6

+Unexpected situations

• Gag reflex
• Nurse unable to pass tube
• Signs of respiratory distress
• No gastric contents can be aspirated
• Epistaxis (nose bleeding)
• Accidental removal of tube

Question 7

Confirmation of Placement

Answer 7

When do we verify placement?

X-ray – most reliable method, used after insertion and when tube may have been moved
Visual assessment & pH measurement of aspirate
Auscultation (10-30ml of air) –unreliable
Check exposed tube length that was recorded after insertion. Use indelible marker at exit point from nares

Question 8

Patient Safety

Answer 8

Check tube placement
Check residual according to hospital policy
Tube feeding should be interrupted or delayed if residual is 10-20% above the hourly rate
Abdominal assessmen
HOB at least 30 degrees during feeding and for 1 hour after to prevent reflux and aspiration
Prevent contamination
Medications
Restraint patient only when necessary (MD order)
Pause pump if patient is laid flat because there might be a chance of aspiration

For clogs, use suction w/ saline
For medicine, use H20

Question 9

Enteral Medications

Answer 9

Oral medications may be delivered via gastrointestinal tube
Elevate the HOB to prevent reflux
Check tube placement
Flush the tube per MD order / policy and procedures
Give 1 medication at a time with flush between meds
May hold feeding before and after giving certain meds
Hold suction after giving meds
Document water intake and liquid meds

Pause suction 20-30 minutes when giving medications

Question 10

Enteral Feeding Formulas

Answer 10

Composition of formula
Feeding route
Patient’s ability to digest and absorb nutrients
Patient’s nutrient and fluid requirements
Availability and cost of formulas
Medical condition / Diet modification
Food intolerance
Allergies

Question 11

Tube Feeding Administration

Answer 11

+Based on patient’s physical/medical/nutritional needs

• Continuous feeding
• **May cause dumping syndrome
• Intermittent feeding
• Bolus Intermittent feeding
• Cyclic feeding

Question 12

Patient Safety

Answer 12

+Feeding rate begins at 10-40 mL/hr & advanced by 10-20 mL/hr at regular intervals until goal rate is achieved
+Rate advancement is based on patient tolerance
-Absence of nausea and vomiting
-Minimal or no gastric residual
-Absence of diarrhea and constipation
-Absence of abdominal pain and distention
-Presence of bowel sounds

Question 13

Monitor For Complications

Answer 13

• Aspiration
• Check tube placement
• HOB 3-40 degrees
• Clogged Tube = normal saline
• Nasal erosion - petroleum jelly if no O2 therapy
• Diarrhea
• **start feeding at slower rate
• ** prevent contamination by changing formula per protocol (24 hours), refrigerate unused, limit hang time to 4 hours.
• N/V and Distention: check residual volume and avoid oversedating
• Stoma Infection: clean soap and water, topical antibiotic, assess signs of infection
• Refeeding Syndrome: an electrolyte and metabolic disorder that occurs as a result of reinstitution of nutrition to patients who are starved or severely malnourished.
• Leeking gastric contents

Question 14

Provide Comfort Measures

Answer 14

• oral care every 2-4 hours
• moisturize lips
• encourage patient to verbalize concerns
• ensure tube is secure
• ability to taste the feeding
• patient teaching
• removal of the tube

Question 15

Nasogastric Tubes for Decompression

Answer 15

+Tubes connected to suction

• Continuous
• Intermittent
• Decompress air
• Drain fluids (poison, medications)
• Monitor GI bleeding
• Prevent intestinal obstruction

Irrigation to maintain patency and electrolytes

Suction:
low 0-80
medium 80-120
high 120-200