Magazine article American Nurse Today

Enteral Feeding: Indications, Complications, and Nursing Care: Get Up to Date on Current Enteral Nutrition Guidelines

Magazine article American Nurse Today

Enteral Feeding: Indications, Complications, and Nursing Care: Get Up to Date on Current Enteral Nutrition Guidelines

Article excerpt

ENTERAL FEEDINGS deliver nourishment through a tube directly into the GI tract. They're ordered for patients with a functioning GI tract who can't ingest enough nutrition orally to meet their needs. The feeding tube may stay in place as briefly as a few days or permanently, until the patient's death. (See Indications for enteral feeding.)

This article discusses types of enteral feeding tubes, methods, and formulas. It also reviews enteral feeding complications and describes related nursing care.

Defining malnutrition

People experiencing the physiologic stress of illness may have increased metabolic demands with reduced capacity to take in nutrition. Prolonged calorie restriction can lead to malnutrition. According to the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), patients with at least two of the following criteria are malnourished:

* insufficient energy intake

* weight loss

* muscle mass loss

* subcutaneous fat loss

* localized or generalized fluid accumulation that may mask weight loss

* diminished functional status as measured by handgrip strength.

Malnourished patients with inadequate caloric and protein intake may suffer emaciation, poor healing, and pressure injuries. In severe cases, they may develop osteopenia, osteomalacia, osteoporosis, muscle weakness, increased fracture risk, polyneuropathy, paresthesias, confusion, dementia, and pancytopenia. Some also may have low albumin and prealbumin levels, which can cause fluid to pool in a localized or generalized distribution. But before blaming malnutrition for abnormal albumin or prealbumin levels, clinicians must consider such factors as persistent inflammation and hepatic or renal impairment.

Types of enteral feeding tubes

The practitioner selects the type of feeding tube based on the specific enteral formula the patient requires and the anticipated duration of enteral feeding. The two main types of feeding tubes are prepyloric and postpyloric.

* Prepyloric tubes end in the stomach above the pyloric sphincter. They're preferred for intermittent feeding and to allow gastric absorption.

* Postpyloric tubes end beyond the pyloric sphincter in the jejunum. They're indicated for patients with gastroparesis, acute pancreatitis, gastric outlet stenosis, hyper emesis (including gravida), recurrent aspiration, tracheo esopha geal fistula, and stenosis with gastroenterostomy. Postpyloric feedings must be administered on a continuous basis. (See Comparing enteral feeding tubes.)

Enteral feeding formulas

Entering feeding formulas fall into several general categories, such as polymeric formulas, feeding modules, elemental, and specialized or disease-specific formulas. Practitioners choose the formula that bests meet the patient's individual needs. Nutritional demands vary with age, weight, height, current nutritional status, laboratory values, and activity level. Also, enteral feeding requirements may vary even within similar groups of patients, such as those with renal dysfunction or liver failure.

To calculate the correct volume to deliver, practitioners consider the total protein, fat, and carbohydrates needed to restore the patient's health. Some dietitians start with a basic formula of 25- to 35-cal/kg and adjust it to the patient's condition. Certain medical conditions create a higher metabolic demand, necessitating increased feeding volume.

Enteral formulas can be administered using either an open or a closed (ready-to-use) system and can be delivered through several methods. (See Understanding enteral feeding systems and methods.)

Complications of enteral feeding

Patients with feeding tubes are at risk for such complications as aspiration, tube malpositioning or dislodgment, refeeding syndrome, medication-related complications, fluid imbalance, insertion-site infection, and agitation. …

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