Overview
This lecture covers the basics of enteral nutrition, its indications, administration methods, safety considerations, and essential steps for tube feeding management.
Enteral Nutrition Basics
- Enteral nutrition delivers nutrients through the GI tract, either by mouth or feeding tube.
- Parenteral nutrition delivers nutrients via IV, bypassing the GI tract.
- Indications for enteral feeding include dysphagia (difficulty swallowing), upper GI obstruction, malnutrition, severe anorexia, and comatose state.
Types of Feeding Tubes
- Short-term enteral nutrition uses a nasogastric (NG) tube.
- Long-term enteral nutrition (over 4 weeks) uses a gastrostomy tube, often placed by percutaneous endoscopic gastrostomy (PEG) procedure.
- PEG tubes are inserted through the abdominal wall into the stomach.
Methods of Tube Feeding
- Feeding can be continuous (gravity or pump) or intermittent (gravity, pump, or bolus with syringe).
- Feeding rate should be started slowly and gradually increased to the ordered rate to improve tolerance.
Key Steps for Safe Tube Feeding
- Perform an abdominal assessment and confirm bowel sounds before feeding.
- Keep the head of bed at 30–45° during and for 1 hour after feeding to prevent aspiration.
- Confirm initial tube placement with an X-ray.
- Ongoing placement checks use aspirated gastric content pH (should be <5.5).
- Instilling air and auscultating the abdomen is not a best practice for confirmation.
Tube Maintenance and Feeding Procedures
- Aspirate and measure gastric residual volume (GRV) before each feeding; follow facility policy on next steps if GRV is high.
- Flush tube with 30 mL water before/after feeding, before/after meds, after residual check, and every 4 hours for continuous feeding.
- Change feeding bag and tubing every 24 hours or per facility policy.
- Limit formula hang time: 4 hours for open systems (manual fill), 24–48 hours for closed/pre-filled systems.
Key Terms & Definitions
- Enteral nutrition — Feeding via the GI tract by mouth or tube.
- Parenteral nutrition — IV delivery of nutrients, bypassing the GI tract.
- Dysphagia — Difficulty swallowing.
- PEG tube — Gastrostomy tube placed via percutaneous endoscopic gastrostomy.
- Aspiration — Inhalation of food or fluid into the airway.
- Gastric Residual Volume (GRV) — Amount of stomach content remaining before feeding.
Action Items / Next Steps
- Review your facility’s policies on tube feeding procedures and gastric residual management.
- Study manufacturer guidelines for formula hang times.
- Prepare for exam questions on tube placement confirmation and aspiration prevention.