TUBE FEEDING

 In tube feeding, a formula passes through a small tube that connects directly to
part of the patient’s digestive system (the body system that processes food).
 The formula is a liquid that contains the nutrients that your patient needs.
 Your patient’s doctor, nurse or dietitian will help figure out which type of tube
feeding is best.
 This staff member will also decide how long the patient will need tube feeding.
 While most patient need tube feeding for only a few days, others need it the
entire time they are having treatments, sometimes longer.
 Unless a doctor, nurse or dietitian tells you otherwise, the patient may take part
in meals and eat some regular foods.
 Sometimes, the patient may receive medicines through the feeding tube.
 The methods for placing the tube are simple and fairly painless. Your patient’s
doctor will use one of these five ways to connect the tube to either the stomach or
the small intestine:
• A nasogastric tube (NG tube) passes through the nose, down the throat and to the
stomach.
• A nasojejunal tube (NJ tube) passes through the nose, down the throat, through the
stomach and to the small intestine.
 Nasogastric Tube
 Nasojejunal Tube
• A gastrostomy tube (G tube) passes through a small cut in the skin directly into the
stomach.
• A gastroenteric or transgastric jejunal tube (GJ tube) passes through a cut in the skin
directly into the stomach and extends into the small intestine
 Gastroenteric or Transgastric Jejunal Tube

Why would you need to consider tube feeding?

 difficulties chewing and swallowing your food

 reduced hand and arm control making it difficult to get food to your mouth
 weight loss due to eating less and muscle wasting
 dehydration and constipation due to drinking less
 changes to your sense of taste or reduced appetite
 lack of energy caused by eating too few calories
 food and liquid passing into the lungs, causing coughing or choking (known as
aspiration, this can cause chest infections).
 ENTERAL FEEDING

 Pertains to the delivery of food and nutrients either orally or by the tube directly
into the GIT. It is used on patients with a functioning GIT but unable to ingest
required nutrients orally or for patients with impaired digesting capacity or
unable to absorb nutrients.

Types of enteral formulation

1. Ready-to-use Formulations
1. Nutritionally complete formulation can be used alone and provides
total needs in a specified volume of formula.
2. Modular Formulation provides different forms of individual
nutrients to supplement existing formulas.
3. Combined formulation meets therapeutic needs.
2. Tube Feedings may be prepared from regular foods
2. Standard Tube Feeding is fiber-free and high in cholesterol, fat and sugar. It is
milk based, sugar, and soft cooked eggs.
3. Blenderized Tube Feeding are soft diet allowances which be blenderized easily.
Complications:
1. Mechanical
1. Nasopharyngeal irritation (ice chips, topical anesthetic and
decongestant)
2. Luminal obstructi0n (Flush, Replace Tube.)
3. Mucosal erosions (Reposition tube, ice water lavage; Remove
Tube.)
4. Tube displacement (Replace Tube)
5. Aspiration (Discontinue tube feeding)
2. Gastrointestinal
1. Cramping/distention (Change formula; Reduce infusion rate)

2. Vomiting/diarrhea (Dilute formula; Reduce infusion rate,

antidiarrheal agents)
3. Constipation (Promote sufficient fluids and fibers; Encourage
patient activity)
3. Metabolic
1. Hypertonic dehydration (Increase free water)
2. Glucose intolerance (Reduce infusion rate; Give
insulin)
3. Cardiac failure (Reduce sodium content; fluid
restriction)
4. Renal Failure (Decrease phosphate, magnesium,
potassium, protein restriction, essential amino acids
solution)
 5. Hepatic encephalopathy (Decrease amount of
protein.)

Modes Of Feeding

Bolus feeding entails administration of 200–400 ml of feed down a feeding tube over
15–60 minutes at regular intervals.
 The technique may cause bloating and diarrhea and bolus delivery into the
jejunum can cause a ‘‘dumping’’ type syndrome and should therefore be avoided
 Bolus feeding can be performed using a 50 ml syringe, either with or without the
plunger
 If the latter is removed, the syringe can be hung up to allow gravity feeding.
 Continuous feedings are usually delivered using a pump at a constant infusion
rate over an established number of hours during the day and/or at night.
 Continuous infusions over 24 hours are often better tolerated by critically ill
patients.
 Cycled continuous feedings over a decreased number of hours throughout the
day (e.g., 20 hours of infusion with 4 hours “off”) allow freedom for
developmental activities and stimulation of hunger and thirst in infants.
 Continuous overnight feedings may facilitate the development of hunger and
thirst during the day for children able to feed orally.
 Overnight continuous feedings into the stomach are not routinely recommended
for children under one year of age or any child at risk for reflux and aspiration.
 Continuous infusions must be used for infusions into the jejunum. For home
patients, financial support for a pump is available only if the infusion time is
equal to or greater than 6 hours per 24 hour period.

PARENTERAL FEEDING

 Parenteral nutrition means feeding someone via their blood stream

‘intravenously’, TPN means feeding a patient solely via the intravenous route.

INDICATIONS

 When patient gastrointestinal tract is paralyzed and nonfunctional, as in the case

of small bowel obstruction
 When >7 days of nothing-by-mouth (NPO) status is anticipated, as in the case of
inflammatory bowel disease, patients with an acute exacerbation, critically ill
patients and so on
 When the baby’s gut is too immature or has congenital malformations
 When the patient is suffering from chronic diarrhea and vomiting or is extremely
undernourished and needs to have surgery, chemotherapy and so on
 When patients with bowel anastomosis develop anastomotic leaks in the early
postoperative period
COMPLICATIONS OF TPN

 Subtle deterioration of the overall clinical well-being of the patient may be the
first clue that a TPN-related complication has occurred.
 The catheter insertion site infection should be ruled out as the first possibility.
 In case of any tenderness, redness, drainage, warmth or other inflammatory
signs at the site of insertion, a fresh catheter should be re-sited at a different site
and the tip of the present catheter along with a wound swab should be sent for
culture and sensitivity tests.
 Differentiation between the systemic inflammatory response syndrome and the
actual infection remains a difficult task, although preliminary evidence suggests
that new markers such as procalcitonin may be valuable in some circumstances
 Short-term potential adverse effects of PN include: infection, hyperglycemia,
hepatic steatosis, essential fatty acid deficiency, electrolyte abnormalities,
acidbase disturbances, hypertriglyceridemia, bacterial translocation and
compromise of gut integrity.
 The symptoms of essential fatty acid deficiency include dermatitis, alopecia, poor
wound healing, increased platelet aggregation, increased capillary fragility and
hepatic dysfunction.
 Re-feeding syndrome characterized by hypophospatemia, hypomagnesemia,
hypokalaemia and hyperinsulinemia may be observed in patients kept NPO for
greater than 7 – 10 days, chronic alcoholics and those with severe systemic
derangements on initiation of TPN.
 Correction of electrolyte abnormalities, administration of thiamine in alcoholics
and a regular check of electrolyte levels may help to prevent this re-feeding
syndrome.