Enteral Feeding -Gastrostomy

-a way of providing nutrition for patients who are unable to consume an -Jejunostomy
adequate oral intake but have at least a partially functional gastrointestinal Image 1: Nasogastric Tube
(GI) tract that is accessibleand safe to use.
-the delivery of nutrients by tube, catheter, or stoma into the
gastrointestinal tract beyond the oral cavity; commonly known as tube
feeding.
-may augment an oral diet or may be the sole source of nutrition.
Indicated for:
● patients who have problems chewing and swallowing
● prolonged lack of appetite
● have an obstruction, fistula, or altered motility in the upper GI tract
● in a coma
● have very high nutrient requirements are candidates for tube feeding
Enteral Feeding is contraindicated when the GI tract is nonfunctional as in
● diffuse peritonitis,
● gastric or intestinal obstruction,
● paralytic ileus,
● intractable vomiting
● severe diarrhea
● GI ischemia.

Feeding Route
Feeding route, or placement of the feeding tube, depends on the patient’s
medical status and the anticipated length of time tube feeding will be used.

Transnasal Routes: feeding routes that extend from the nose to either the
stomach or the small intestine.
Generally used for tube feedings of relatively short duration (i.e., 3–4
weeks).

Includes the following:

 nasogastric (NG)- most common
 nasoduodenal (ND)
 nasojejunal (NJ)
Ostomy: a surgically created opening (stoma) made to deliver feedings
directly intothestomach or intestines. Image 2: nasogastic (NG), nasoduodenal (ND), nasojejunal (NJ)
- For permanent or long-term feedings
Image 3: Gastrostomy

Formula Characteristics
Most institutions have a formulary of various enteral products available
within major categories (Table 15.5). Formulas come in cans or sealed
containers to which the tubingis attached for administration. Formulas are
designed to provide complete nutrition withnutrient amounts similar to
what a normal mixed diet supplies. Virtually all commerciallyavailable
enteral formulas are gluten and lactose free.

Image 4: Jejunostomy

Delivery Methods
Formulas may be given intermittently or continuously over a period of 8 to
24 hours. Therates may be regulated either by a pump or by gravity drip.
The type of delivery methodto be used depends on the type and location of
the feeding tube, the type of formulabeing administered, and the patient’s
tolerance.
1. Intermittent Feedings
-tube feedings administered in equal portions at selected intervals. - are
administered throughout the day in equal portions of 250 to 400 mL of
formula over 30 to 60 minutes every 4 to 6 hours, usually by gravity flow or
an electronic pump. -Feedings may be spaced throughout an entire 24-hour
period or may be scheduledonly during waking hours to give patients time
for uninterrupted sleep. -for noncritical patients, home tube feedings, and
patients in rehabilitation -resembles a more normal pattern of intake
allowing the client more freedomof movement between feedings.
-For tolerance, formula is infused at room temperature
-To decrease the risk of aspiration, gastric residuals are checked before each
feedinguntil tolerance is clearly established. Although there is no consensus
on howmuchresidual is too much, residual volumes of 200 mL or more on
two successiveassessments suggest poor tolerance (Palmer and Metheny,
2008).
2. Bolus Feedings
-rapid administration of a large volume of formula.
-The formula is poured into the barrel of a large syringe attached to the
feeding tube. Alarge volume of formula (500 mL maximum; usual volume is
250–400 mL) is deliveredrelatively quickly, usually in 15 to 30 minutes.
- given four to six times per day
- Only used for stomach feeding.
-Infusion to the intestines causes dumping syndrome: nausea, diarrhea,
glycosuria, distention, cramps, and vomiting.
3. Continuous Drip Method
-given at a constant rate over a 12- to 24-hour period to maximize tolerance
and nutrient absorption. Infusion pumps are used to ensure consistent flow
rates. -recommended for feeding of critically ill clients because it is
associated with smaller residual volumes, lower risk for aspiration, and a
decrease in the severity of diarrheawhen compared to other delivery
methods.
-Continuous feeding is also preferred for feedings delivered into the
jejunum; it isfrequently used to begin a feeding into the stomach (i.e. NG,
gastrostomy, percutaneous endoscopic gastrostomy [PEG]).
-Continuous feedings should be interrupted every 4 hours so that water can
be infusedinto the line to clear the tubing and hydrate the client.
-Gastric residuals are measured every 4 to 6 hours. If the volume of gastric
residual exceeds 500 mL, the feeding should be held and patient tolerance
reassessed(Bankhead et al., 2009).
 Image 7. Barrel syringe or open system of tube feeding

Image 5: Continuous Drip Method using an infusion pump

Image 6. Calibrated plastic bag for tube feeding