Enteral nutrition

BY KESHENI
 Enteral nutrition

• The term ‘enteral feeding’ means delivery of nutrients into the

• gastrointestinal tract. The alimentary tract should be used whenever

possible. This can be achieved with oral supplements (sip
Tube-feeding techniques
• Enteral nutrition can be achieved using
• conventional nasogastric tubes (Ryle’s),
• fine-bore feeding tubes inserted into the stomach,
• surgical or percutaneous endoscopic gastrostomy (PEG)
• or, finally,
• post-pyloric feeding utilising nasojejunal tubes or
• various types of Jejunostomy.
Introduction
• supervised by an experienced dietician who will calculate the
patient’s requirements and aim to achieve these within 2–3 days of the
instigation of feeds.
• Conventionally, 20–30 mL
• are administered per hour initially, gradually increasing to goal
• rates within 48–72 hours. In most units, feeding is discontinued
• for 4–5 hours overnight to allow gastric pH to return to normal.
• There is some evidence that this might reduce the incidence of
• nosocomial pneumonia and aspiration
• There is good evidence to confirm that feeding protocols
optimise the tolerance of
• enteral nutrition. In these, aspirates are performed on a regular
• basis and if they exceed 200 mL in any 2-hour period, then feeding is
temporarily discontinued..
• Tube blockage is common. All tubes should be flushed with
• water at least twice daily. If a build up of solidified diet occurs,
• instillation into the tube of agents such as chymotrypsin or
• papain may salvage a partially obstructed tube. Guidewires
• should not be used to clear blockages as these may perforate the
• tube and cause contiguous damage.
 Fine-bore tube insertion
• The patient should be semi-recumbent. The introducer wire is lubricated
and inserted into the fine-bore tube (Figure 20.4).
• The tube is passed through the nose and into the stomach via the
nasopharynx and oesophagus. The wire is withdrawn and
• the tube is taped to the patient. There is a small risk of malposi_x0002_tion
into a bronchus or of causing pneumothorax. The position of the tube
should be checked using plain abdominal radiography (Figure 20.5).
Alternatively, 5 mL of air can be injected
• and a stethoscope used to confirm bubbling from the stomach.
• Confirmation of position by pH testing is possible but limited by the
difficulty of obtaining a fluid aspirate with narrow lumen tubes.
 Gastrostomy
• The placement of a tube through the abdominal wall directly
• into the stomach is termed ‘gastrostomy’. Historically, these
• were created surgically at the time of laparotomy. Today, the
• majority are performed by percutaneous insertion under endoscopic
control using local anaesthesia, known as PEG (percutaneous
endoscopic gastrostomy) tubes (Figure 20.6).
• Gastrostomy
• The placement of a tube through the abdominal wall directly
• into the stomach is termed ‘gastrostomy’. Historically, these
• were created surgically at the time of laparotomy. Today, the
• majority are performed by percutaneous insertion under endo_x0002_
scopic control using local anaesthesia, known as PEG
(percuta_x0002_ neous endoscopic gastrostomy) tubes (Figure 20.6).
 Two methods of PEG are commonly used. The first is called
the ‘direct-stab’ technique in which the endoscope is passed
and the stomach filled with air. The endoscopist then watches
a cannula entering the stomach having been inserted directly
through the anterior abdominal wall. A guidewire is then passed
through the cannula into the stomach. A gastrostomy tube
(commercially available) may then be introduced into the stom_x0002_ach
through a ‘peel away’ sheath. The alternative technique is
the transoral or push-through technique, whereby a guidewire
or suture is brought out of the stomach by the endoscope after
 Two methods of PEG are commonly used
• Two methods of PEG are commonly used. The first is called
• the ‘direct-stab’ technique in which the endoscope is passed
• and the stomach filled with air. The endoscopist then watches
• a cannula entering the stomach having been inserted directly
• through the anterior abdominal wall. A guidewire is then passed
• through the cannula into the stomach. A gastrostomy tube
• (commercially available) may then be introduced into the stom_x0002_ach
through a ‘peel away’ sheath. The alternative technique is
• the transoral or push-through technique, whereby a guidewire
• or suture is brought out of the stomach by the endoscope after
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Thank you