Enteral feeding Flashcards
When is enteral feeding indicated?
In patients who have an inability to maintain oral intake with a functioning GI tract
What are the consequences of malnutrition?
Physical decline
Impaired psychosocial function
Function decline
Reduced QoL
Poor clinical outcomes
More healthcare use
What screening tool is used to identify patients who are malnourished, at risk of malnourishment or obese?
Malnutrition Universal Screening Tool (MUST)
What is step 1 of MUST?
BMI score
What is step 2 of MUST?
Weight loss score
What is step 3 of MUST?
Acute disease effect score (eaten in the last 5 days)
What equation is used for calorie estimation?
Schofield equation
What is bolus feeding?
Give feed, supplements, water and medication as a bolus by syringe when required.
Only purple enteral syringed can be used with feeding tubes
What is an alternative to bolus feeding?
Continuous method with an enteral feeding pump and a giving set
What are absolute contraindications to enteral feeding?
Intestinal obstruction
Severe ileus
Intestinal perforation
Proximal GI fistula
Refusal in a competent patient
How do you check the position of the NG tube?
Aspirating and testing the pH.
pH between 0 and 5 is in the stomach and safe to use
What is NG tube used for?
Short term feeding only
What are some examples of NG use?
Swallowing disorders
Head and neck cancers
CF
Anorexia nervosa
What are absolute contraindications to NG use?
Basal skull fracture
Nasopharyngeal/ oropharyngeal pathology prevents passage of tube
What are the relative contraindications to NG use?
Nasal problem
Previous traumatic insertion
What are the risks of NG use?
Malposition into lungs or intracranially
Removal by patient
Tube blockage
Oesophageal/ gastric ulceration
What is NJ feeding?
Nasojejunal
Tubes run through pylorus into jejunum to deliver post pyloric feeding
Inserted under direct vision in endoscopy
What are some examples of NJ use?
Delayed gastric emptying
Reflux causing an aspiration risk
Upper GI surgery
Pancreatitis
What are absolute contraindications to NJ use?
Basal skull fracture
Nasopharyngeal/ oropharyngeal pathology prevents passage of tube
Gastric outlet obstruction
What are relative contraindications to NJ use?
Inability to pass endoscope
What are the risks of NJ use?
Malposition into lungs or intracranially
Removal by patient
Tube blockage
Oesophageal/ gastric ulceration
Post-pyloric position not sustained
What are the three types of gastrostomy?
PEG
RIG
Surgical
What does PEG stand for?
Percutaneous Endoscopic Gastrostomy
What does RIG stand for?
Radiologically Inserted Gastrostomy
When is a gastrostomy indicated?
When enteral feeding will be required long term (>30 days)
What are absolute contraindications to gastrostomy?
Inability to pass endoscope due to pathology
Gastric Outflow Obstruction
Planned curative oesophageal resection
What are relative contraindications to gastrostomy?
Coagulopathies
Peritoneal dialysis
Gastroparesis
Portal HTN
Gastric ulcer
Gastric malignancy
Gastrectomy
Severe obesity
Oesophageal cancer
Active infection
What are the risks of gastrostomy?
Pain
Haemorrhage
Peritonitis
Pneumoperitoneum
Gastrocolic fistula
Infection
Blockage
Over granulation
What are the three types of jejunostomy?
PEJ
PEG-J
Surgical
What is PEJ?
Percutaneous Endoscopic Jejunostomy
What is PEG-J?
PEG with Jejunal extension
What is the indication for Jejunostomy?
Patient requires long term feeding and post-0pyloric feeding
What are absolute contraindications to jejunostomy?
Inability to pass endoscope
Jejunal disease at insertion site
Intestinal obstruction distal to site
What are relative contraindications to jejunostomy?
Coagulopathies
Portal HTN
Ascites
Peritoneal dialysis
What are the risks of jejunostomy?
Pain
Haemorrhage
Peritonitis
Infection
Blockage
Post pyloric position not sustained
