Enteral feeding Flashcards
what is dysphagia?
Dysphagia is the term used to describe a swallowing disorder usually resulting from a neurological or physical impairment of the oral (mouth), pharyngeal (upper throat) or oesophageal (lower throat) mechanisms
How to manage dysphagia
Degree of dysphagia needs to be determined
Speech and Language Therapist (SLT)
Modified diet and fluids
Water protocol with oral diet
Water protocol only or NBM (nil by mouth)
MUR
Tablets or capsules when possible should be administered whole & intact.
Small tabs or caps can be safely swallowed when mixed with food of suitable consistency ie. a puree.
Liquids can be used but only if thickened to appropriate consistency
Safety of crushing tablets or opening capsules (UKMi / Manufacturer)
Specials – Short expiry and costly – Ensure consistency is appropriate
What type of enteral feeding tube is preferred if feeding <4 weeks
Nasogastric
What type of enteral feeding tube is preferred if feeding is greater than 4 weeks
PG - Percutaneous
State the French size for nasogastric feeding
6-12 fr
State the tube diameter for medication administration
least 8Fr (1.96 mm inner diameter)
What type of feeding is preferred for jejunal feed
Continuous feeding is preferred for jejunal tubes but interruptions needed for drug delivery.
what is bolus feeding?
Bolus feeding mimics meals and is preferred for gastric feeding while allowing drug administration to be spaced between feedings
facts about intermittent feeding
Longer periods for drug administration than bolus planned around feeds
Facts about syringes used in enteral feeding tubes
Re-designed with fittings that are only compatible with each other (ISO 80369-3)
ISO 80369-3 enteral syringes have a substantial dead-space at the tip, which should not be allowed to fill with liquid medicine. If this space fills with liquid, and if the syringe is then connected to an enteral tube, there is a risk of overdosage and / or leakage (with resulting medicine waste and contamination of the area). The dead-space can be prevented from filling by the use of appropriate bottle adapters or medicine straws which are available from the syringe manufacturers.
Luer-tipped syringes never used – avoid risk of accidental IV administration
Immunocompromised patients and those with enteral feeding tubes which terminate in the jejunum should usually be managed with single-use, sterile syringes
state the type of water that can should be used for enteral feeding
Freshly tap water: Not immunosuppressed, ending in stomach
FBCW or sterile water: Immunosuppressed, ending in jejunum
De-ionised (water for injection, water for irrigation) – Medicine interact with ions, new bottle every 24hrs. E.g. ciprofloxacin
State how to flush during enteral feeding
Push-pause technique to create turbulence within the tube which helps to dislodge particles
Flush with 30 mls of distilled water after feed and 10 mls between meds to prevent drug-drug interactions
Flush with 30 mls after all meds before restarting feed.
Care with some drugs e.g. Phenytoin, fluid-restricted patients (renal, cardiac disease)
Pt should be sitting up at an angle of 30o or greater to reduce reflux of the medication and flushes
What angle should a be sitting up during enteral feeding to reduce reflux of the medication and flushes?
at an angle of 30o or greater
Delivery of drugs to stomach bypasses the normal enteral route where saliva may assist degradation of the drug. True or false?
True
Facts about drug absorption
Residence time in stomach is reduced:
Drug absorption impaired if prolonged contact in acid stomach environment is required for drug dissolution
Jejunum ending tubes: Stomach is bypassed leading to partial or no absorption of some drugs
