Enteral Feeding Flashcards

1
Q

Who should healthcare professionals consider for enteral tube feeding?

A

People who are malnourished or at risk of malnutrition and have inadequate or unsafe oral intake and a functional, accessible gastrointestinal tract

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2
Q

What are the types of enteral feeding?

A
  • Nasogastric feeding tube (NG)
  • Nasojejunal feeding tube (NJ)
  • Percutaneous Endoscopic Gastrostomy tube (PEG)
  • Radiologically Inserted Gastrostomy tube (RIG)
  • Jejunostomy tube (JEJ)
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3
Q

What length feeding is NGT usually used for?

A

Shorter term feeding
< 4 weeks

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4
Q

Where is NGT usually placed?

A

Generally bedside insertion.
May be placed via endoscopy or interventional radiology if difficult placement.

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5
Q

What are the risks in NGT?

A
  • Displacement
  • Malposition
  • Blockage
  • Migration
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6
Q

What is the tube care involved in NGT?

A

Position checks (pH) before every use

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7
Q

What are the indications of used for NG feeding?

A
  • Physical issues: unconsciousness/sedation, stroke, neurological conditions, inflammation of mouth/oesophagus
  • Decreased appetite due to: severe illness, psychological disturbances, eating disorders
  • Hypercatabolic state as a result of: malignancy, burns, severe sepsis, major trauma, major surgery
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8
Q

What are the types of NGTs?

A
  • Fine bore feeding NGT
  • Ryles tube
  • Feeding-drainage tube
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9
Q

Which type of NG tube is purely used for feeding?

A

Fine bore feeding NGT

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10
Q

What type of NG tube is purely used for drainage?

A

Ryles tube

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11
Q

What type of NG tube can be used for either feeding or drainage?

A

Feeding-drainage tube

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12
Q

What equipment is needed for NGT insertion?

A
  • Nasogastric tube
  • Apron and sterile gloves
  • pH indicator strips
  • Cup of water for patient to sip (if appropriate)
  • Sterile enteral syringe
  • Tissues or wipes
  • Nasal or cheek dressing to secure tube
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13
Q

What is the first line of confirming NGT position?

A

pH check of gastric aspirate.
Nationally an aspirate pH of 5.5 is used to confirm
gastric placement, although some Trusts may use 5.0.

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14
Q

What is the second line of confirming NGT position?

A

Chest Xray confirmation.
If gastric aspirate is either not obtained after
troubleshooting or pH >5.5.

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15
Q

When should the position of the NGT be checked?

A
  • Before starting the feed, before each bolus (if being used) and before each drug administration or water flush
  • If the patient is complaining of discomfort or feed reflux into
    mouth/throat or if there is evidence of coughing or SOB whilst feeding.
  • Following: vomiting or violent retching, severe coughing bouts,
    endotracheal tube or tracheotomy suctioning
  • If the tube appears visibly longer or if measurement on the tube is not
    the same as measurement recorded in notes.
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16
Q

What length feeding is NJ tube usually used for?

A

Shorter term feeding (<4weeks)

17
Q

What are the indications for use of NJ tube?

A

Poor gastric feeding tolerance (e.g. gastroparesis,
nausea)
Altered anatomy (e.g. gastrectomy, gastric outflow
obstruction)

18
Q

Where is NJ tube placed?

A

Placement via bedside (CorTrak), Endoscopy or IR

19
Q

What are the risks of NJ tubes?

A

Risk of displacement, kinking, blockage, migration

20
Q

What tube care is needed in NJ tubes?

A

Tube care: position checks (tube length) before each use
High risk of blockage

21
Q

What length is PEG used for?

A

Longer term feeding (>4weeks)

22
Q

How is PEG insterted?

A

Requires endoscopic placement and patient needs to
be able to lie flat.

23
Q

What are the contraindications of PEG?

A

Gross ascites, peritonitis,
oesophageal obstruction/varices, malignancy at proposed puncture site, inability to pass endoscope,
active gastric ulceration, deranged clotting, gastric
outflow obstruction.

24
Q

What tube care is needed for PEG?

A

Includes advance and rotate

25
Q

What length is RIG used for?

A

Longer term feeding (>4week)

26
Q

Why may someone have a RIG insertion?

A

Unsuccessful or unsuitable for PEG placement (e.g.
failed insertion, unable to lie flat for scope, partial
oesophageal/H&N obstruction).

27
Q

What does RIG require?

A

Requires NGT for stomach inflation.

28
Q

What is the risk of RIG?

A

Risk of tube falling out (balloon retained)

29
Q

What does RIG tube care involve?

A

Includes checking/replacing balloon volume.

30
Q

What length is JEJ for?

A

Longer term feeding (>4weeks)

31
Q

What are the indications of JEJ?

A

Poor gastric feeding tolerance (e.g. gastroparesis,
nausea).
Altered anatomy (e.g. gastrectomy, gastric outflow
obstruction).

32
Q

What are the risks of JEJ?

A

Placed surgically.
Increased risk of blockage.
Held in place via stitches rather than internal fixation device

33
Q

What is parenteral nutrition?

A

The intravenous administration of a solution containing macronutrients, electrolytes,
micronutrients and fluid, given to support patients with intestinal failure.

34
Q

What are examples of parenteral nutrition?

A
  • Functional obstruction e.g. post-operative ileus
  • Mechanical obstruction e.g. tumour
  • Severe malabsorption e.g. high output stoma,
    short-bowel syndrome
  • Poor feeding tolerance e.g. pancreatitis, severe
    treatment side-effects