Enteral Feeding Flashcards
Who should healthcare professionals consider for enteral tube feeding?
People who are malnourished or at risk of malnutrition and have inadequate or unsafe oral intake and a functional, accessible gastrointestinal tract
What are the types of enteral feeding?
- Nasogastric feeding tube (NG)
- Nasojejunal feeding tube (NJ)
- Percutaneous Endoscopic Gastrostomy tube (PEG)
- Radiologically Inserted Gastrostomy tube (RIG)
- Jejunostomy tube (JEJ)
What length feeding is NGT usually used for?
Shorter term feeding
< 4 weeks
Where is NGT usually placed?
Generally bedside insertion.
May be placed via endoscopy or interventional radiology if difficult placement.
What are the risks in NGT?
- Displacement
- Malposition
- Blockage
- Migration
What is the tube care involved in NGT?
Position checks (pH) before every use
What are the indications of used for NG feeding?
- 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
What are the types of NGTs?
- Fine bore feeding NGT
- Ryles tube
- Feeding-drainage tube
Which type of NG tube is purely used for feeding?
Fine bore feeding NGT
What type of NG tube is purely used for drainage?
Ryles tube
What type of NG tube can be used for either feeding or drainage?
Feeding-drainage tube
What equipment is needed for NGT insertion?
- 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
What is the first line of confirming NGT position?
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.
What is the second line of confirming NGT position?
Chest Xray confirmation.
If gastric aspirate is either not obtained after
troubleshooting or pH >5.5.
When should the position of the NGT be checked?
- 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.
What length feeding is NJ tube usually used for?
Shorter term feeding (<4weeks)
What are the indications for use of NJ tube?
Poor gastric feeding tolerance (e.g. gastroparesis,
nausea)
Altered anatomy (e.g. gastrectomy, gastric outflow
obstruction)
Where is NJ tube placed?
Placement via bedside (CorTrak), Endoscopy or IR
What are the risks of NJ tubes?
Risk of displacement, kinking, blockage, migration
What tube care is needed in NJ tubes?
Tube care: position checks (tube length) before each use
High risk of blockage
What length is PEG used for?
Longer term feeding (>4weeks)
How is PEG insterted?
Requires endoscopic placement and patient needs to
be able to lie flat.
What are the contraindications of PEG?
Gross ascites, peritonitis,
oesophageal obstruction/varices, malignancy at proposed puncture site, inability to pass endoscope,
active gastric ulceration, deranged clotting, gastric
outflow obstruction.
What tube care is needed for PEG?
Includes advance and rotate
What length is RIG used for?
Longer term feeding (>4week)
Why may someone have a RIG insertion?
Unsuccessful or unsuitable for PEG placement (e.g.
failed insertion, unable to lie flat for scope, partial
oesophageal/H&N obstruction).
What does RIG require?
Requires NGT for stomach inflation.
What is the risk of RIG?
Risk of tube falling out (balloon retained)
What does RIG tube care involve?
Includes checking/replacing balloon volume.
What length is JEJ for?
Longer term feeding (>4weeks)
What are the indications of JEJ?
Poor gastric feeding tolerance (e.g. gastroparesis,
nausea).
Altered anatomy (e.g. gastrectomy, gastric outflow
obstruction).
What are the risks of JEJ?
Placed surgically.
Increased risk of blockage.
Held in place via stitches rather than internal fixation device
What is parenteral nutrition?
The intravenous administration of a solution containing macronutrients, electrolytes,
micronutrients and fluid, given to support patients with intestinal failure.
What are examples of parenteral nutrition?
- 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
