Enteral Feeds Flashcards
What are the different types of EN Tubes?
Nasogastric/ Orogastric
Nasoduodenal
Nasojejunal
When should a nasogastric/ orogastric tube be used?
Dysphagia
Fully functioning gut with no complications such as nausea, vomiting, aspiration or reflux
Allows for higher feeding rates/bolus feeding if indicated
Acute Pancreatitis (similar tolerance and outcomes for acute pancreatitis when patients are fed via NG or NJ)
When should the short term tubes be replaced?
Every 4 to 6 weeks
When should a nasoduodenal tube be used?
Delayed gastric emptying
Gastro-oesophageal Reflux Disorder (GORD)
Gastric outlet obstruction or surgery
Aspiration risk
When should a Nasojejunal tube be used?
High risk of aspiration
Continual nausea and vomiting
Upper GI strictures, obstruction or surgery
Unconscious patients in supine position
What are the long term tubes called?
Percutaneous Endoscopy Gastrostomy (PEG)
Percutaneous Endoscopy Jejunostomy (PEJ)
How long till long term tubes should be removed?
18 Months - 2 Years
When should a PEG be used?
Dysphagia (Multiple Sclerosis, Motor Neuron Disease)
Cerebrovascular Accident (CVA)
Mechanical obstruction to swallow
Increased nutrient needs e.g. burns, trauma, Human
Immunodeficiency Virus (HIV)
Head and neck surgery
Chemo/radio-therapy
Dementia (if deemed appropriate)
Contraindicated for chronic liver disease patients with ascites
When should a PEJ be used?
For bypassing stomach and duodenum
Unconscious patients in supine position
Gastrostomy feeding intolerance
Severe GORD
Intestinal Failure
Gastric output/outlet obstruction
Strictures
Inflammatory diseases
What are the problems with certain drugs and EN?
Phenytoin:
Enteral feed formulas can significantly reduce absorption.
So you need to Give 2 hours before and 2 hours after EN
Levodopa:
Food, enteral nutrition and protein reduce the absorption of levodopa.
Given on an empty stomach 30mins before and after food/EN
What are the different EN delivery techniques and when should they be used?
Gravity feed
Ideal for bolus feeds
Syringe delivery
Ideal for small to moderate volume boluses
Pump delivery
Ideal for continuous & intermittent feeds
What are the different type of feed regiments?
Continuous
Feeds administered continuously at a specified rate for 24/24
Intermittent
Feeds administered at a specified hourly rate over a predetermined period of time - Considerations include: therapy, medications, operating theatre
Bolus
Feeds delivered in aliquots at specific intervals. Larger volumes in a shorter time frame.
When and how much should water flushes be used?
Flush with a minimal 30mL:
Every 4hours (q4/24)
Before/during/after medication administration
Before/after bolus feeds
Post feeds and before recommencing (i.e intermittent)
What should the bed position be during feeding?
Bed elevation >30° during & 30mins post feeds
What is a Possible PESS statement for a patient with EN Support?
Swallowing difficulty related to CVA as evidenced by dysphagia & high-risk aspiration.
