Enteral Nutrition Part 1 Flashcards
the provision of nutrients into the GIT through a tube
enteral nutrition
Indications for EN
inadequate oral nutrition intake
malnutrition
hyper-metabolic states (burns)
gastroparesis; total gastrectomy (intestines still work)
Relative Contraindications (cant have EN) (need PN)
Malfunctioning small bowel
Severe bowel inflammation
Hemodynamically unstable (hypovolemic shock)
Expected short-term duration
Terminal illness
reasons someone would have small bowel malfunction
Small bowel obstruction
Small bowel ileus
Severe GI hemorrhage
Intractable vomiting or diarrhea
Severe malabsorption
Severe short bowel syndrome
High output small bowel fistula (>500 mL/day)
benefits of enteral nutrition
maintain small bowel function
provides luminal nutrients (glutamine)
- may provide fiber
avoid complications of PN
lower cost than PN
how does enteral nutrition maintain small bowel function
digestive and absorptive capacity remains
mucosal barrier function and integrity
- prevention of bacterial translocation
general characteristics of feeding tubes
material
lumen
eyelets (where food comes into body)
ports (entrance into feeding tube)
what are different materials of feeding tubes
polyurethane or silicone
most tubes have additional ports for _______ and ________
irrigation
medication administation
Outer diameter of the tube lumen is designated by _________
Nasoenteric=>For patient comfort, the _______ tube diameter possible should be used
Do not use fiber-containing formulas with tubes ______
French units
smallest
<8 Fr
two types of tubes
nasoenteric (NG, ND, NJ)
enerostomy (PEG, GT, JT, G-J)
Nasogastric (NG) should be used for ____ term use of ________
NG tube feeding requires a functioning ______
____Fr
______ inches in length
short
<4 weeks
stomach
8-12
40-43
____ or lower is small bore
12
Nasal insertion at bedside by ___, ____, or ____
placement must be confirmed with _____
there are also NG _____________ tubes
MD, RN, PA-C
xray
suction/drainage
Advantages of NG tubes
normal digestive and bactericidal processes in stomach
any type of administration method can be used
placement does not require surgery or medical procedure
more cost effective than other tubes
Disadvantages or possible complications of GN tube feeding
Increased risk of misplacement on insertion
Easily displaced
Sinusitis & nasal erosion
Increased risk of clogging
Increased risk of GERD leading to aspiration
Cosmetically unappealing
Nasoduodenal Placement
_____ term use of _______
uses include for _______, _______
need to confirm placement with _______
risk?
no ____ or _____ feeding
short term <4 weeks
delayed gastric emptying or gastroparesis
xray
tip often coils or pulls up in the stomach
bolus or intermittent feeding
Nasojejunal tubes (NJ)
used for_____ term of ______
_____Fr
_____ inches
short term of <4 weeks
8-10 Fr
55-60 in
How are Nasojejunal Tubes placed
fluoroscopically or endoscopically to confirm tip is past the Ligament of Treitz
Blind bedside placement but this is challenging
- computer guidance systems
- confirm with xray
NJ Tubes – Indications for Use
Delayed gastric emptying
Persistent nausea
Severe, acute pancreatitis
High aspiration risk
NJ Tubes - Advantages
May reduce risk of aspiration
Can still feed into the small bowel while providing gastric suction
NJ Tubes - Disadvantages
Difficult placement
Tube displacement
Sinusitis; nasal necrosis
Cosmetically unappealing
Prone to clogging due to small bore size
Potential GI intolerance from NJ tubes because?
Jejunum is sensitive to high volume or hyperosmolar feeding
No bolus or intermittent feeding
Enterostomy tubes are tubes that are _____ or ______ placed through the _______
surgically
endoscopically
abdominal wall
indications of use for enterostomy tubes
long term >4 weeks
chronic severe dysphagia
oral, esophageal, or gastric cancer
neurologic disease
dementia
chronic poor intake for other reasons
Percutaneous Endoscopic Gastrostomy (PEG)
Used for _______ feeding
_______ placement
requires __________
____ Fr
long term
endoscopic
functioning stomach
15-28 Fr
Contraindication for PEG tubes
GI obstruction proximal to the stomach
obesity
ascites
gastric varices
Advantages of PEG Tubes
No surgery required
More physiologic for digestion & absorption
More comfortable & aesthetic
Can use any administration method
Decreased risk of clogging secondary to larger bore size
May decrease risk of aspiration (compared to NG tube)
Disadvantages/Possible Complications of PEG Tubes
If dislodges, must be replaced within few hours or tract will close
Site infection
Potential for skin breakdown from leakage of gastric contents
Migration of internal bumper through the gastric wall
PEG Migration of internal bumper through the gastric wall can cause __________ which can result in _______
Possible leakage of gastric contents internally=>causing peritonitis
Gastrostomy Tube (GT) is _______
Used for ______ feeding
________ placed
Need a __________
For patients requiring EN who are either ______________ or __________
_____ Fr
Same as PEG but placed surgically
long-term
Surgically
well-functioning stomach
undergoing a surgical procedure
cannot undergo endoscopic placement
15-28 Fr
Advantages - GT
More physiologic for digestion & absorption
More comfortable & aesthetic
Can use any administration method
Decreased risk of clogging secondary to larger bore size
May reduce risk of aspiration (compared to NG tube)
Disadvantages/Possible Complications - GT
Requires surgery & general anesthesia
Potential for skin breakdown from leakage of gastric contents
Site infection
Dislodgement of the tube; peritonitis
Migration of internal bumper through the gastric wall
Jejunostomy Tube (JT)
_________ placed
_______ use
______ Fr
Use ______________ or ________ only
Surgically
Long-term
10-20
pump-controlled continuous infusion
cyclic feeding
Indications for a JT
Gastroparesis
total gastrectomy
chronic N/V
total esophagectomy
Advantage of JT
Decreases aspiration risk
Disadvantages - JT
Dislodgement; Difficult to replace
Occlusion
Wound infection; skin erosion
Potential GI intolerance to goal rates/volume
Bowel obstruction
Potential GI intolerance to goal rates/volume with JT because __________
No bolus or intermittent feeding
Needle Catheter Jejunostomy
bore tube is _____Fr
Disadvantages?
5-8 Fr
easily dislodged
clogs easily
fiber containing formulas not recommended
Gastrojejunostomy (G-J tube)
These are _______ tubes
__________ placement
______Fr
Used for ___________
multi-lumen (gastric suction and feeding into jejunum)
surgical or endoscopic
GT : 15-28
JT : 6-12
long term gastroparesis
Advantages of G-J Tube
Simultaneous gastric decompression and feeding into small bowel
Reduced aspiration risk
Disadvantages of a G-J Tube
Risk of bleeding and infection of the abdominal wall
Migration of internal bumper through the gastric wall
Dislodgment
Cannot use bolus or intermittent feeding
Factors Used to Determine the Optimal Enteral Access Route
Anticipated duration of enteral feeding
Condition/function of the stomach
Risk of aspiration
Planned surgical intervention
