Enteral Nutrition Part 1 Flashcards by Sydney Perry

the provision of nutrients into the GIT through a tube

enteral nutrition

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Indications for EN

inadequate oral nutrition intake
malnutrition
hyper-metabolic states (burns)
gastroparesis; total gastrectomy (intestines still work)

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Relative Contraindications (cant have EN) (need PN)

Malfunctioning small bowel
Severe bowel inflammation
Hemodynamically unstable (hypovolemic shock)
Expected short-term duration
Terminal illness

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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)

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benefits of enteral nutrition

maintain small bowel function

provides luminal nutrients (glutamine)
- may provide fiber

avoid complications of PN

lower cost than PN

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how does enteral nutrition maintain small bowel function

digestive and absorptive capacity remains

mucosal barrier function and integrity
- prevention of bacterial translocation

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general characteristics of feeding tubes

material
lumen
eyelets (where food comes into body)
ports (entrance into feeding tube)

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what are different materials of feeding tubes

polyurethane or silicone

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most tubes have additional ports for _______ and ________

irrigation

medication administation

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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

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two types of tubes

nasoenteric (NG, ND, NJ)
enerostomy (PEG, GT, JT, G-J)

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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

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____ or lower is small bore

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Nasal insertion at bedside by ___, ____, or ____

placement must be confirmed with _____

there are also NG _____________ tubes

MD, RN, PA-C

xray

suction/drainage

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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

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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

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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

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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