Enteral Nutrition Support (part 1) Flashcards
_____ ____ is the provision of nutrients into the GIT through a tube
Enteral nutrition
Indications for enteral nutrition:
-Poor appetite
-Dysphagia
-Oral or esophageal trauma or cancer
-Altered mental status; comatose state
-Mechanical intubation
-Malnutrition
-Hypermetabolic states (ex: severe burns, CF)
-Gastroparesis; total gastrecotmy
Relative contraindications for enteral nutrition (indications for parenteral):
-Malfunctioning small bowel
-Severe bowel inflammation
-Hemodynamically unstable
-Expected short-term duration
-Terminal illness
What causes a malfunctioning small bowel:
-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 (compared to parenteral nutrition):
-Maintains small bowel function (digestive and absorptive capacity, mucosal barrier function and integrity-> prevention of bacterial translocation)
-More effective metabolism and utilization of nutrients (1st pass metabolism)
-Provides luminal nutrients: glutamine, may provide fiber
-Avoid the complications of parenteral nutrition
-Lower cost that parenteral nutrition
What are the general characteristics of feeding tubes?
-Material: polyurethane or silicone
-Lumen
-Eyelets
-Ports (may contain additional ports for irrigation and medication administration)
The outer diameter of the tube lumen is designated by ____ units (1 Fr = 0.33 mm)
French
For _____ feeding, the smallest tube diameter possible should be used for patient comfort
Nasoenteric
We should not use fiber-containing formulas with tubes that are less than ____ French
8
A nasogastric tube should only be used for short term, less than ___-___ weeks
4-6
Nasogastric tubes require proper ____ functioning
Stomach
Nasogastric tubes are around ____-____ inches in length
40-43
Nasogastric tubes are typically ____-____ French
8-12
Nasogastric tubes are inserted at the bedside by _____ or _____
MD, RN
You must confirm the placement of an NG with an ____
X-ray
There are also NG ____/____ tubes
Suction/drainage
NG tubes take advantage of normal _____ and _____ processes in the stomach
Digestive and bactericidal
One advantage of NG tubes is that any ____ methods can be used
Administration
Another advantage of NG tubes is that it is easily placed and does not require ____ or a medical procedure
Surgery
NG tubes are also more ____ effective than other tubes
Cost
What are disadvantages/possible complications of an NG tube?
-Increased risk of misplacement on insertion
-Easily displaced
-Sinusitis and nasal erosion
-Increased risk of clogging
-Increased risk of GERD leading to aspiration
-Cosmetically unappealing
A nasoduodenual tube is also used for short-term use, less than ____-___ weeks
4-6
Indications of a nasoduodenal tube:
-Delayed gastric emptying
-Gastroparesis
You need to confirm the tip location of a nasoduodenal tube with an ____
X-ray
A complication with a nasoduodenal tube is…
The tip often coils or pulls up into the stomach
You cannot use ___ or ____ feeding with a nasoduodenal tube
Bolus, intermittent
Nasojejunal tubes are also used for short-term, less than ___-___ weeks
4-6
Nasojejunal tubes are between ___-___ inches in length
55-60
Nasojejunal tubes have a small bore size of ___-___ French
8-10
Nasojejunal tubes are placed endoscopically or fluoroscopically to confirm the tip is past the ____ _____ _____
Ligament of Treitz
“____” bedside placement of a nasojejunal tube is challenging
Blind
Indications for the use of a nasojejunal tube:
-Delayed gastric emptying
-Persistent nausea
-Severe, acute pancreatitis
-High aspiration risk
Advantages of nasojejunal tube feeling:
-May reduce risk of aspiration
-Can still feed into the small bowel while providing gastric suction
Disadvantages of nasojejunal tube feeding:
-Difficult placement
-Tube displacement
-Sinusitis; nasal necrosis
-Cosmetically unappealing
-Prone to clogging due to small bore size
-Potential GI intolerance (the jejunum is sensitive to high volume or hyperosmolar feeding)
You cannot use ____ or ____ feeding with a nasojejunal tube
Bolus or intermittent
A tube _____ is when a tube is surgically or endoscopically placed into the GIT via the abdominal wall
Enterostomy
Indications for the use of tube enterostomy:
-Long-term enteral nutrition: >4-6 weeks
-Dementia
-Neurological disease
-Chronic severe dysphagia
-Oral, esophageal, or gastric cancer
A Percutaneous Endoscopic Gastrostomy (PEG) tube is used for ___-___ feeding and requires an endoscopic placement
Long term
A PEG tube requires someone to have a proper functioning ____
Stomach
Contraindications for a PEG tube:
-GI obstruction proximal to the stomach
-Obesity
-Ascites
-Gastric varices
A PEG tube is between ___-___ French
15-28
Advantages of a PEG tube:
-No surgery required
-More physiologic for digestion and absorption
-More comfortable and 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 with a PEG tube:
-If dislodged, must be replaced within a few hours or the tract will close
-Site infection
-Potential for skin breakdown from leakage of gastric contents
-Migration of internal bumper through the gastric wall
Migration of the internal bumper of a PEG tube through the gastric wall can cause possible leakage of gastric contents internally, causing _____
Peritonitis
A gastrostomy tube (GT) use used for ___-___ feeding and must be surgically placed
Long-term
In order for a G tube to be used, a patient needs to have a well-functioning ____
Stomach
A G tube is indicated for…
-Patients requiring enteral nutrition who are either undergoing a surgical procedure or cannot undergo endoscopic placement
G tubes are usually between ____-____ French
15-28
Advantages of G tubes:
-More physiologic for digestion and absorption
-More comfortable and 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 of G tubes:
-Requires surgery and 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
A Jejunostomy Tube (JT) is for long-term use and is ____ placed
Surgically
Indications of a J tube:
-Gastroparesis
-Total gastrectomy
-Chronic N/V
-Total esophagectomy
What administration methods of feeding can be used with a J Tube?
-Pump-controlled continuous infusion
-Cyclic feeding
J Tubes are between ___-___ French
10-20
Advantage of a J Tube:
-Decreases aspiration risk
Disadvantages of a J Tube:
-Dislodgement; difficult to replace
-Occlusion
-Wound infection; skin erosion
-Potential GI intolerance to goal rates/volumes (no bolus or intermittent feeding)
-Bowel obstruction
A ____ ____ Jejunostomy is a very small bore tube, around 5-8 French
Needle Catheter
Disadvantages of a needle catheter jejunostomy:
-Easily dislodged
-Clogs easily (fiber-containing formulas are not recommended)
A Gastrojeunostomy (GJ Tube) is a ____-____ tube
Multi-lumen
With a GJ Tube, one lumen is for ____ ___, while the second lumen feeds into the jejunum
Gastric suction
A GJ Tube can be used if someone has long-term ____ with severe nausea
Gastroparesis
GJ Tubes are placed with ____ or ____ placement
Surgical or endoscopic
With a GJ tube, the G tube is ___-___ French while the J Tube is ___-___ French
15-28; 6-12
Advantages of GJ Tubes:
-Simultaneous gastric decomposition/drainage and feeding into small bowel
-Reduced aspiration risk
Disadvantages of GJ tubes:
-Risk of bleeding and infection of the abdominal wall
-Migration of internal bumper through the gastric wall
-Dislodgement
-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
