Feeding Tubes Flashcards
Enteral feeding tubes:
- used to provide nutritional support to pt’s who cannot eat by mouth
- possess sufficient functioning GIT
- enteral access can be safely achieved
ex’s:
- stroke
- altered mental status
- organ dysfunction
- or even some specific GI disease critically ill pt
Enteral feeding tubes in contrast to parental feeding?
- maintains integrity of the GI tract by preventing changes due to atrophy
- less expensive & risky
- avoids bacterial translocation, systemic infection
- since bile flow is maintained, development of cholestasis is avoided
Short-term:
4-6 weeks
- orogastric
- nasogastric
- orojejunal
- nasojejunal
- occasionally in the duodenum
Long-term:
- gastrostomy
– PEG
– PRG
– G-tube - jejunostomy
When are tubes into the stomach appropriate?
only when there is a NORMAL functioning GI tract form the lower esophagus down
______ usually more convenient & able to tolerate hypertonic formulas
STOMACH
______ feedings may cause abdominal cramping & diarrhea
JEJUNAL
When is the Upper duodenum or jejunum appropriate?
- when there is gastric emptying problems, a non-functional upper GI tract & in pt’s at sign. risk of aspiration
– i.e. when there’s a problem w/ the stomach - for pt’s w/ pancreatitis, gastroparesis (delayed gastric emptying) or severe reflux disease
For SHORT-term nutritional support…
ORAL or NASAL placement is used
For LONG-term tx or when nasal or oral placement is not possible…
use PERCUTANEOUS placement such as gastronomy, jejunostomy
______ bore tubes more comfort but _____ risk of clogging
SMALL
GREATER
What are the enteral formulations?
- COMMERCIAL products contain vitamin & mineral supplementation & are sterile
- HOME-prepared feedings NOT STERILE & may not be nutritionally complete
- use of ELEMENTAL (pre-digested) formulations should be reserved for pt’s w/ severe nutrient absorption dysfunction
Admin may be intermittent or continuous
Ideally:
- medication should NOT be mixed w/ formula
- feeding should be interrupted for medication admin. & the tube should be flushed before & after medication admin.
Care should be taken w/ drugs having a ______ therapeutic window when the feeding tube is placed in the ________
NARROW
JEJUNUM
_______ access preferred over _______
GASTRIC > JEJUNAL
- tubes usually LARGER & less prone to clogging
- stomach is more TOLERANT of HYPERTONIC medications
- gastric feedings usually INTERMITTENT so feeding & medication may be given at separate times
- drug ABSORPTION is MORE PREDICTABLE w/ gastric placement
______ are preferred for enteral admin b/c…
LIQUIDS
they’re readily absorbed & are less likely to cause tube occlusions
BUT may be a challenge b/c they are usually meant for children
Large amounts of sorbitol in liquid preps:
- NOT well tolerated when delivered into the SI (duodenum, jejunum)
- stomach able to dilute hypertonic solutions before transferring into the duodenum
- BUT if given too rapidly it may be “dumped” into the small bowel resulting in osmotic diarrhea
Hypertonic medications should NOT be administered directly…
into the SMALL INTESTINE UNLESS they are diluted w/ water
- protective acid barrier of stomach by-passed so sterile water used for dilution to reduce risk of infective diarrhea
- admin of hypertonic medication into the small intestine may result in bloating, nausea, cramping & diarrhea
Must ensure that the ______ & ______ do NOT come into contact
feeding formula & syrup
as the tube may become clogged or even blocked
________ tablets including those that are sugar or film-coating may be crushed
immediate-release
Special care should be taken w/ _____________ capsules that contain beads or pellets
enteric, extended or controlled-release
Enteric-coating products should NOT be crushed:
- AE’s may occur or the drug’s effectiveness may be reduced
- crushing extended or CR tablets destroys delivery mechanism & may result in potentially toxic peaks & low troughs (may lead to erratic absorption)
- sublingual preps not designed for GI absorption & enteral admin may result in reduced drug absorption & lack of efficacy
Some injectable formulations may be used…
orally
Drug-nutrient interactions:
ex: Phenytoin showed a 70% decrease in bioavail when admin w/ enteral feeding
- possibly due to binding of phenytoin w/ components in the feeding & not be absorbed
- therefore, hold EN for 1 hour before & 2 hours after medication dosing (instead of 30 mins)
________ problematic as highly unstable in an acidic environment & inactivated by gastric acid
PPI’s
Bedsite modification problems:
taste, acid stability & over-dosing when CR products are used
