Tube Feeding
Staff Inservice
Use: Nutrition staff members to deliver this inservice to nurses, nursing assistants, and kitchen staff. Have an example of a closed feeding system available for staff to look at. Serve a healthy snack.
Introduction: Sometimes patients are unable to get proper nutrition orally due to swallowing problems or an unwillingness or inability to eat. In these cases tube feeding might be needed. Tube feeding is a liquid food that is delivered to a patient, usually via a naso-gastric tube (through the nose, down the throat, and into the stomach) or gastrostomy tube (a tube surgically place in the stomach), bypassing the mouth. Before starting tube feeding the benefits and risks should be clearly reviewed with a patient and/or responsible party. In elderly and/or demented patients, tube feeding may not prevent malnutrition.
In most cases tube feeding patients are not allowed to eat orally. Sometimes a patient is transitioning to oral feeding and will have a physician’s order for a meal tray.
Quick reading to review the topic:
American Family Physician: Feeding Tubes in Patients with Severe Dementia. April 15,
2002. Available at www.aafp.org/afp/20020415/1605.html. Accessed May 2, 2006.
Objectives:
1.
Staff members will know the reasons a patient/family might decide to initiate tube feeding
2.
Staff members will know the different ways to administer tube feedings
3.
Staff members will know the complications of tube feeding.
Outline:
I. Reasons for tube feeding a. Weight loss related to dysphagia, willingness to eat (often due to cognitive issues) or hypermetabolic states requiring supplemental nutrition (burns, trauma, etc). b.
Medical problems that require bypassing part of the digestive tract (Esophageal obstruction, cancer, Inflammatory Bowel Disease. c.
Organ system failure (Renal, liver, or respiratory failure, comatose state).
II. Different ways to administer tube feeding
a. Closed system via pump, providing a continuous drip at a specific rate b . Gravity feeding (gravity drip over a period of 30-60 minutes) c. Bolus feedings (syringe or funnel feeding)
III. Complications of tube feeding a.
GI problems (nausea, diarrhea, vomiting, cramping, abdominal pain, constipation)
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b.
Metabolic complications (hyperglycemia, dehydration, hypernatremia, etc) c.
Mechanical problems (patient improperly placed for tube feeding, clogging of tube, pulling of tube by patient, malfunction of pump, etc)
IV. Appropriate interventions for plan of care a.
Registered Dietitian should assess all tube feeders for adequacy of feeding and flush. b.
Oral intake of food or fluids is not allowed unless the physician’s order
Activity: specifically indicates they are. c.
Review nutrition needs regularly, adjusting feeding as needed. d.
Monitor urine output and stool frequency. e.
Periodically evaluate ability to return to oral feeding .
Pretend you are an alert and oriented patient who cannot swallow and is placed on a feeding tube. Think about what it must feel like to not be able to eat or drink anything you want. As a group, discuss how a person must adapt to the tube feeding.
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1. True or false: Tube feeding can result in stomach problems.
2. Which of the following is not a way to deliver tube feeding a.
Naso-gastric tube b.
G-tube c.
Oral tube d.
PEG tube
3. True or false: Every person who cannot or will not eat is a candidate for
tube feeding.
4. Which of the following is not a potential complication of tube feeding? a.
Constipation b.
Vomiting c.
Diarrhea d.
They are all potential complications of tube feeding
5. True or false: Once a person is placed on a tube feeding they will never
be able to eat again.
Answer key:
1.
True
2.
c. Oral tube
3.
False
4.
d. They are all potential complications
5.
False
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