Enteral Nutrition
What is enteral nutrion
o Any form of administration that involves any part of the GI tract
o Nutrients given in the GI tract
o Preserves GI integrity
Enteral routes
o Orally
o Rectally
o Gastric – duodenal – jejunum
TPN (aka HAL) – total parental nutrition
o Has to be in a central line
o Nonfunctional GI Tract
o Extended Bowel Rest
o Severe diarrhea
o Pancreatitis
o Inflammatory bowel disease
 Chromes, diverticulitis
o Preoperative TPN
o GI tract nonusable for greater than 4-5 days
o Severe malnutrition – not under pre-op TPN
Conditions requiring enteral feeding
• Gastrointestinal problems – short bowel syndrome, fisula formation,
infalmmatory bowel disease (chron’s disease, diverticulitis)
• Cancer therapy – radiation and chemo (require enteral feeding cause cant keep
food down)
• Convalescent care – period needed for returning to health after illness
• Hypermetabolic conditions – burns, trauma, AIDS, alcoholism, anorexia nervosa
• Debilitation – in a state of not being able to do anything – coma, paralysis, stroke,
respiratory distress, head injury
• Surgical interventions – surgery – facial surgery, broken jaw
Enteral Tubes
• Deliver fluid to stomach
– Salem sump – type of NG tube
– Gastrostomy (G-tube) – directly into the stomach, surgically placed, cut
into the stomach (from the outside  in) and place the tube, long term
• Deliver fluid to intestine (duodenum or jejunum)
– Dobbhoff – nasoenteric tube into the duodenum – through the nose into
the duodenum
– J-tube and dobbhoff safer cause there is no chance for aspiration**
Care of the gastrostomy tube site
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PEG tubes – remove dressing 24 hrs after insertion unless otherwise ordered, by
endoscopic, does not go under anesthesia, put through the mouth
Other type of gastrostomy tubes – by surgery, sterile dressing change for 14 days,
cover with sterile gauze x14 days or if draining it could be longer, ½ normal
saline, ½ hydrogen peroxide, dry then dressing
Findings to report to physician – redness, swelling, color and amount of drainage
Types of enteral feedings
• Intermittent
– Usually gastric administration
– Large amounts of solution 4-8 times/day
– Typically administered over 30 minutes
– Can be by pump or gravity
• Bolus
– Continuous feedings at faster rate over shorter time
– By syringe or gravity
– Example: ensure
• Continuous
– Usually intestinal administration
– Continuous rate via pump
• Cyclic
– Over longer period of time
– Usually on pump
– Typically over several hours
– Example: feeding infused over night- so pt has one going on during the
day – remember: sit them up at the start
Management of enteral tubes
• Patient position – HOB up at least 30 degrees (#1)
• Check for gastric residual – (#3) every 4 hours, withdraw all of it and return up to
150 mL in the stomach (return gastric enzymes and so there is not an electrolyte
imbalance)
– Rule: hold meds if more than 100 mL is withdrawn in the stomach or more
than 2x the rate of the feeding – hold for 2 hrs and then recheck, if less
than 100 mL give med and resume feeding, if still 100 or more mL then
hold meds and food still and call the dr.
• Verify placement – if its not continuous – on everything else (#2) – aspirate to
visual contents and ascultate ove LUQ 10-20 mL of air (do not verify if
continuous, jejunum, duodenum)
• Maintaining tube patency – check for gastric residula every 4 hours
– flush tube with 20-50 mL with warm tap water
• If clogs then use “clog zapper” (carbonated liquid and wire)
– 7-up
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Maintaining equipment – have reserve battery just in case
Enteral solutions
• Choice depends on
– Size & location of tube – small tubes need thinner solution/ formula
– Caloric needs of patient – dietician and dr. collaborate to make sure the pts
needs are met – (post-op – a pt needs 1500 calories per day)
– Type of nutritional supplement – whatever the pt needs, extra fat, extra
protein, extra carbs
– Method of delivery – on and off (bolus, intermittent, cyclic) or continuous
– Patient convenience – minimal prep in home care, most enteral feedings
do not have to stay in the refrigerator – they can sit out at room temp
Nutritional products
• Commercial formulas (good for 24 hrs)
– Fixed – components are predetermined and mixed
– Modular – specific components can be mixed to pt specific needs
– Disease specific – specific to the disease
• Supplements – ensure, boost
• Blenderized – normal foods that are liquefied
Complications of enteral therapy
• Gastrointestinal –
– diarrhea (most common – caused by hyperosmolar formulas – can also be
caused by cold formulas, different meds, a change in the feeding rate)
– gas or cramps – caused by air in the tube
– dumping syndrome- goes right through you – too rapid, cold formulas, too
much fluid when flushing the tube
– constipation – can be caused by lack of fiber, high milk content,
inadequate fluid intake
• Mechanical – tube obstruction – inadequate flushing or rate of formula or residue
from med administration, unsecured tube will lead to improper placement – tube
migration – can cause aspiration pneumonia (symptoms: coughing, vomiting)
• Metabolic – hyperglycemia – if you get glucose intolerance from feeding formula
and cause this, abnormal electrolytes, hydration problems – dehydration or fluid
overload
Minimizing complications
• GI
– Room temp formulas – if too hot or cold can stimulates peristalsis causing
diarrhea or dumping syndrome
– Monitor gastric residual (every 4 hrs)
– Appropriate fiber & water content – constipation prevented by having
adequate fiber and water
• Mechanical
– Check tube placement – to prevent aspiration
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– HOB elevated 30 degrees – unless contraindicated
– Appropriate medication formulation – get the liquid meds when possible
and dilute them, if thick crush meds and mix with warm water
Metabolic
– Check blood glucose levels – check blood levels to determine
hyperglycemia
– I&O - could be experiencing dehydration (tenting, sticky mouth, tired) or
fluid overload
– Report and regulate feeding rates/formulation – work with dietician and dr
to determine feeding rates and needs