Enteral Nutrition

Ella YU

Enteral Nutrition
An alternative feeding method  Enteral nutrition (EN)  Total enteral nutrition (TEN)  Nasogastric tube  Nasoenteric tube  Gastrostomy  Jejunostomy

Nasogastric tube

Nasogastric tube

Nasogastric tube

One of the nostrils→ nasopharynx tract→ alimentary tract How about through the mouth and pharynx?

Nasogastric tube

Traditional large-bore nasogastric tube  Larger than 12 Fr in diameter, firm  E.g. Levin tube, single lumen  E.g. Salem sump tube, double lumen  Will cause pharyngitis, tracheal-oesophageal erosion  Advantage: easy to aspirate the gastric content, ↓aspiration Small- bore tube  Smaller than 12 Fr in diameter, softer  More flexible,less irritating  Need to check the correct placement as migrate easily

Fr Unit (French unit)

unit for denoting the size of catheter or other tubular instruments, each unit being roughly equivalent to 0.3mm in diameter  18French (Fr) indicates a diameter of 6mm

What does it for? Levin tube

Salem sump tube

•It acts as a air vent •To prevent build up of suction pressure in the tube •To avoid damage to gastric mucosa Levin tube

Salem sump tube

Nasogastric tube

 

For clients who have intact gag and cough reflexes To provide nutrition To prevent nausea, vomiting and gastric distention following surgery To remove stomach contents for laboratory analysis To lavage (wash) the stomach in cases of poisoning or overdose of medications

Nasoenteric tube
   

A longer tube (at least 40 inches for an adult) Nostril to upper small intestine Requires special trained nurses or physicians for this procedure For client who are at risks for aspiration  Decreased level of consciouness  Poor cough or gag reflexes  Endotracheal intubation  Recent extubation  Inability to cooperate with the procedure  Restlessness or agitation

How to confirm the tube is in-situ?
      

Aspiration of visually recognizable gastrointestinal secretion Auscultation of air insufflated through the tube pH testing of aspirates Observing for coughing and choking Testing the ability to speak Observing for bubbling when the tip of the tube is held under water X-ray

Percutaneous endoscopic gastrostomy(PEG)

Percutaneous endoscopic gastrostomy (PEG) A technique for the endoscopic insertion of a gastrostomy feeding tube, for the purpose of providing enteral feeding

Percutaneous endoscopic gastrostomy(PEG

Percutaneous endoscopic jejunostomy (PEJ) •A technique for the endoscopic insertion of a feeding tube through a PEG Tubing and into jejunum, for the purpose of providing enteral feeding (Kozier)

Enteral feeding

Intermittent feeding
 300-

500ml *several times for day  Administer at least 30 minutes

Continuous feeding
 24

hours feeding with infusion pump

Cyclic feeding
 E.g

12-16 hours  Nocturnal feeding

Enteral feeding

Types of enteral formulas
 Majority  Also

are lactose-free→ why???

• E.g Isocal, Ensure, Resource

have lactose containing

• Carnation instant breakfast • Must be refrigerated once mixed- avoid bacteria contamination • Restricted in the lactose intolerance patient
 Disease-specific

• Hepatic failure (hepatic aid) • Renal failure (Amin Aid) • Glucose intolerance (Glucerna)

Observe the client with the enteral feeding with the complication of the diarrhoea
 Perianal

excoriation  Dehydration  Electrolytes imbalance  Muscle cramping  Cardiac dysrhythmias

In the laboratory, you will learn about the cares of
 the

insertion and removal of the nasogastric tube  The administration of the enteral feeding

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