Jejunostomy Feeding

Benefits
• Maintains gastrointestinal structure and
function
• Reduces translocation of toxins and possibly
bacteria
• Less expensive than parenteral nutrition
therapy
• Fewer complication than parenteral
 Indications
• Feeding contraindicated for upper GI tract
• Gastric motility disorders
• History / risk of reflux or aspiration
 Contraindications
Absolute
• Complete bowel obstruction
• Severe small bowel ileus with abdominal
distention
• Complete inability to absorb nutrients through
the GI tract
 Contraindications
Relative
• Severe postprandial pain
• Short bowel syndrome
• Intractable vomiting
• Severe diarrhea
 Complications
• Mechanical
• Gastrointestinal
• Metabolic
 How to prevent mechanical
complications?
• Properly secured jejunostomy tube
• Head of bed elevated 30  – 45 
• Pump ensures safe delivery
• Monitoring gastric residuals
• Maintain tube patency
 Maintain tube patency
• Flush regularly, every 3-4 hours with 25 ml
warm water
• Use feeding tube only for formula delivery
• Flush the tube with water before and after
administering medications
 How to prevent gastrointestinal
complications?
• Not attributed to enteral feeding
– Medical condition
– Pre existing GI condition which reduces the
bowels functional capacity
– Medications
– Atrophy from lack of use
 How to prevent gastrointestinal
complications?
• Related to enteral feeding :
– Formula composition
– Administration method (rate and volume)
• Full strength formula slowly, gravity or infusion pump
• Continous feeding
– 25 ml/hour ; 24 hours/dayor during part of the day or night
– Formula contamination
 Administration
• Infusion Pump Indications
– Small intestine feeding
– Fluid restrictions
– Risk of aspiration
– Need for precise flow rate
– Nocturnal feeding
– Infants and small children

• Gravity Infusion Indications

– Suitable for intermittent feeding
– Ambulatory patients
– Gastric feeding
 Prevention of Tube Feeding
Contamination
• Recommended formula hang time :
– 8-12 hours for open systems
– 24 hours for pre-filled containers
 Summary
• Enteral nutrition should always be the first
option considered
• Use post-pyloric route if gastric access not
possible
• Nasogastric route should be used for short
term feedings
• Surgical or percutaneous enterostomies
should be the choice for long term cases and
for laparotomy patients