A feeding tube, or medically referred to as an enteral feeding, is used when a person is unable to consume adequate nutrition by mouth. A feeding tube may be needed when a person has difficulty swallowing due to a stroke or weakened esophageal muscles, is receiving radiation in the neck region or is unable to digest nutrition due to a gastrointestinal disorder. The appropriate enteral feeding formula and rate are calculated by a qualified medical professional, such as a registered dietitian or physician, and is necessary to provide nutritional needs. When a person is unable to receive adequate calories, protein, fat and fluid by way of tube feeding, there are factors which must be identified and resolved.
Gastrointestinal Distress
Gastric residuals, diarrhea, constipation, abdominal distention, pain, absent bowel sounds and vomiting are signs of gastrointestinal distress that may signal enteral feeding intolerance. Medications designed to increase gut motility, antidiarrheals, prokinetics and antiemetics may be used to reduce side effects until feeding tolerance is established. Verifying tube placement, lowering formula administration rate, establishing blood glucose control, maintaining the head of bed at a 30 to 45 degree angle if medically feasible and minimizing the use of sedation are also ways to reduce gastrointestinal distress. If gastrointestinal problems continue, the enteral feeding should be stopped and function of the intestinal tract should be evaluated.
Clogged Tubing
Enteral feeding tubes are prone to clogging when calorically-dense formulas, high-fiber formulas, small tubes, gastric tubes, inadequate water flushes or slow administration rates are used. Blockage may occur when medications are crushed and fed through the tube. Appropriate water flushes, using larger feeding tubes and intestinal tubes and administering dislodging solutions may maintain tube patency. If unable to clear the feeding tube, it should be replaced with new tubing.
Infection
Infections may arise when the enteral feeding becomes contaminated with microorganisms. To reduce the risk of contamination, closed feeding systems are recommended by American Society for Parenteral and Enteral Nutrition. A closed system contains a pre-filled, sterile enteral formula, which is ready to be administered. By comparison, an open system requires a non-sterile powder to be mixed with water or a can to be opened and then poured into another container prior to dispensing. Adhering to administration times also decrease the microbial contamination of the enteral feeding. A closed system formula may be used from 24 to 48 hours once open, whereas an open system formula varies from 4 to 12 hours. Lastly, sterilizing equipment, proper hand washing, wearing disposable gloves, using sterile water for feeding flushes and maintaining a clean environment reduce the risk of enteral formula contamination and infection.
