Tubes
Single lumen connected to low intermittent suction 30-40 to avoid erosion.
Levin Tube
How can you prevent DUMPING SYNDROME when giving a feeding?
-Slow the formula instillation rate to provide time for carbohydrates and electrolytes to be diluted.
-Administer feedings at room temperature
-Administer feeding by continuous drip rather than by bolus, to prevent sudden distention of the intestine.
-patient to remain in semi-Fowler position for 1 hour after
-Instill the minimal amount of water needed to flush the tubing before and after a feeding
Tube Obstruction-how do you clear it?
do ASAP after obstruction warm water irrigation, milking the tube, infusing digestive enzymes, mechanical de-clogging devices. No cola or cranberry juice make it worse
are available as adjuncts to treat various conditions/Nepro
Disease-specific formula
What is continous?
is the delivery of feedings incrementally by a slow infusion over long periods.
radiopaque (easily visible on x-ray) is a double lumen gastric tube low cont. suction 25 blue vent kept above p/t waist to prevent reflux of gastric contents if below can act as a siphon
Salem Sump
What is a gastrostomy?
is a procedure in which an opening is created into the stomach either for the purpose of administering nutrition, fluids, and medications via a feeding tube to deliver enteral nutrition support longer than 4 weeks
from movement, coughing, suctioning, or air way intubation
Dislodgement/malposition
the most common; require normal digestive function.
Polymeric formulas
Intermediate Drip-what is it?
method requires administering feedings over 30 minutes or longer at designated intervals by a reservoir enteral bag and tubing, with the flow rate regulated by a roller clamp or automated pump.
inserted through nose past pyloric into the small intestine
Nasoenteric
What is the difference between open and closed systems?
When should you change the tube and flush
Open-contains a powder/liquid that has to be mixed with water
Closed-prepackaged that is hung,
should be changed every 24 hours and flushed every 4-8 if continuous and after every feeding/med admin if not continuous
dislodgement, or blue vent being below the waist. P/t must be semi-fowlers 30-45 degrees during admin of feeds or meds and maintain position 1 hr. after feeding.
Aspiration/Pneumonia
contain easier-to-absorb nutrients.
Chemically defined/ predigested formulas
What is Gravity?
raising /lowering syringe above the abdomen regulates the rate/flow. Amount/flow rate is determined by p/t reaction. p/t feels full, it may need to slow delivery time/give smaller volumes more frequently.
inserted through mouth into small intestines
Oroenteric
What is the difference between large bore and small bore?
Small bore- better tolerated; however, they require diligent monitoring and frequent flushing
Lrg bore- (> 12 Fr) uncomfortable, usefulness for tube feedings is limited; may be used for feedings for several days
Who is at the most risk for aspiration/pneumonia?
+70 yrs., unable to protect airway, altered mental status, receives ventilation, Supine position
contain only one major nutrient, to enhance commercially prepared products.
Modular products
Bolus-what is it?
divided into 3 to 4 feedings daily and can be given into the stomach through a large syringe with a plunger or by gravity. can be delivered as quickly as the patient can tolerate them but are initiated slowly, increase rate as tolerated
through nose to duodenum upper most part of small intestine
nose to the jejunum middle part of intestines below duodenum
Nasoduodenal tube
Nasojejunal tube
Administering medications through post-pyloric enteric tubes? Good idea or not? If so why, if not why? If you don't know, why?
Administering medications through post-pyloric enteric tubes may adversely affect their absorption; therefore, this should be avoided if possible. In addition, to avoid nutrient and drug interactions, medications should not be mixed with the feeding formulas.
What are s/s of aspiration/pneumonia?
fever, tachypnea, can’t clear airway, coughing during admin of food or meds, lab values
What is osmolarity for tube feedings?
normal body fluids are 300 mOsm/kg. keep the osmolality of the contents of the stomach and intestines at this level. Osmolality is important for tube feedings through the duodenum/jejunum high osmolality may lead to water moving rapidly into the intestinal lumen
What is cyclic?
alternative to the continuous infusion, the infused feeding is given by pump over 8 to 18 hours. Feedings may be infused at night. For patients who are being weaned from tube feedings to an oral diet, those who cannot eat enough and need supplements, and patients at home who need daytime hours free from the pump.