Enteral Feeding Complications And Problem Solving

ENTERAL FEEDING COMPLICATIONS AND PROBLEM SOLVING PROBLEM

MECHANICAL

CAUSE

Delayed gastric emptying, Gastroparesis, Gastroesophageal reflux Diminished gag reflex

PREVENTION AND TREATMENT

Initially and regularly check tube replacement Aspiration pneumonia Regularly check gastric residuals, tube placements, and abdominal girth Pharyngeal irritation otitis Prolonged intubation with large-bore Use small-bore feeding tubes nasogastric tubes whenever possible. Consider gastronomy or jejunostomy sites for long-term feeding Nasolabial, esophageal, and mucosal Prolonged intubation with large-bore Use small-caliber feeding tubes irritation and erosion nasogstric tubes made of biocompatible materials. Use of rubber or plastic Tape feeding tube properly to avoid placing pressure on the nostril Consider gastronomy or jejunostomy sites for long-term feeding. Irritation and leakage at ostomy site Drainage of digestive juices from Attend to skin and coma care stoma site Use gastronomy tubes with retention devices to maintain proper tube placement. Tube Lumen obstruction Thickened formula residue Irrigate feeding tube frequently with Formation of insoluble formulaclear water or use an enteral pump medication complexes that provides a water flush. Avoid instilling medications into feeding tubes, when possible

GASTROINTESTINAL

ENTERAL FEEDING COMPLICATIONS & PROB. SOLVING

PROBLEM

CAUSE

PREVENTION AND TREATMENT

Diarrhea

Low-residue formulas Rapid formula administration Hyperosmolar formula Bolus feeding using syringe force Hypoalbuminemia Nutrient malabsorption Microbial contamination Disuse atrophy of the GI tract transit time Prolonged antibiotic treatment or other drug therapy

Rule out non-formula-related causes Select fiber-supplemental formula Initiate feedings at low rate Temporarily decrease rate Reduce rate of administration Select isotonic formula or dilute formula concentration and gradually increase strength. Reduce rate of absorption Select alternate method of administration Use hydrolyze, peptide-based formula or parenteral malnutrition until absorptive capacity of small intestine is restored Select a hydrolyzed, peptide-based formula that restricts offending nutrients Avoid prolonged hang times. Use sanitary handling and administration techniques Use enteral nutrition support whenever possible. Select fiber-supplemented formula

Cramping, Gas Abdominal distention

Nutrient malabsorption Rapid, intermittent administration of refrigerated formula Intermittent feeding using syringe force

Cramping, Gas Abdominal distention (continuation) Nausea and vomiting

Rapid formula administration Gastric retention

Constipation

Inadequate fluid intake Insufficient bulk inactivity

Review medication profile and eliminate causative agent if possible Select a hydrolyzed formula or one that restricts offending nutrients Administer formula by continuous method Administer formula at room temp. Advance administration rate according to patient tolerance Reduce rate of administration Select alternate method of administration Initiate feedings at low rate and gradually advance to desired rate Temporarily decreased rate Select isotonic or dilute formula Reduce rate of administration Select low-fat formula Consider need for postpyloric feeding. Supplement fluid intake Select fiber-supplemented formula Encourage ambulation, if possible

Metabolic PROBLEM

Dehydration

Over hydration

Hyperglycemia

Hypernatremia Hyponatremia

ENTERAL FEEDING COMPLICATIONS & PROB. SOLVING CAUSE

PREVENTION AND TREATMENT

Elevated fluid needs or losses of GI fluid and electrolytes

Supplement intake with appropriate fluid. Monitor and intervene to maintain hydration status Rapid refeeding Use a calorically dense formula. Excessive fluid intake Reduce rate of administration, esp. in patients with severe malnutrition or major organ failure. Inadequate insulin production for the Select low-carbohydrate formula amount of formula being given Initiate feedings at low rate Metabolic Stress Monitor blood glucose Diabetes Mellitus Use insulin if necessary Inadequate fluid intake or excessive loses Fluid overload Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Excessive GI fluid losses from diarrhea, vomiting Chronic feeding with relatively lowsodium enteral formulas as the sole source of dietary sodium

Assess fluid and electrolyte status Increase water intake Assess fluid and electrolyte status Restrict fluids, if necessary Use diuretics, if necessary Use a re-hydration solution such as equaLYTE Enteral Rehdration Solution to replace water and electrolytes Supplement sodium intake, if necessary

Hypophosphatemia Hypercapnia Hypokalemia Hyperkalemia

Aggressive re-feeding of malnourished patients Insulin therapy Excessive carbohydrate loads given patients with respiratory dysfunction and CO2 retention Aggressive re-feeding of malnourished patient Excessive potassium intake Decreased excretion

Monitor serum levels Replenish phosphorus levels before re-feeding Select low-carbohydrate, high-fat formula Monitor serum levels Provide adequate potassium Reduce potassium intake Monitor serum levels