Nutrition - Enteral: Nursing skills

There are many reasons why a client might encounter problems with eating or drinking. It could be due to difficulties with chewing, swallowing, or digestion as a result of trauma, surgery, or various medical conditions. Several alternative methods of providing them the nutrients and fluids they need are available. As the nurse, you will be responsible for administering these alternative delivery methods including enteral feedings, as well as assessing and caring for clients receiving enteral feedings. Some clients might receive enteral nutrition, otherwise known as “tube feeding.” This means nutrition is delivered through a tube directly into the gastrointestinal, or GI, tract. And this might be especially helpful for those who can’t properly chew or swallow as a result of head or neck trauma; surgery; coma; dementia; nervous system disorders; or tumors of the head, neck, or esophagus that block the passage of food.

Now, there are various ways the feeding tube can go into the GI tract. The most common one is a nasogastric tube connected to a feeding bag or delivered through a pump; it goes through the nose and down into the stomach. A nasointestinal tube also goes through the nose but ends in the small intestines. These tubes can irritate the client’s throat and nose, and the clients will often dislodge the tubes. As the nurse, you may be responsible for inserting a nasogastric tube. Be sure to consult your organization’s protocols and policies to determine when and how this skill is done at your facility. Next, tubes can be inserted through a surgical opening, or stoma, in the abdominal wall and into the stomach, known as a gastrostomy tube, or G-tube. Tubes can also be inserted into a part of the small intestine called the jejunum, which is known as a jejunostomy tube, or J-tube. A common type of gastrostomy tube is the percutaneous endoscopic gastrostomy tube, or PEG tube for short.

Here, an endoscope, or a tube with a light, camera, and guidewire, is inserted through the mouth and into the stomach. The endoscope lets the doctor see where the surgical incision should be made. Next, a guidewire is inserted through the incision and pulled up and out through the mouth along with the endoscope. The PEG tube is then attached to the guidewire and sent through the mouth until it can be pulled out through the stoma opening in the abdominal wall, creating a path directly into the stomach from the outside. Nasogastric and nasointestinal tubes are mostly preferred when enteral feeding is needed for a short period of time, typically a few days to 6 weeks; whereas gastrostomy, jejunostomy, and PEG tubes are usually used for more than 6 weeks or when a nasogastric or nasointestinal tube cannot be used.

Before a client can start enteral feedings be sure to confirm the tube is in the proper location in the gastrointestinal tract and not in the respiratory tract. The best way to do this is with an X-ray. Once the client has an enteral feeding tube placed, they can begin receiving feedings. Enteral formula that meets the client’s nutritional needs is delivered through the tube. There are different types of formula that can be ordered, and sometimes water might be added to dilute the formula. Usually the client will begin receiving the feeding slowly to make sure they don’t have any signs of intolerance like nausea, abdominal pain, or diarrhea. If the rate and amount of feeding is tolerated, the provider will increase the feedings. Be sure to review the orders to determine the type, amount, and rate of feedings. Now, enteral tube feedings can either be administered using an enteral tube feeding infusion pump, or using an enteral feeding syringe. When using a tube feeding infusion pump, there are two general types of administration schedules: continuous and intermittent . A continuous feeding is when a client has feedings running through their feeding tube throughout the day.

If, instead, they get scheduled feeds over the course of the day, this is called intermittent feeding. One other type of tube feeding that does not use a feeding infusion pump is called a bolus feeding. This is when feedings are given in a large quantity at one time, usually using a large enteral feeding syringe instead of running through a pump. Before starting a feeding, first review the order, collect your supplies and make sure you have the correct formula. Inform the client about the procedure before beginning and answer any questions related to the procedure. Perform hand hygiene, apply gloves, and check two client identifiers. Next, tube placement must be confirmed before starting a feeding. At least two measures should be taken to make sure the tube is in the correct place. This might include visual inspection of the color and appearance of gastric aspirate which should be consistent with that seen during initial tube placement.