An individualized care plan for the patient must be developed and all other options considered prior to use of a foley catheter. Prime the tubing sometimes done by the pump itself. Nursing management of nasogastric tube feeding in adult. Maintaining hydration and tube patency in enteral tube feedings. Table 1 lists common reasons for enteral feeding in adults in the uk. He is currently suffering from a severe concussion and lapses of consciousness, a broken jaw, multiple broken bones, and possible internal injuries. A wide range of children may require enteral feeding either for a short or long period of time for a variety of reasons including. Enteral feeding manual for adults in health care facilities.
Effective 2016, the joint commission tjc requires that all enteral feeding tubes be outfitted with a enfittype connector to prevent inadvertent connection of tubes with different functions e. Patients with recent abdominal surgeries require prior discussion with the surgeon before commencing enteral feeding. Feeding tube refers to a medical device used to provide enteral nutrition to a resident by. The different methods of enteral tube feeding are listed below. Long term tube feeding is an integral part of the management of many patients with chronic disease, for example. Enfit is an fdaapproved solution from safety organizations and manufacturers.
A gastrostomy tube or device is inserted into the stomach through the abdominal wall, so that liquid nutrition. The key points when administering medicines as per bapen guide 2003 state. To assess tolerance of enteral feeding and minimize the potential for aspiration. An antirelux valve is located inside and toward the top of the feeding port. These guidelines, designed for healthcare professionals, offer clinical advice in sections 27 for managing the pathway of care for this group of patients, e. R, a 35 yo drug user, is hospitalized after a motor vehicle accident mva. Pdf enteral nutrition en is the introduction of nutrients into the gastrointestinal tract through a tube placed in a natural or artificial stoma find, read and cite all the research you. Standard gastric residual volumes grv protocol responsibility. Nursing management of nasogastric tube feeding in adult patients. This guideline will provide guidance on the use of enteral feeding in the trust. Nursing care of the patient with an enteral feeding tube.
Enteral feeding can be used as a sole source of nutrition or to supplement a poor oral intake. Kangaroo epump enteral feeding pump section i general information the kangaroo epump enteral feeding pump is a simpletouse, precision enteral feeding pump. At the outset the aim was to produce guidelines for the management of home enteral tube feeding, however, it soon became evident that enteral feeding resides in two separate but interdependent settings primary and secondary care. Adult enteral feeding policy amendments date pages comments approved by. The kangaroo epump enteral feeding pump has been built and tested according to ul606011, e181931 csac22. Enteral nutrition en is the introduction of nutrients into the gastrointestinal tract through a tube placed in a natural or arti. Guideline for the care and management of enteral feeding. Enteral feeding formulae are about 7080% water and the remainder of the volume consists of. Follow your facility policy and procedure for unclogging eads.
Jan 11, 2017 enteral feedings deliver nourishment through a tube directly into the gi tract. Starting with enteral feeding, applicationspecific. Consideration needs to be made regarding patient prognosis and longterm nutritional care and a plan should be discussed and decided by the multidisciplinary team. Select nursing considerations to highlight important aspects of each procedure. Enteral nutrition instructions handi medical supply. Pdf clinical practice guidelines for the nursing management. Also called tube feeding, enteral nutrition is a mixture of all the needed nutrients.
For shortterm feeding 30 days, use a gastrostomy or jejunostomy feeding tube c. Delegation considerations when appropriate, are identified as a quickreference option. Adult gastrostomy and jejunostomy feeding tube management. The set should be changed every 24 hours or as per manufactures instructions. It is thicker and sometimes it looks like a milk shake. Guideline for the care and management of enteral feeding in.
Enteral nutrition support refers to the introduction of a nutritionally complete liquid formula directly into the stomach or small intestine via a narrow, often specifically designed, tube. Maintain elevation of patients head of bed as determined appropriate for the individual not only during feedings, but during all aspects of the patients daily routine. Best practices for managing tube feeding abbott nutrition. Always refer to the policies and procedures site for the. Kendall kangaroo epump operation and service manual pdf download. Guidelines for the administration of enteral and parenteral. Almost all 50, 98% participants indicated that enteral nutrition was part of their nursing training in college and that they had had a practical demonstration of the procedure. The american society for parenteral and enteral nutrition aspen recommends warm water as the best initial choice for trying to unclog a feeding tube.
Guideline for the care and management of enteral feeding in adults. The agency for clinical innovation and the gastroenterological nurses. This helps prevent stomach contents from leaking out of the tube. Some infants and children require nasogastric tube feeding because they are unable to. Enteral tube feeding can be used in a wide range of disease states. Standard gastric residual volumes grv protocol guidelines page 3 of 3 procedure point of emphasis 14.
Use feeding tubes made of polyurethane or silicone to reduce risk of allergies. Guidelines represent the written instructions about how to ensure high. Small bore feeding tubes are preferred for enteral feed administration. Lippincott procedures is your online source for instant, evidencebased procedure guidance at the point of care. Gastric ng tube or a percutaneous endoscopic gastrostomy peg. For longterm feeding 30 days, use a gastrostomy or jejunostomy feeding tube c. First, attach a 30 or 60ml piston syringe to the feeding tube and pull back the plunger to help dislodge the clog. This guideline will use this term describe orogastric, nasogastric and gastrostomy tube feeding. Jejunal tube feeding via a gj or surgically placed jejunostomy. The procedure before tube feeding can begin, the tube has to be placed. Printed copies may not reflect the most recent updates. They are not intended to be an exhaustive list of potential nursing considerations, rather they are intended to be specific keys to safely performing the procedure. The authors and planners of this cne activity have isc l oed nrv a tf hp w any commercial companies pertaining to this activity.
Clamp the tube prior to pouring it in the bag if giving pump feeding. Enteral feeding is a method of supplying nutrients directly into the gastrointestinal tract. This view is supported by the courts, by professional bodies and by. The oro gastric route is the preferred method for inserting intra gastric tubes. Always consult your policy and procedure manual at your facility before preforming any nursing procedures. Total parenteral nutrition and intradialytic parenteral nutrition page 2 of 7 initial approval duration for tpn is for 3 months. Nursing staff may need to titrate the ratevolume of an enteral feed.
Enteral feeding can be administered via nasogastric, nasoduodenal and nasojejunal means. The daa nutrition support interest group has developed this manual for dietitians and other health. The user of the pump should assure that it is used in such an environment. Guidelines for the administration of enteral and parenteral nutrition in paediatrics. He had not eaten anything for several days pta because he. The procedure for the feeding tube placement depends on the type of tube that has been recommended by the healthcare team. You can find more information about the types of feeding tubes here. Feeding procedure mix formula and pour total amount to be given into a graduateif using a pump use a feeding bag. Guideline for the care and management of enteral feeding in adults directorate nutrition and dietetics, professional services date approved. Nurses competency and challenges in enteral feeding in. Content introduction access methods administration. The feeding tube may stay in place as briefly as a few days or permanently, until the patients death. Liaison with medical and nursing staff regarding the patients enteral feeding. Audience all employees of utmb hospitals, clinics, outpatient surgical center, contract workers, volunteers, and students involved in enteral feedings.
Enteral nutrition manual for adults in health care facilities nutrition support interest group. Drape the towel over the patients abdomen next to the gastrostomy. Enteral feeding methods dr dharma rajiv gandhi cancer institute, delhi. Special considerations salem sump tubes are designed for gastric decompression and may be used for feeding and medication administration on a short term basis only. Discuss the nursing care of pa tients receiving enteral feeding. This applies to intra gastric tubes used for drainage of gastric secretions, gastric decompression and enteral feeding.
Aarp health insurance plans pdf download medicare replacement pdf download medicare benefits pdf download medicare part b pdf download enteral feeding tube adapter procedure code. What procedures should be updated with the enfit connector december 2014 introduction a new design standard for medical device tubing connectors is on its way. Adult gastrostomy and jejunostomy feeding tube management nursing and midwifery manual the latest version of this document is available on the cdhb intranetwebsite only. The kangaroo epump enteral feeding pump is intended for use in the electromagnetic environment speci. Caring for people with gastrostomy tubes and devices 1 introduction gastrostomy tubes and devices are an established means of providing long term enteral nutrition. The technique may cause bloating and diarrhoea and bolus delivery into the jejunum can cause a dumping type syndrome and. It is given through a tube in the stomach or small intestine. Xray will be ordered to confirm initial tube placement prior to use. Theyre ordered for patients with a functioning gi tract who cant ingest enough nutrition orally to meet their needs. Continued approval duration is 6 months, given that the member has no evidence of unacceptable complications from treatment, and documentation supports positive response to therapy. Enteral nutrition manual for adults in health care facilities.
The focus of this clinical practice guideline is on the nursing management of nasogastric tube feeding. For patients at risk for aspiration of gastric contents, consider using a smallbowel feeding tube d. Forwardhealth covers enteral nutrition products administered using a feeding tube when a member is diagnosed with one of the medical conditions listed below, meets all of the clinical criteria listed. Introduction dietary foods for special medical purposes independent of the route of application. Chart enteral feeding and tube flushes, bowel activity, and any signs of feeding intolerance, in the fluid chart, progress notes, andor nursing care plan. With over 1,700 procedures and skills from a wide variety of nursing specialties including allied health, it combines the most trusted clinical content with powerful online workflow functionality that will enable your clinical staff to save time, standardize care and deliver.
Walsh k, schub e, pravikoff d, cinahl nursing guide, march 25, 2016. Critical care program lhsc guideline for enteral feeds and. Nasogastric tube feeding may be accompanied by complications. Enteral feedings deliver nourishment through a tube directly into the gi tract. Guidelines for enteral feeding in adult hospital patients. Enteral tube feeding is not an emergency procedure and should be planned carefully. High gastric residual volumes grv increase the risk for pulmonary aspiration the most severe complication of tube feedings. Tubes may be passed into the stomach gastrostomy or the jejunum jejunostomy in patients who cannot obtain adequate. Nurses competency and challenges in enteral feeding in the. Lippincott procedure enteral tube feeding intermittent or bolus. Lippincott procedure enteral tube feeding intermittent or bolus, paediatric or. Critical care program lhsc guideline for enteral feeds and surgical procedures this guideline is meant to assist with the management of enteral feeding in critically ill patients that are going to the operating room for a procedure. When nourishment or liquids are not being administered, the feeding port is capped o.
Administering medications through an enteral feeding tube. Introduction dietary foods for special medical purposes independent of. Enteral enteral nutrition is another way people can receive the food they need. With the enfit connector, enteral feeding devices will. Initial placement of feeding tube cannot be verified by by any other method. Best practices for unclogging feeding tubes in adults. Decisionmaking and practices during a hospital admission impact on home management. Enteral nutrition should be considered when an individual is not safe for oral intake for example. If patients are unable to take supplemental sip feeds safely then enteral tube feeding is required. Document enteral feeding decision in clinical notes liaison with dietitian regarding the patients nutritional requirements and enteral feeding prescription organise an xray to confirm nasogastric tube placement before enteral feeding commences unless correct placement confirmed. Misconnections between enteral devices and non enteral devices iv, respiratory, urinary, etc. Enteral feeding should be initiated within 1224 hours of admission to icu, unless the patient is hemodynamically unstable, inadequately resuscitated, or the gastrointestinal gi tract is believed to be nonfunctioning. Guidelines for enteral feeding in adult hospital patients gut. Enteral feeding, by whichever route, is considered to be artificial feeding and as such is regarded as a medical treatment.
578 1457 938 1293 321 1338 717 1097 1529 759 828 1494 1095 802 501 1023 1419 126 109 602 1638 1576 1094 1615 1262 1459 83 218 991 1278 1237 1361 1030 697 1204 374 1377