• Choose a category
• All
• Classic-Fiction

Postprocedural considerations

Immediate care

As soon as the feed commences, check that it appears to be running without problems and is at the correct rate. Monitor this regularly throughout the feed administration.

Monitor the patient for signs of nausea/abdominal discomfort within the first hour and every 2–4 hours during feed administration. This may not be possible if the feed is given overnight and the patient is asleep.

Ongoing care

If appropriate, the patient should be taught how to follow the procedure of setting up the enteral feeding equipment. They should be confident with the maintenance of the equipment and be aware of how to trouble shoot.

Complications

Aspiration

This may occur due to regurgitation of feed, poor gastric emptying or incorrect placement of a nasogastric tube. The risk of this can be reduced by:

the use of prokinetics which encourage gastric emptying, for example metoclopramide

checking the position of the tube before feeding

ensuring the patient has their head at a 45° angle during feeding. If the patient is in bed then this can be achieved through raising the head of the bed and ensuring the patient has sufficient pillows for support.

Nausea and vomiting

This could be caused by a number of factors. It could be related to disease or a side-effect of treatment or a medication such as antibiotics or analgesia. A combination of poor gastric emptying and rapid infusion rates could also stimulate nausea and vomiting. Nausea and vomiting can be better controlled through the use of antiemetics, a reduction in the infusion rate or a change from bolus to intermittent feeding.

Diarrhoea

This could be a result of:

medications such as antibiotics, chemotherapy or laxatives

radiotherapy to the abdomen or pelvis

disease or treatment, for example pancreatic insufficiency, bile acid malabsorption

gut infection, for example Clostridium difficile.

Antidiarrhoeal agents could be used if a person is experiencing diarrhoea as a side-effect of medication. If possible, an alternative medication should be found that does not cause diarrhoea. In the case of antibiotics, these should be stopped as soon as possible. When the diarrhoea is disease related, the underlying problem should be treated, that is, if a person has pancreatic insufficiency they should be provided with a pancreatic enzyme supplement.

Avoiding microbiological contamination of the feed or equipment will help to reduce the risk of diarrhoea. This will involve keeping the equipment clean and, when feeding, maintaining a sealed system.

A stool sample should be sent to check for any gut infection. If the sample is found to be positive then the infection should be treated appropriately.

Constipation

Constipation could be caused by inadequate fluid intake, immobility, bowel obstruction or the use of opiates or other medications causing gut stasis.

Methods to improve symptoms of constipation include:

checking fluid balance and increasing fluid intake if necessary

providing laxatives/bulking agents

if possible, encouraging mobility

if in bowel obstruction, discontinuing enteral feeding.

Abdominal distension

This could be caused by poor gastric emptying, rapid infusion of feed, constipation or diarrhoea. Possible ways to improve distension include:

gastric motility agents

reducing the rate of infusion

encouraging mobility if possible

treating constipation or diarrhoea.

Blocked tube

Blockage can be a result of inadequate flushing or failure to flush the feeding tube or administration of inappropriate medications via the tube.

Enteral feeding tubes: administration of medication

Evidence-based approaches

Rationale

Indications

Patients requiring medications who are not able to take oral preparations due to dysphasia.

Contraindications

Not all medications can be administered through an enteral tube due to risk of blockage.

If the medication has an enteric coating it should not be crushed.

Some medications such as cytotoxic chemotherapy may be harmful to the administrator