The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [279]
To avoid interactions between medicines (BAPEN 2003b, C).
14 Flush the tube with at least 30 mL water following the administration of the last drug.
To avoid medicines blocking the enteral tube (BAPEN 2003b, C).
15 If the patient is on fluid restriction or for a paediatric patient, consult the dietitian and pharmacist about the quantity of water to be given before and after medication.
To ensure that the patient does not exceed their fluid restriction or requirements (BAPEN 2003b, C).
Postprocedure
16 Record the administration on the prescription chart.
To maintain accurate records (NMC 2008c, C; NMC 2009, C)
Problem-solving table 8.5 Prevention and resolution (Procedure guideline 8.13)
Postprocedural considerations
Immediate care
The tube patency should be checked to ensure that the medication has not caused a blockage. This could be done by flushing the tube.
The patient should be monitored to ensure that there are no side-effects of the medication administered.
Ongoing care
In order to avoid complications and ensure optimal nutritional status, it is important to monitor the following in patients on enteral tube feeds:
oral intake
bodyweight
urea and electrolytes
blood glucose
full blood count
fluid balance
tolerance to feed, for example nausea, fullness and bowel activity
quantity of feed taken
care of tube
care of stoma site (where appropriate).
Education of the patient and relevant others
If the patient is going home with the enteral tube in place, it should be ensured that the patient is educated and confident with administering their medication. If this is not possible then the patient should be referred to a healthcare professional, such as a district nurse, who can undertake this aspect of care.
Home enteral feeding
Some patients who are established on tube feeding in hospital also require enteral tube feeding at home. A multidisciplinary approach is needed for a successful discharge, usually involving a dietitian, doctor, ward nurse, community nurse and general practitioner. The patient’s circumstances and the ability of the patient or carers to manage the feed must be considered when discharge is being planned. Adequate time should be allowed in the hospital setting for patients to become fully accustomed to the techniques of feed administration and care of the feeding tube, prior to discharge home. Patients should also be given written information to reinforce the education they receive prior to discharge (BAPEN 2003a).
Support in the form of the general practitioner, community nurse and community dietetic services should be established before discharge. A multidisciplinary discharge meeting may be of benefit to both the patient and the professionals involved. Many of the commercial feed companies organize for the patient’s feed and equipment to be delivered to their home, after consultation with the local community services (BAPEN 2003a). The hospital or community dietitian can arrange this. Early notification of discharge is essential as it usually takes a minimum of 7 days to set this up.
Termination of enteral tube feeding
It is important to ensure that an individual is able to meet their nutritional requirements orally prior to termination of the feed. Ideally, the feeds should be reduced gradually, according to the dietary intake (BAPEN 1999). It may be useful to maintain an overnight feed while the patient is establishing oral intake.
Transfusion of blood and blood components
Definition
Blood transfusion is the administration of a blood component- or plasma-derived product to the patient (Gray et al. 2007). Blood is a raw material from which different therapeutic products are made (McClelland 2007).
Anatomy and physiology
ABO blood groups and rhesus types
In 1901, Landsteiner discovered that human blood groups existed and developed the ABO system which marked the start of safe blood transfusion (Bishop 2008). There are four principal