Enteral Feeding: Device & Location Choices

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Questions and Answers

What is a potential disadvantage of intravenous (IV) medications?

They cannot cause rapid effects.

They can cause irritation or toxicity. (correct)

They are always compatible with the vehicle.

They are free from any pathogens.

What is an essential characteristic of IV fluids in relation to sterility?

They must contain live microorganisms.

They should contain particulates for effectiveness.

They can have up to 1% contamination.

They should be free from any disease-causing microorganisms. (correct)

What is the required pH level for IV fluids to be considered acceptable?

Above 8.0

Between 6.0 and 6.5

Around 7.4 (correct)

Below 7.0

Which of the following is an example of a sterile vehicle used for IV admixture?

Sodium chloride Signup and view all the answers

Why is it important to check compatibility of medications with their IV vehicles?

To avoid adverse reactions. Signup and view all the answers

What is one of the key roles of magnesium in the body?

Facilitates neuromuscular transmission Signup and view all the answers

Which compound is an example of calcium chloride usage?

Calcium gluceptate Signup and view all the answers

What is a primary function of sodium chloride in intravenous therapy?

Serving as a vehicle for chemotherapeutic agents Signup and view all the answers

What procedure is referred to as 'priming' in IV administration?

Flushing the tube with a vehicle to remove unwanted contents Signup and view all the answers

What is one of the responsibilities of chloride in the body?

Regulating interstitial osmotic pressure Signup and view all the answers

Which of the following is a function of potassium chloride?

Aids in muscle excitability Signup and view all the answers

What does magnesium sulfate primarily assist with in medical treatments?

Controlling neuromuscular function Signup and view all the answers

Which water type is often used in injectable medications?

Bacteriostatic water for injection Signup and view all the answers

Which type of enteral feeding device is contraindicated for patients with head and neck obstruction?

Nasogastric tube Signup and view all the answers

What is the ideal length of therapy for a short-term enteral feeding device?

4 weeks Signup and view all the answers

Which condition is an indicator for using enteral feeding directly into the stomach?

Pediatric patients Signup and view all the answers

What is a primary disadvantage of using pump-assisted continuous infusion for enteral feeding?

Cost and convenience Signup and view all the answers

For which situation would nasoenteric feeding tubes NOT be suitable?

Patients with esophageal pathology or injury Signup and view all the answers

What type of IV solution is considered isotonic?

0.9% NaCl Signup and view all the answers

What is a potential complication when diluting a full-strength enteral formula with water?

Increased risk for bacterial contamination Signup and view all the answers

Which type of enteral feeding device is suitable for long-term use?

Gastrostomy tube Signup and view all the answers

Which factor does NOT influence the choice of enteral feeding device?

Cost of feeding materials Signup and view all the answers

During enteral feeding, what complication can occur from aspiration of gastric contents?

Pneumonia Signup and view all the answers

Which type of therapy bypasses the alimentary canal for medication delivery?

Parenteral therapy Signup and view all the answers

What volume of parenteral solution is categorized as large volume?

Greater than 250 mL Signup and view all the answers

What type of formula is typically used for critical care patients in enteral feeding?

Full-strength formula Signup and view all the answers

What is the primary use of D5W in IV therapy?

Vehicle in IV admixture Signup and view all the answers

Which solution is most appropriate for post-surgical patients requiring fluid replacement?

Ringer’s Solution Signup and view all the answers

What is the isotonic solution used for fluid and electrolyte replacement?

Sodium Chloride 0.9% Signup and view all the answers

Which electrolyte is crucial for muscle contraction and nerve impulse transmission?

Calcium Signup and view all the answers

Which of the following is a major intracellular cation?

Potassium Signup and view all the answers

What is the primary role of sodium in the body?

Interstitial osmotic pressure Signup and view all the answers

What is the reactive agent in Bacteriostatic Sodium Chloride that prevents bacterial growth?

Inhibitory agents Signup and view all the answers

Which electrolyte participates in protein synthesis and muscle excitability?

Potassium Signup and view all the answers

Lactated Ringer’s Solution contains which of the following?

Sodium lactate and multiple electrolytes Signup and view all the answers

What is the primary use of water in the context of IV solutions?

For reconstitution and dilution Signup and view all the answers

Which of the following solutions is combined with dextrose for IV therapy?

Lactated Ringer’s Solution Signup and view all the answers

Which of the following solutions does NOT contain sodium lactate?

Ringer's Solution Signup and view all the answers

Which of the following is NOT an example of a sodium compound?

Potassium Chloride Signup and view all the answers

What type of solution is D50W primarily known for providing?

Source of carbohydrates Signup and view all the answers

Which of the following properties characterizes phosphate in the body?

Major intracellular anion Signup and view all the answers

What is the primary role of acetate in the human body?

Bicarbonate precursor Signup and view all the answers

Which condition is characterized by inflammation of the veins due to drug administration?

Phlebitis Signup and view all the answers

Which of the following agents is classified as a platinum derivative?

Cisplatin Signup and view all the answers

What is the purpose of using a vertical laminar flow hood during the preparation of antineoplastic agents?

To prevent air from entering the workspace Signup and view all the answers

Which of the following routes of administration is suitable for total parenteral nutrition?

Central venous route Signup and view all the answers

What is a major indication for utilizing total parenteral nutrition?

Gastrointestinal malfunction Signup and view all the answers

Which personnel requirement is necessary when handling chemotherapeutic agents?

Specialized training Signup and view all the answers

What complication arises from the infiltration of administered drugs into subcutaneous tissues?

Extravasation Signup and view all the answers

Which group of drugs is often reconstituted with sterile water or saline for administration?

Antibiotics Signup and view all the answers

What type of personal protective equipment is recommended for handling antineoplastic drugs?

Closed-front cuffed gown Signup and view all the answers

Which condition is often associated with the use of biologic drugs related to inflammatory bowel disease?

Gastrointestinal impairment Signup and view all the answers

Which of the following is a common reason to use recombinant technology in drug preparation?

To address antimicrobial resistance Signup and view all the answers

Study Notes

Enteral Feeding

Factors for choosing optimal device and location
- Patient age
  - Pediatric patients - prefer direct stomach placement to prevent movement restriction.
- Lifestyle
  - Choose option that doesn't restrict movement (e.g., athletes).
- Gastric motility
  - Consider risk of aspiration and GI motility alterations.
- Pre-existing medical conditions
  - Diabetes = slow wound healing: carefully plan incision size and tube type.
- Anticipated length of therapy
  - Short term (less than 4 weeks): NG, ND, NJ, NGJ (nasogastric, nasoduodenal, nasojejunal, nasogastric-jejunal) may be used.
  - Contraindications for nasoenteric feeding tubes: head & neck obstruction, esophageal pathology or injury.
  - Long term (greater than 4 weeks): Enterostomy (stomach or small intestines). Long-term percutaneous enteral devices (EADs) may be used with local anesthetics due to discomfort from frequent use.
    - Indictions: Facial trauma (nasogastric not recommended), nosebleeds, anticoagulant therapy.
Enteral Access Device Types
- Stomach for Gastric Feeding:
  - Reserved for patients with normal gastric emptying and low risk of pulmonary aspiration.
- Continuous Infusion:
  - Pump-assisted.
  - Full-strength formula can be painful and damaging to veins, causing discomfort and anxiety.
  - Start at a slow rate and titrate every 8-12 hours.
  - Diluting with water increases bacterial contamination risk.
- Isotonicity:
  - Isotonic (0.9% NSS) reduces discomfort and RBC damage.
  - Hypertonic solutions cause crenation (shrink) and hypotonic solutions cause hemolysis (burst).

Parenteral Therapy

Parenterals:
- Medications given outside the alimentary canal.
- Most common route is intravenous (IV) directly into veins.
Sterility:
- Free from pathogens and disease-causing microorganisms.
Clarity:
- Free from unintentional particulates (glass, rubber, cloth fibers).
pH:
- Close to physiological pH (7.4).
Types of IV Solution:
- Small volume parenteral (50 to 250 mL): Used as a medication vehicle.
- Large volume parenteral (greater than 250 mL): Primarily used for fluid and electrolyte replacement.
Types of IV Administration:
- IV push or IV bolus: Rapid effect IV injection.
IV Fluids and Electrolytes:
- Used in preparation and administration of parenteral products.
- Vehicle for IV admixture.
- Common examples:
  - Sterile water, Sodium chloride, Ringer’s solution.
- Compatibility: Check package insert for drug compatibility with vehicle.
Dextrose:
- Most used glucose solution.
- Hydrating solution.
- Red packaging.
D5W:
- IV vehicle for admixture.
D50W:
- Carbohydrate source in parenteral nutrition solutions.
Sodium Chloride:
- Given as 0.9% solution – isotonic with blood.
- IV vehicle:
- Fluid and electrolyte replacement.
Bacteriostatic Sodium Chloride for Injection:
- Multiple reconstitution only.
- Contains agents that inhibit bacterial growth.
Ringer’s Solution:
- Fluid and electrolyte replacement (commonly used in post-surgical patients).
Lactated Ringer’s Solution (Hartmann’s solution, Ringer’s lactate):
- Contains sodium lactate, NaCl, KCl, CaCl2.
- Frequently combined with dextrose.
Ringer’s Solution:
- Does not contain sodium lactate but has slightly different concentrations of NaCl and CaCl2.
Electrolytes:
- Sodium:
  - Key roles:
    - Interstitial osmotic pressure.
    - Tissue hydration & dehydration.
    - Acid-base balance.
    - Nerve impulse transmission.
    - Muscle contraction.
  - Examples:
    - Sodium chloride, sodium acetate, sodium phosphate.
- Potassium:
  - Major intracellular cation.
  - Key roles:
    - Carbohydrate metabolism.
    - Protein synthesis.
    - Muscle excitability.
  - Examples:
    - Potassium Acetate, Potassium chloride, Potassium phosphate.
- Calcium:
  - Key roles:
    - Nerve impulse transmission.
    - Muscle contraction.
    - Cardiac Function.
    - Bone formation.
    - Capillary & cell permeability.
  - Examples:
    - Calcium chloride, Calcium gluconate, Calcium gluceptate.
- Magnesium:
  - Key roles:
    - Enzyme activities.
    - Neuromuscular transmission.
    - Muscle excitability.
  - Example:
    - Magnesium sulfate.
- Chloride:
  - Key roles:
    - Regulate interstitial osmotic pressure.
    - Control blood pH (acidity levels).
  - Examples:
    - Sodium Chloride, Potassium Chloride, Calcium Chloride.
Phosphate:
- Examples:
  - Sodium phosphate, Potassium phosphate.
Priming IV Tubing:
- Amber-colored tubing should be primed before adding medication & flushed with vehicle (e.g., sodium chloride) to remove unwanted content.
- This is especially critical when handling chemotherapeutic agents.

Phosphate and Chloride

Phosphate is the major intracellular anion.
Chloride is the major extracellular anion.

Acetate

Acetate is a bicarbonate precursor.
Acetate provides alkali to maintain plasma pH.
Examples of acetate:
- Potassium acetate
- Sodium acetate

Parenteral Chemotherapy Agents

Can be toxic to those administering them.
Can be given via IV injection, either short or long term.
Can also be administered subcutaneously, intramuscularly, intrathecally, or intraarterially.
Safe disposal procedures:
- Used needles and broken ampules are disposed of in a sharps container.
- Used vials and other wastes are disposed of in an orange bag/trash bag.

Problems Encountered during Parenteral Chemotherapy Treatment

Phlebitis: inflammation of the veins around the administration site.
- Causes pain, swelling, redness, and heat sensation.
- Occurs with:
  - Highly concentrated drugs: Dilute with vehicles like dextrose or sodium chloride to reduce pain.
  - Large particles: Use a filter to slow the flow and reduce particle size.
Extravasation: The administered drug infiltrates subcutaneous tissues.

Cisplatin and Bevacizumab

Cisplatin is a platinum-derivative drug.
Bevacizumab (Avastin) is a newly released antineoplastic drug.

Handling Chemotherapy Agents

Personnel preparing or administering antineoplastics require special training.
Preparation should take place in a vertical laminar flow hood to protect personnel from airborne contaminants.
Use syringes and IV tubing with Luer-Lock fittings.
Wear PPE:
- Closed-front cuffed gown resistant to liquid permeation.
- Latex or nitrile gloves (double gloves, a cap, and boots may be needed).

Parenteral Antibiotic Preparation

Commonly reconstituted with sterile water, normal saline, or D5W.
Used to address serious infections demanding high antibiotic levels.
Examples:
- Co-amoxiclav (Augmentin)
- Cefuroxime (Zinacef)

Parenteral Biologic Preparation

Utilizes recombinant technology to generate therapeutic agents.
Primarily used for conditions lacking cures and are approved by the FDA for this specific purpose.
Applications:
- Cancer therapy
- Infections (especially in cases of antimicrobial resistance)
- Transplant rejection (immunosuppressants)
- Rheumatoid arthritis
- IBD/Inflammatory Bowel Disease (combination of diarrhea and constipation with an unknown cause)
- Respiratory diseases
- Malaria
Protein and peptide biotechnologies have a shorter half-life.

Total Parenteral Nutrition (Hyperalimentation)

Nutrition given intravenously.
Contains dextrose, amino acids, electrolytes, and additives.
Indication:
- Enteral nutrition is not possible due to GIT malfunction.
- Gut is not accessible.
- Tube feeding is unsafe or ineffective.

Route of Administration

Central Venous Route:
- Preferred for hypertonic parenteral solutions (dextrose >10%).
- The thick superior vena cava can tolerate hypertonic solutions.
Peripheral Venous Route:
- Used for solutions with dextrose ≤10%.
- Thinner veins cannot tolerate hypertonic solutions due to the risk of phlebitis or extravasation.

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Description

This quiz explores the factors influencing the choice of enteral feeding devices and their placement for patients. Covering considerations such as patient age, lifestyle, medical conditions, and therapy duration, it provides an in-depth look at both short-term and long-term feeding options.