Enteral Nutrition Overview

Enteral Nutrition

• Delivery Method: Nutrients delivered via tube, catheter, or stoma.
• Pre-Requisite: Patient must have a functional gastrointestinal (GI) tract (present bowel sounds).
• Assessment of Effectiveness: Monitor weight gain and albumin levels to assess protein status. Improved parameters indicate effective nutrition.
• Care Management:
  • Use aseptic technique during all procedures.
  • Verify all lines/tubes are correctly connected to patient to prevent accidental misconnections.
  • Elevate head of bed (HOB) to >30 degrees during and for 30-60 minutes after feeding to prevent aspiration/reflux.
  • Confirm tube placement before each feeding (X-ray or pH testing). Use caution – bolus or intermittent feeds of >200 mL can cause tolerance issues.
  • Administer feedings at room temperature; warm or cold can cause diarrhea and abdominal discomfort.
  • Do not microwave formula.
  • Flush feeding tube with 15-30 mL of warm water every 4 hours to maintain tube patency and hydration. Crushing medications for oral administration should be done 1 medication at a time and flushed with warm water between medications.
  • Introduce calories gradually.
  • Discard feeding bag and tubing daily
• Complications:
  • GI discomfort/diarrhea: Start infusion slowly and increase rate based on tolerance. Ensure feedings are at room temperature. Slow down rate. Notify healthcare provider. If diarrhea persists, evaluate for C. Diff.
  • Dumping syndrome: Symptoms include rapid weight gain postprandial. Bolus or intermittent feeding can contribute to dumping syndrome; administer small, frequent, protein-rich meals. Avoid concentrated sugars and lactose. Avoid fluids for 1 hour before and after meals (do not take fluids with meals) and lie down for 20-30 minutes after meals.
  • Infection: Discard supplies daily - strict hygiene
  • Aspiration Pneumonia: Confirm placement, elevate HOB, stop feeding, turn patient, suction airway, administer oxygen, monitor vitals and lung sounds, notify HCP, get X-ray.

Total Parenteral Nutrition (TPN)

• Use: For patients with a nonfunctional GI tract or severe illness.
• Delivery Method: Delivered through central or PICC lines.
• Calorie Limit: Max 700 calories/day.
• Formula Composition: TPN is 70% glucose solution.
• Medication Administration: Only insulin and heparin are allowed to be added, per pharmacy protocols, to the TPN bag, to control blood glucose and clotting, respectively.
• Potential Complications:
  • Metabolic Imbalances: Glucose imbalances, hypokalemia, hypophosphatemia, hypocalcemia are possible.
• Care Management:
  • Assess for allergies (soybeans, safflower, eggs).
  • Monitor blood glucose levels (BSL) frequently (every 4-6 hours).
  • Monitor for hyperglycemia/hypoglycemia.
  • NEVER stop TPN abruptly, this can cause severe hypoglycemia. Adjust rate gradually. Do not attempt “catch up” feeding increases to previous deficit.
  • Monitor vital signs (VS) frequently (every 4-8 hours).
  • Daily weight monitoring.
  • Change TPN bag daily.
  • TPN administration requires its own line and pump - no medications should be added to it via “piggybacking”.
  • Monitor intake and output (I&O) to prevent dehydration/hypovolemia.
  • Keep a backup dextrose solution (10%) on hand to treat hypoglycemia.
  • Check TPN bag for abnormal signs [e.g., oil layer] and do not use if present. Contact pharmacy immediately.
  • Gradually discontinue TPN to avoid rebound hypoglycemia.
• Desired Outcomes: Weight gain of 1 kg daily and increased albumin/pre-albumin levels.
  • Complications:
    • Infection: Strict aseptic technique is critical. Monitor for redness, tenderness, or drainage at the IV site. Change dressings and tubing per appropriate intervals.
    • Air Embolus: Symptoms: SOB, chest pain, anxiety, hypoxia, increased heart rate. Immediate actions: clamp the catheter, place the patient on the left side in Trendelenburg position, administer oxygen, and notify the healthcare provider.
    • Perforation: Symptoms: bleeding, decreased blood pressure, increased heart rate. Immediately notify the healthcare provider.