Many patients do not tolerate NG and nasoenteric tube feedings well. Often a medium- or fine-bore Silastic nasoenteric tube is tolerated better than a plastic or rubber tube. The finer-bore tube requires a finely dispersed formula to ensure that the patency of the tube is maintained. For long-term tube feeding therapy, a gastrostomy or jejunostomy tube is used (see later discussion).
The tube feeding/Feeding Tube method chosen depends on the location of the tube, patient tolerance, convenience, and cost. Intermittent bolus feedings are administered into the stomach (usually by gastrostomy tube) in large amounts at designated intervals and maybe given 4 to 8 times per day. The intermittent gravity drip is another method for administering tube feedings into the stomach and is commonly used when the patient is at home. In this instance, the tube feeding is administered over 30 minutes at designated intervals. Both of these tube-feeding methods are practical and inexpensive. However, the feedings delivered at variable rates may be poorly tolerated and time-consuming.
The continuous infusion method is used when feedings are administered into the small intestine. This method is preferred for patients who are at risk for aspiration or who tolerate the tube feedings poorly. The feedings are given continuously at a constant rate by means of a pump. The continuous tube feeding method, which requires a pump device, decreases abdominal distention, gastric residuals, and the risk of aspiration. However, pumps are expensive, and they permit the patient less flexibility than intermittent feedings do.
An alternative to the continuous infusion method is cyclic feeding. The infusion is given at a faster rate over a shorter time (usually 8 to 12 hours). Feeding may be infused at night to avoid interrupting the patient’s lifestyle. Cyclic continuous infusions may be appropriate for patients who are being weaned from tube feedings to an oral diet, as a supplement for a patient who cannot eat enough, and for patients at home who need daytime hours free from the pump.
Tube feeding solutions vary in terms of required preparation, consistency, and the number of calories and supplemental vitamins they contain. The choice of solution depends on the size and location of the tube, the patient’s nutrient needs, the type of nutritional supplement, the method of delivery, and the convenience for the patient at home. A wide variety of containers, feeding tubes and catheters, delivery systems, and pumps are available for use with tube feedings.
NURSING PROCESS: THE PATIENT RECEIVING A TUBE FEEDING
A preliminary assessment of the patient who requires a tube feeding
includes several considerations, as well as the family’s need for
- What is the patient’s nutritional status, as judged by current physical appearance, dietary history, and recent weight loss?
- Are there any existing chronic illnesses or factors that will increase metabolic demands on the body (eg, surgical stress, fever)?
- What is the patient’s hydration status? What are the electrolytelevels?
- Is the patient’s digestive tract functioning?
- Are the kidneys functioning normally?
- Are fluid requirements (ie, 30 to 40 mL/kg body weight)being met?
- What medications and other therapies is the patient receiving that may affect digestive intake and function of the digestive system?
- Does the dietary prescription fulfill the patient’s needs?
Based on the assessment data, the major nursing diagnoses may
include the following:
- Imbalanced nutrition, less than body requirements, related to inadequate intake of nutrients
- Risk for diarrhea related to the dumping syndrome or to tube feeding intolerance
- Risk for ineffective airway clearance related to aspiration of tube feeding
- Risk for deficient fluid volume related to hypertonic dehydration
- Risk for ineffective coping related to discomfort imposed by the presence of the NG or nasoenteric tube
- Risk for ineffective therapeutic regimen management
- Deficient knowledge about home tube feeding regimen
Planning and Goals
The major goals for the patient may include nutritional balance, normal bowel elimination pattern, reduced risk of aspiration, adequate hydration, individual coping, knowledge and skill in selfcare, and prevention of complications.
- MAINTAINING FEEDING EQUIPMENT AND NUTRITIONAL BALANCE
- PROVIDING MEDICATIONS BY TUBE
- MAINTAINING FEEDING REGIMENS AND DELIVERY SYSTEMS
- MAINTAINING NORMAL BOWEL ELIMINATION PATTERN
- REDUCING THE RISK OF ASPIRATION
- MAINTAINING ADEQUATE HYDRATION