When Administering Intermittent Enteral Feeding to an Unconscious Client

---

Introduction

Enteral feeding provides physiologic, metabolic, safety, and cost benefits over parenteral nutrition. There are various ways enteral nutritional is administered and scheduled. The method of administration must be individualized to each patient's specific needs. The functioning and capacity of the GI tract, underlying disease states and patient tolerance must be assessed in order to determine the appropriate administration method.

---

Routes of administration

Understanding the purpose, advantages, and disadvantages of each access route will allow the clinician to choose a method which is best for the patient.

EN administration routes

	Indications	Advantages	Disadvantages
Nasogastric	Intact gag reflex No esophageal reflux Normal gastric emptying Stomach uninvolved with primary disease	Easy tube insertion Larger reservoir capacity in stomach	Highest risk of pulmonary aspiration Patient self-conscious due to appearance of nasogastric tube
Nasoduodenal	Gastroparesis or impaired gastric emptying Esophageal reflux	Reduced aspiration risk compared to NG	Potential GI intolerance (bloating, cramping, diarrhea) to goal TF infusion rate May require endoscopic placement of nasoenteric tube Patient self-conscious due to appearance of nasoenteric tube Tube displacement and potential aspiration
Nasojejunal	Gastroparesis or impaired gastric emptying Esophageal reflux Gastric dysfunction due to trama or surgery	TF may be initiated immediately after injury Reduced aspiration risk compared to NG	Potential GI intolerance to goal TF infusion rate May require endoscopic placement of tube Patient self-conscious due to appearance of nasoenteric tube Tube displacement and potential aspiration
Gastrostomy	Long-term feeding; normal gastric emptying Swallowing dysfunction and subsequent impairment of ability to consume an oral diet Nasoenteric route unavailable Intact gag reflex; no esophageal reflux Stomach uninvolved with primary disease	Placed adjunctly with GI surgery No surgery needed for percutaneous endoscopic gastronomy (PEG) PEG less costly than surgical gastronomy Large bore tube provides decreased risk of tube occlusion Larger reservior capacity in stomach	Potential risk of aspiration Stoma care needed; potential infection at stoma site Potential skin excoriation from leakages of digestive secretions at stoma site Potential fistula after tube removed Surgery needed for surgical gastrostomies
Jejunostomy	Long-term feeding High risk of aspiration Esophageal reflux Inability to access upper GI tract Gastroparesis or impaired gastric emptying Gastric dysfunction due to trama or surgery	Reduced risk of aspiration Placed adjunctly with GI surgery No surgery needed for percutaneous endoscopic jejunostomy (PEJ) PEJ less costly than surgical jejunostomy TF may be initiated immediately after injury	Potential GI intolerance to goal TF infusion rate Stoma care needed; potential infection at stoma site Potential skin excoriation from leakages of digestive secretions at stoma site Potential fistula after tube removed Tube occlusion with small bore tube or needle catheter Surgery needed for surgical jejunostomies

---

Methods of administration

Enteral tube feedings are administered either on a continuous or intermittent basis. Continuous feedings are used to prevent GI intolerance and minimize risk of aspiration. Intermittent feedings may be used in medically stable patients who have adequate absorptive capacity to tolerate bolus feedings. An enteral infusion device (feeding pump) may enhance the safety and accuracy of enteral feedings.

EN administration methods

	Indications	Advantages	Disadvantages
Continuous	Initiation of TF Crtically ill patient Small bowel feeding Intolerance of intermittent or bolus TF	Pump Assisted Minimizes risk of high gastric residuals and aspiration Minimizes risk of metabolic abnormalities	Restricts ambulation Infused over 24 hr/d Increased cost due to equipment and supplies
Intermittent	Noncritically ill patient Home TF Rehabilitation patient	Flexibility of feeding regimen Inexpensive (less equipment and supplies) Feeding over short time period allows free time between feedings	Higher risk of aspiration, nausea, vomiting, abdominal pain, distention, and diarrhea Potential GI intolerance to goal TF infusion rate May require formula with more calories and protein
Bolus intermittent	Noncritically ill patient Home TF Rehabilitation patient	Ease of administration Inexpensive (no pump) Feeding over short period (usually 15 minutes)	Highest risk of aspiration, nausea, vomiting, abdominal pain, distention, and diarrhea Potential GI intolerance to goal TF infusion rate
Cyclic intermittent	Noncritically ill patient Home TF Rehabilitation patient	Physical and psychological freedom from equipment for 8-16 hr/d Beneficial for transitioning TF to oral diet (TF at night with oral diet during the day)	Requires high infusion rate over short period (8-16 hr per period) May require formula with higher calorie and protein density Potential GI intolerance to goal TF infusion rate

---

Monitoring

Once EN has been initiated for a patient, a variety of complications may develop. For this reason, diligent monitoring is necessary.

Suggested monitoring schedule

Parameter	During intiation	Stable acute patient	Long term patient
Blood chemistry	2 - 3 times/week	Every 1 - 2 weeks	Every 6 months
Lytes, BUN, creatinine	Daily	2 - 3 times/week	Every 6 months
Triglycerides	Weekly	Every 1 - 2 weeks	Every 6 months
Glucose	2 - 3 times/week	Every 1 - 2 weeks	Every 6 months
Serum proteins	Weekly	Monthly	Every 6 months
Weight	Daily	2 - 3 times/week	Weekly
I & O	Daily	2 - 3 times/week	Weekly
Nitrogen balance	PRN	PRN	PRN

---

---

www.rxkinetics.com
©Copyright 1984 - 2022, All rights reserved.
RxKinetics, Plattsburg, MO 64477

pollardhenow1948.blogspot.com

Source: https://www.rxkinetics.com/tpntutorial/2_2.html

Share this post