Delivery of nutrients and water through a gastrostomy/jejunostomy.
Objectives:
– Provide balanced nutrition to the patient to maintain optimal nutritional status. – Maintain bowel function. – Educate patient and family on gastrostomy/jejunostomy care.
Equipment:
– Enteral feeding pump. – Stethoscope. – Drip stand.
Material:
– Enteral nutrition bag. – Waste bag. – Fixative dressing. – Sterile gauze. – Sterile and non-sterile gloves. – Commercial enteral nutrition preparation. – Enteral nutrition system. – Gastrostomy/jejunostomy tube. – Cellulose wipes. – Nursing records.
Procedure:
– Follow enteral tube feeding procedure. – Check bowel sounds. – Check gastrointestinal residual (should not be > 30 ml before starting feeding in the jejunostomy). – Pass 30 ml of water by tube before feeding (in children no more than 5 ml). – Administer continuous infusion feeding. – Aseptic technique if the stoma is not healed. – Secure the tube to the abdomen to avoid traction or contamination. – Record in the nursing documentation: procedure, date and time, condition of the skin surrounding the stoma, incidences and patient response.
Observations:
– If there is no bowel sound, notify the physician. – In the cleaning and hygiene of the skin surrounding the gastrostomy tube, chemical compounds containing alcohol or benzoin should be avoided as they may irritate and affect the skin. Avoid rubbing the skin around the gastrostomy tube. – Sterility is not essential for the whole system, but maximum hygiene is essential. – Oral hygiene should be carried out to avoid possible irritations. – The temperature of the nutrition should be at room temperature.
– Note down and inform the physician of any incidents such as vomiting, diarrhea, abdominal distension, abdominal discomfort.
Forms of administration of enteral nutrition:
– Syringe bolus: method that presents more risk of aspiration, vomiting, diarrhea and abdominal distention. 300-500 ml is usually administered 5-8 times a day depending on tolerance. It should be administered very slowly. – Infusion pump drip: this is the method of choice, especially in severe patients. It allows the dosage to be regulated. It is very useful when large volumes are administered or when very fine probes or very dense formulas are used. – Continuous: best tolerated method. It can be performed throughout the day or for 12-16 hours both during the day and at night. – Intermittent: 350 ml over a period of 20-30 min 5-8 times a day.
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