Delivery of nutrients and water through the digestive tract by tube.
Objectives:
– Maintain an optimal nutritional status. – Provide the necessary nutrients and water using a route as physiological as possible. – Maintain intestinal function. – Educate patient and family on tube feeding care.
Equipment:
– Enteral nutrition infusion pump. – Stethoscope. – Clamp clamp. – Drip stand. – Vessel.
Material:
– Water. – Bag for enteral nutrition administration. – Bag for waste. – 1 Syringe of 50 c.c. sterile. – Non sterile gloves. – Commercial enteral nutrition preparation. – Enteral nutrition system. – Tube for enteral nutrition feeding. – Cap for nasogastric tube. – Cellulose wipes. – Soaker. – Nursing records.
Procedure:
– Perform hand washing. – Prepare the material. – Preserve the patient’s privacy. – Inform the patient. – Ask the patient and family to cooperate. – Place the patient in Fowler position during the procedure and up to one hour after the nutrition administration. – Put on non-sterile gloves. – Check the correct placement of the tube and its patency before each feeding. – Check tolerance before each feeding and change of bottle, verifying that the residue does not exceed 100 ml in adult patients (reintroduce the residue).
Intermittent bolus administration: Clamp the tube. Connect the cylinder of the 50 cc syringe without the plunger to the end of the tube. Fill with the commercial preparation. Unclamp the probe. Allow the preparation to fall by gravity or by exerting light pressure. Wash the nasogastric tube at the end with 25 ml of water in adults and no more than 10 ml in children.
Intermittent administration by gravity: Clamp the tube. Connect the drip system to the bottle of commercial preparation and to the tube.
Unclamp tube. Hang the container on a dripper foot about 30 cm above the tube. Regulate the drip speed. Wash the nasogastric tube at the end with 25 ml water in adults and 10 ml in children.
Continuous infusion by pump: Clamp the tube. Connect the pump system to the distal end of the tube and program the rate. Check tolerance every 4-8 hours or change of bottle. Flush the tube with water every 8 hours with 25 ml of water and whenever medication is administered or change of bottle. Change feeding system and feeding bag every 24 hours.
– One hour after administration of enteral nutrition, leave the patient in a comfortable position. – Collect material. – Remove gloves. – Perform hand washing. – Record in the nursing documentation the procedure, intake, date and time, tolerance and patient response.
Observations:
– In infants or young children, advise the mother/ father to hold or even put the pacifier if used, as it provides comfort, supports the normal suckling instinct, and facilitates digestion. – Sterility is not essential for the whole system, but maximum hygiene is essential. – Perform oral hygiene to avoid possible irritation. – It is used whenever there is any difficulty in oral intake in patients with proper bowel function. – Keep nutritional formulas in a dry place, not exposed to the sun and at room temperature. Nutritional products should not remain open for more than 12 hours. – Monitor the appearance of vomiting, diarrhea, abdominal distension, etc. If they appear, inform the doctor. – Weigh every 72 hours, if the patient’s conditions allow it. – Measure diuresis every 24 hours and stools, observing the number and appearance.
Forms of administration of enteral nutrition:
1. Syringe bolus: method that presents more risk of aspiration, vomiting, diarrhea and abdominal distention. It is usually administered 300-500 ml 5-8 times a day depending on tolerance. It should be administered very slowly. 2. 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. 3. Continuous: best tolerated method. It can be performed throughout the day or for 12-16 hours both during the day and at night. 4. Intermittent: 350 ml over a period of 20-30 min 5-8 times a day.
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