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Enteral Nutrition Overview

Amy Long Carrera, MS, RD, CNSC, CWCMS
Registered Dietitian Nutritionist | Shield HealthCare
07/26/11  6:28 PM PST

Enteral Nutrition refers to the process of a liquid formula administered through a feeding tube directly into the digestive tract. If the patient has a functioning gastrointestinal tract and cannot be sustained nutritionally through oral feedings, they must rely on enteral feeding. This nutritional support must be ordered by a physician and considered reasonable and necessary.

The physician will choose the most appropriate route for nutritional support and appropriate feeding formula based on each patient’s gastrointestinal function and condition.

 Enteral Feeding Methods:

Nasogastric Tube/NG Tube: The Nasogastric Tube (NG tube) is used for those individuals who are unable to ingest nutrients by mouth. The NG tube is placed in either nostril, passed down the pharynx through the esophagus and into the stomach and is usually used for short term feeding. After placement is checked, it is then secured to the nose with tape. The amount of tube required can range from 36″ to 45″.  Placement must be checked before each feeding. Only a licensed physician or nurse may pass a NG tube.

The most popular tubes are silicone and the polyurethane.  Always ask for the french size and the length when accepting an order for a NG Tube.

NG Tube Considerations: french size, length, material, weighted or guide wire

Gastrostomy Tube/G-Tube: The G-Tube is designed to provide a convenient access route for the delivery of long term Enteral Nutrition. It is surgically placed into the abdominal wall. The tube is located below the rib cage and slightly off to the left. The skin surrounding the tube should be kept clean and dry, and in some instances covered with a gauze dressing.

A benefit of the G-Tube is ease of replacement, patient comfort and convenience of care. Other tubes available are the Mushroom, MIC, PEG, and Malecot tube. The french size and balloon size are needed when placing an order for a G-Tube.

A typical complication of the G-Tube can be the moderate amount of gastric leakage. Gastric juices are highly corrosive and can cause skin irritation.

J-Tube/Jejunostomy Tube: The J-Tube is surgically implanted in the upper section of the small intestine called the jejunum, which is just below the stomach. The tube will be located lower and more towards the center of the abdomen, when comparing it to the location of a G-Tube.

The primary reason for use of the J-Tube is to bypass the stomach and to be fed directly into the intestinal tract. The patient must always be fed with an enteral feeding pump. The tube is sometimes secured in place with sutures. The skin surrounding the tube should be kept clean and dry and covered with a gauze dressing.

The placement of the tube is done by the physician. The type of tubes may vary.

* Note: Shield HealthCare does not carry J-Tubes.

Bolus/Syringe Method: This method of feeding is achieved when a syringe is attached to the feeding tube and formula is poured into the syringe, it is allowed to flow into the tube by gravity. This method is very quick and simple. The only equipment needed for this method is a feeding tube, formula and the proper size syringe. 

The recommended types of syringes are: 60cc Catheter Tip Syringe for feeding and a 30cc Luer Tip Syringe for inflating the feeding tube  

Gravity Drip Method: The Gravity Drip Method of feeding is achieved when a gravity feeding bag set is used to administer the patient’s formula. The bag or set is filled with formula through an opening at the top. The bags are marked in ml. for easy measuring. The bags are also equipped with roller clamps to control the flow rate, which is determined by the physician. Many bags have an ice pouch on the outside to keep the formula fresh during feedings. The bag must be changed every 24-hours to reduce the rate of bacteria. 

Pump Feeding: The Pump Feeding Method is controlled by an electrical or battery operated device. The pump feeding set is thread through the pump and set to secure the rate of infusion ordered by the physician due to the patient’s past or current medical condition.

Shield HealthCare Enteral Nutrition Support Program

Shield HealthCare’s Registered Dietitians train the caregiver or patient on how to use the equipment upon discharge from the hospital.

An employee will also be available 24-hours a day, 7 days per week via an answering service for emergencies. A back-up pump will be available if needed for replacement.

Comments

7 Comments

  1. ALICE GOODMAN
    Posted December 17, 2011 at 5:27 am PST

    Thank you for your information, my husband had a J-tube placement and the home health nurse came by BEFORE he was allowed to receive feedings via the tube (post-op), so we really were on our own this first time. We felt better after reading all the supplies directions and looking at this website for more info. Much appreciated as it was scary the first time!

  2. Gloria Grant
    Posted February 26, 2015 at 6:15 pm PST

    My husband has a feeding tube, there is always a lot of liquid coming up into his mouth so we have to suction a lot, what causes this and what should i do to stop it? also he gets the hiccups quite often, what is this from? and what can I do to stop it?

  3. Posted February 26, 2015 at 6:33 pm PST

    Hi Gloria,

    Thank you for your question. This is definitely something that you should bring up to your husband’s doctor, as there are numerous possible reasons for having to suction him frequently. Check with your doctor to see if he might benefit from an anti-reflux medication. He runs the risk of developing pneumonia if the liquid goes into his lungs.

    In terms of the tube feeding, you can make sure that the head of the bed is elevated to at least 30 to 45 degrees or that he is sitting up during feedings and at least for an hour afterward.

    Check with your doctor or dietitian about lowering the rate of the feeding or decreasing the amount of formula he gets at one time to see if that helps. Keep in mind that if you lower the rate you may have to run the feeding for longer to make sure he gets the calories he needs. If he gets additional water with his feedings, try giving some of the water separately to decrease the volume of liquid that he gets at one time.

    Hiccups are typically caused by irritation of the diaphragm, a muscle that sits below the lungs and above the stomach. Among other possible causes, it can become irritated by eating too quickly or too much at once, so lowering the amount of formula/water he gets at one time may possibly help.

    Work with your doctor or dietitian to adjust the rate and volume of his feedings.

    If you would like to discuss further, you can email me at rd@shieldhealthcare.com.

    Thank you!
    Amy

  4. rosa
    Posted July 19, 2016 at 8:54 pm PST

    do you have ensure plus feeding solution if there is please contact me tomorrow or live me a message. i want to order 4 cases of ensure plus

  5. Posted August 9, 2016 at 4:17 pm PST

    Hello Rosa, I hope you were able to get through to place your order! Unfortunately, we do not place orders through this website. Please call 1-800-228-7150. Thank you!

  6. Chris
    Posted September 27, 2016 at 12:44 pm PST

    When my dietician said to take 20-30 minutes per feeding, was she referring to pet carton or per 2 carton which is my at a time amount?

  7. Posted September 28, 2016 at 8:54 am PST

    Hi Chris, thanks for your question! It’s hard to say what your RD meant but I usually suggest to start at about 15 minutes per “carton.” You can go slower or faster depending on your tolerance. If you are slowly pouring formula into the syringe with the plunger removed, it will flow faster as you raise it up in relation to your stomach and slower as you lower it down. If you start to feel full or nauseous, you should slow things down. Your tolerance may improve as you get used to your feedings. Hope that helps, thanks!

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