Enteral Nutrition

Ella YU
Enteral Nutrition
 An alternative feeding method
 Enteral nutrition (EN)

 Total enteral nutrition (TEN)

 Nasogastric tube

 Nasoenteric tube

 Gastrostomy

 Jejunostomy
Nasogastric tube
Nasogastric tube
Nasogastric tube
 One of the
nostrils→
nasopharynx
tract→ alimentary
tract
 How about through
the mouth and
pharynx?
Nasogastric tube
 Traditional large-bore nasogastric tube
 Larger than 12 Fr in diameter, firm
 E.g. Levin tube, single lumen
 E.g. Salem sump tube, double lumen
 Will cause pharyngitis, tracheal-oesophageal erosion
 Advantage: easy to aspirate the gastric content,
↓aspiration
 Small- bore tube
 Smaller than 12 Fr in diameter, softer
 More flexible,less irritating
 Need to check the correct placement as migrate easily
 Fr Unit (French unit)
A unit for denoting the size of catheter
or other tubular instruments, each unit
being roughly equivalent to 0.3mm in
diameter
 18French (Fr) indicates a diameter of
6mm
 What does it for?

Levin tube

Salem sump tube

 •It acts as a air vent
•To prevent build up of
suction pressure in the tube
•To avoid damage to
gastric mucosa

Levin tube

Salem sump tube

Nasogastric tube
 For clients who have intact gag and cough
reflexes
 To provide nutrition
 To prevent nausea, vomiting and gastric
distention following surgery
 To remove stomach contents for laboratory
analysis
 To lavage (wash) the stomach in cases of
poisoning or overdose of medications
Nasoenteric tube
 A longer tube (at least 40 inches for an adult)
 Nostril to upper small intestine
 Requires special trained nurses or physicians for this
procedure
 For client who are at risks for aspiration
 Decreased level of consciouness
 Poor cough or gag reflexes
 Endotracheal intubation
 Recent extubation
 Inability to cooperate with the procedure
 Restlessness or agitation
How to confirm the tube is
in-situ?
 Aspiration of visually recognizable
gastrointestinal secretion
 Auscultation of air insufflated through the
tube
 pH testing of aspirates
 Observing for coughing and choking
 Testing the ability to speak
 Observing for bubbling when the tip of the
tube is held under water
 X-ray
 Percutaneous endoscopic
gastrostomy(PEG)

Percutaneous endoscopic gastrostomy (PEG)

A technique for the endoscopic insertion of a gastrostomy feeding tube, for the
purpose of providing enteral feeding
 Percutaneous endoscopic
gastrostomy(PEG

Percutaneous endoscopic jejunostomy (PEJ)

•A technique for the endoscopic insertion of a feeding tube through a PEG
Tubing and into jejunum, for the purpose of providing enteral feeding
(Kozier)
Enteral feeding
 Intermittent feeding
 300-500ml *several times for day
 Administer at least 30 minutes
 Continuous feeding
 24 hours feeding with infusion pump
 Cyclic feeding
 E.g12-16 hours
 Nocturnal feeding
Enteral feeding
 Types of enteral formulas
 Majority are lactose-free→ why???
• E.g Isocal, Ensure, Resource
 Also have lactose containing
• Carnation instant breakfast
• Must be refrigerated once mixed- avoid bacteria
contamination
• Restricted in the lactose intolerance patient
 Disease-specific
• Hepatic failure (hepatic aid)
• Renal failure (Amin Aid)
• Glucose intolerance (Glucerna)
 Observe the client with the enteral
feeding with the complication of the
diarrhoea
 Perianal excoriation
 Dehydration
 Electrolytes imbalance
 Muscle cramping
 Cardiac dysrhythmias
 In the laboratory, you will learn about
the cares of
 the insertion and removal of the
nasogastric tube
 The administration of the enteral
feeding