|
|
Concern
|
Possible Causes
|
Possible Prevention
and Solutions
|
|
Gastrointestinal
|
aspiration
|
- nasoenteric tube may be misplaced
|
- stop the feed
- seek medical attention
|
|
|
abdominal distension or pain, cramping, nausea, vomiting, diarrhea, retching, or dumping syndrome |
- first feed of the day may be more sensitive due to mucous in the stomach
- air in the stomach, stomach is too full, or feed is given too quickly
- tube has moved into a poor position -spoiled formula or dirty equipment
- acute illness
- excessive or inadequate feed volumes
- gut dysmotility including potential influence of medications
- excessive or inadequate fibre and/or fluids
- temperature of feed is too cold
- medication side effects
|
- check tube placement
- consider venting or burping more permanent tubes before during and after feeding
- administer feeds and flushes more slowly or offer smaller more frequent feedings
- make and store formula as directed
- keep feeding sets clean
- warm the formula
- have the physician or pharmacist review medications
|
|
|
constipation
|
- low fluid intake
- low fibre intake
- low activity level
- medication side effects
- slow movement of intestines
|
- increase fluid intake
- increase fibre intake
- increase activity level
- medication review to support bowel movements
|
|
Anthropometric
|
unintentional weight loss, excessive weight gains
|
- improper preparation of formula leading to excessive or inadequate concentration of formula
- excessive or inadequate feed volumes
- change in metabolic demand
- gastrointestinal complications limiting tolerance and volume administered
|
- review feed preparation, mixing, and recipe
- address gastrointestinal complications to improve tolerance and intake
- assess volume, concentration and metabolic needs
- assess feed type or formula selection
- review potential psychosocial factors
|
|
Mechanical Complications
|
tube blockages
|
- less than optimal feed duration or rapid feed administration
- inadequate water delivery with medications
- tube positioning
- inappropriate tube size
|
- flush tube before, in between and after giving medication
- check that the feeding tube is not clamped or bent
- fill a syringe with 5ml (NG/NJ) or 25ml (g-tube, j-tube) of warm water and gently push and pull on the syringe’s plunger to unblock the tube
- gently massage the tube using your fingers if the tube remains blocked.
- if it can’t be unblocked, seek medical attention.
|
|
Tube Site Care
|
- redness, granulation tissue, bleeding
|
- skin is wet and unclean
- increased tube movement
- infection
- bleeding after tube change or if pulled
|
- clean skin more often, expose to air
- check tube placement and secure as directed by home enteral nutrition program
- seek medical attention
|
|
|
- leakage from the tube site
|
- Illness
- Constipation
- coughing -poor tube fit
- incorrect tube placement
|
- check tube placement and balloon (as applicable)
- keep skin clean and dry
- use dressings as directed by nursing or physician
- set up a bowel routine
|
