Clinical management issues to consider

Enteral feeding is a method of maintaining hydration and nutrition for patients who are suffering from a disability that affects the ability to take in an adequate oral intake to maintain nutritional status. A feeding tube is passed directly into the patient’s stomach or small bowel and liquid nutrition is provided.

The decision to insert a gastrostomy tube should be made via consultation between the patient, next-of-kin or power of attorney, doctor(s) and staff. Consideration should be given to any advance care planning. The health care team, patient and representatives should consider the possible benefits of treatment as well as any risks or contra-indications.

Indications for a gastrostomy tube include:

• intact GI tract but unable to consume sufficient calories to meet nutritional needs
• impaired swallowing related to neurological conditions

Common risks of tube feeding include: pain at the tube site, local infection, aspiration pneumonia, tube occlusion, nausea, vomiting, constipation and diarrhoea. (rxkinetics, 2012)

Feeding regime

Patients requiring enteral feeding should be assessed, by a dietician to determine the most appropriate formula and feeding regime. The dietician should aim to meet the patient’s specific nutritional requirements, minimise complications and maintain cost-efficiency.

Feeding regimes are either continuous or intermittent. Continuous feeds are indicated for patients who are at a high risk of aspiration, have gastro-intestinal tolerance (eg. diarrhoea) or for small bowel feeding. Feeds are either delivered by bolus, gravity flow or using pump-control. Bolus feeds are administered over 5–10 minutes, usually via a syringe. Bolus administration has the advantage of being a quick administration technique and frees the patient from tube lines.

Feeding formulas are made up of carbohydrate, protein, fat, minerals and vitamins including sodium and potassium; and fibre free water is also an important component and constitutes up to 85% of the formula. Selection of a formula type depends on the patient’s nutritional requirements, gastrointestinal function, and any special disease considerations. The most commonly used formula products are lactose-free. Enteral feeds can be administered using a ready-to-hang feeding system (‘closed system’), or decanted (‘open system’) into a feeding bag or syringe.

Weekly or twice weekly weighing is more effective than daily weighing, which is influenced by variations in fluid balance. (NICE 2006)