Guidelines & References
DA Enteral feeding manual and guidelines |
Indications
When the gastro-intestinal track is functioning. |
When a person cannot meet 65% of their needs orally |
When inadequate oral intake is expected for more than 7 days |
Example
Gastrointestinal malabsorption |
↑ reqs w/ low appetite (cancers, burns, trauma) |
Crohn’s |
short bowl disorder |
liver failure |
acute renal failure |
neuromuscular swallowing disorder (eg stroke) |
EDs |
Nut Reqs
NEMO simple ratio (repletion, acute adult, trauma etc) |
P: ↑ stress, wound healing, muscle wasting, reduce immune response |
Obese pt to prevent overfeeding: Use ABW with a 25% correction |
Obese pt w/ goal to meet 100% reqs: Use ABW with 50% correction |
Include flushes: min 30ml before/after each feed |
Total volume does NOT = total fluid Each formula has a differernt amount of fluid. Need to calculate. |
USE DRY WEIGHT |
Mild: oedema = -1kg. Ascites = -2.2kg |
Mod: oedema = -5kg. Ascites = -6kg |
Severe: oedema = -10kg. Ascites = -14kg |
Flushes
Flushes before & after tube feed (min 30mL each). Compare reqs w/ formula, use what’s left over for flushes. |
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Formulas
Consider: renal electrolyte prescriptions, total fluid, availability, allergies, intolerances or allergies. Most are GF |
Standard polymeric feeds: needs the GIT for digestion |
Pre-digested feeds (semi-elemental & elemental): already broken down – less (or no) GIT needed. Eg. Pancreatitis (fat malab - semi), Milk allergy (elemental) |
FUNCTIONING GUT = Only need 60-100cm of working gut |
Separate feed formulas for renal pts |
Feeding Regimes
Continuous |
~16-20 hours. Usually first step. |
Bolus |
Mimic normal eating. Gravity drip or syringe. 100-400mL over 15-60 mins at regular intervals (eg. every 4 hours) |
Transitional feeding |
Commencing oral intake w/ EN – weaning off. Stop EN when they are having 65-75% of requirements from food |
Goal Rate
1. kj reqs ÷ kj 1L feed = L of feed need to meet reqs. |
2. L of feed ÷ hours = goal rate |
Consider max rate for the type of tube. |
Start @ lower end of range. Monitor & ↑ w/ tolerance, wt hx |
Start Rate
goal rate ÷ 2 |
Continuous: Can, but not required: 50% goal rate in first 12 hours. Reduced nausea & diarrhea. 1-2 days to build up to goal rate. |
IF risk of refeeding or hyperglyceamic: 50% of goal rate. ↑ when biochem stable. |
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Monitoring
Reqs change day-to-day – needs to be constantly monitored & adjusted |
GI tolerance – N/V/D. Bowl movements. Anthro – wt. Aspiration. Dehydration – biochem. Electrolyte – refeeding. Hypo/hyperglycaemia |
SGA weekly |
Troubleshooting
Diarrhoea |
Antibiotics, feeding rate too fast, or too large bolus. Check flushes have been included in calculations. Overflow from constipation? |
Constipation |
Swap to higher fibre formula. Increase fluid in flushes. Prokinetics = faster stomach emptying |
Nausea |
feeding too fast, delayed gastric emptying, cold formula. Swap to continuous (if bolus). Prokinetics. |
Hyperglycaemic |
Swap to continuous. Consider insulin. BGL every 4 hours. |
p267 handbook = causes & treatment of EN issues |
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