Dietetic Practice II:
Enteral Tube Feeding:
What is enteral nutrition?
Enteral nutrition generally refers to any methods of feeding that utilises the gastrointestinal
tract
This includes:
- Normal and modified (oral) diet and fluids e.g. food first, food fortification, oral
nutritional supplements
- Enteral tube feeding
Enteral tube feeding = feeding into the gastrointestinal tract using a tube – can be short or
long term. This is not deemed basic care (like ONS) and is regarded as a medical treatment
Indications for Enteral Tube Feeding:
Patients who are malnourished or at risk of malnutrition and either have unsafe (e.g. nbm or
dysphagia) or inadequate (poor oral intake, increased nutritional requirements) intake orally
but in whom the gastrointestinal tract is functioning
Common underlying disease processes leading to EN include…
- Neurological disorders affecting swallow
- Head and neck cancer
- Oesopho-gastric diseases
Enteral tube feeding an also be used to treat active disease e.g. Crohn’s disease
Enteral tube feeding methods:
Bolus Feeding:
Involves delivery of 100-400mls of feed over a short period several times during the day
Usually ONS used – but not always
nutritionally complete so can’t be used as
sole source of nutrition
Administered using a syringe which can
either be done via gravity or plunging
Can only be used in gastrostomy feeding
(contraindicated in jejunostomy feeding)
Continuous Feeding:
Requires a pump, stand and giving set for
administration
Gastrostomy feed is delivered over <20hr
time period (except in ICU)
Jejunostomy feed is delivered over <24hr time period
Feeding times and rates varying depending on the patients’ needs/clinical conditions –
typically around 50-125ml
, Which feeding method to choose?
Continuous vs bolus
Continuous – higher chance of better tolerance
Continuous – feeds more likely to be complete
Continuous – better control for diabetics
Bolus – less time consuming
Bolus – replicates more normal meal patterns
Bolus – if the patients are more mobile
Routes of Enteral Tube Feeding:
Feed Timing:
Drug-nutrient interactions
Staffing practicalities
Volume of feed/rate
Patient’s preferences
Diabetics on insulin
Medication interactions:
Enteral feeding can interact with the dosage, presentation and action of many drugs
Consider the medications the patient is on; are any being given via the enteral tube? If so, do
any interact with enteral feeding?
If a patient is on medications that interact with enteral feeding, manipulate the timing of
feed administration to manage this
Drugs should never be added to the enteral feed, and this can alter the stability of the
medication and be a source of contamination
Some medications are soluble and can be mixed with water and given via EN tube
Other medications cannot and risk tube blockage, thus they need to be given in alternative
form – consult the pharmacist for appropriate preparations to be given via an enteral
feeding tube
Diabetics on insulin:
Enteral Tube Feeding:
What is enteral nutrition?
Enteral nutrition generally refers to any methods of feeding that utilises the gastrointestinal
tract
This includes:
- Normal and modified (oral) diet and fluids e.g. food first, food fortification, oral
nutritional supplements
- Enteral tube feeding
Enteral tube feeding = feeding into the gastrointestinal tract using a tube – can be short or
long term. This is not deemed basic care (like ONS) and is regarded as a medical treatment
Indications for Enteral Tube Feeding:
Patients who are malnourished or at risk of malnutrition and either have unsafe (e.g. nbm or
dysphagia) or inadequate (poor oral intake, increased nutritional requirements) intake orally
but in whom the gastrointestinal tract is functioning
Common underlying disease processes leading to EN include…
- Neurological disorders affecting swallow
- Head and neck cancer
- Oesopho-gastric diseases
Enteral tube feeding an also be used to treat active disease e.g. Crohn’s disease
Enteral tube feeding methods:
Bolus Feeding:
Involves delivery of 100-400mls of feed over a short period several times during the day
Usually ONS used – but not always
nutritionally complete so can’t be used as
sole source of nutrition
Administered using a syringe which can
either be done via gravity or plunging
Can only be used in gastrostomy feeding
(contraindicated in jejunostomy feeding)
Continuous Feeding:
Requires a pump, stand and giving set for
administration
Gastrostomy feed is delivered over <20hr
time period (except in ICU)
Jejunostomy feed is delivered over <24hr time period
Feeding times and rates varying depending on the patients’ needs/clinical conditions –
typically around 50-125ml
, Which feeding method to choose?
Continuous vs bolus
Continuous – higher chance of better tolerance
Continuous – feeds more likely to be complete
Continuous – better control for diabetics
Bolus – less time consuming
Bolus – replicates more normal meal patterns
Bolus – if the patients are more mobile
Routes of Enteral Tube Feeding:
Feed Timing:
Drug-nutrient interactions
Staffing practicalities
Volume of feed/rate
Patient’s preferences
Diabetics on insulin
Medication interactions:
Enteral feeding can interact with the dosage, presentation and action of many drugs
Consider the medications the patient is on; are any being given via the enteral tube? If so, do
any interact with enteral feeding?
If a patient is on medications that interact with enteral feeding, manipulate the timing of
feed administration to manage this
Drugs should never be added to the enteral feed, and this can alter the stability of the
medication and be a source of contamination
Some medications are soluble and can be mixed with water and given via EN tube
Other medications cannot and risk tube blockage, thus they need to be given in alternative
form – consult the pharmacist for appropriate preparations to be given via an enteral
feeding tube
Diabetics on insulin:
