Enteral Nutrition Presented by Melanie Farwell RD, LD Keene Medical Products Dietitian
What is it? Liquid feeding provided to the gastrointestinal tract via nose, stomach or small intestine -Specifically referred to as tube feeding
Medical Conditions Causing Need for Enteral Feeding Dysphagia (inability to swallow) Oral Surgery or Reconstructive Surgery Head and Neck Cancer Severe Burns Stomach/Bowel Surgery Malabsorption /dysmotility Premature Infants Children with special health needs (cerebral palsy, developmental delay)
Short Term vs. Long Term Therapy Dysphagia Oral Surgery Condition/Disease Short Term Long Term Either Head/Neck Cancer Severe Burns Paralysis/Obstruction of Esophagus Stomach/Bowel Surgery Malabsorption of Nutrients Premature Infants Children with special medical needs X X X X X X X X X
Enteral Formulas Formulas are selected by hospital RD and MD based on: Calorie, protein and fluid needs of patient Pediatric formulas have lower calorie and nutrient content due to lower needs. Specific diseases that may require a specialized formula (ie: Fibersource, NutriHep, and Peptamen from Nestle and Pulmocare, Glucerna, and Nepro from Abbott)
Bolus Feeding A syringe is used to feed formula directing into tube
Gravity Feeding A feeding bag with gradual drip (can be used intermittently throughout the day and/or night)
Pump Feeding The feeding rate is controlled flow via pump (can be used 24 hrs/day or intermittently)
Pumps are Transportable
G-tube (gastrostomy)
J-tube (jejunum) Tube bypasses the stomach and is placed in the small intestine
NG tube (nasogastric) Small feeding tube is inserted through nose-used with a feeding pumped and generally not used long term
MIK-KEY Button (made by Kimberly-Clark)
With Extension Tube Attached
Mini One Button (made by Applied Medical Technology)
Feeding Tube Sizes Sizes are listed in French (Fr) based on the diameter of the tube opening The larger the number the larger the opening of the tube 1 Fr = 0.33 mm
Bag/Pump Sets Bags are used for gravity feeding Pump sets have special connection section for pumps Different capacity sizes from 100-1200 ml
Pumps we use at KMP EnteraLite Infinity- (uses EnteraLite Infinity Bag Sets- 500 ml or 1200ml) Higher volume feeding (0.1-600 ml/hr) Weighs 14.4 ounces Takes 6 hours to fully charge, lasts 24 hrs (at 125 ml/hr) Washable under running water No annual maintenance or calibration required
Pediatric (small volume) Pump Infinity Orange (uses Infinity Orange Bag Sets-100ml as well as EnteraLite Infinity 500ml or 1200 ml sets) Small volume feedings (0.1-300 ml/hr) Weighs only 14.4 ounces Takes 6 hours to fully charge, lasts 24 hrs (at 125 ml/hr) Washable under running water No annual maintenance or calibration required
Who may need a feeding pump Any patient with the following: Reflux and/or aspiration Severe diarrhea Dumping syndrome Administration rate is less than 100 ml/hr Blood glucose fluctuations (affected by feedings) Circulatory over load (too much fluid) G/J or J tube is being used for feeding
Let s Set Up a Pump
Physician Order Contains the following: Patient s height and weight Estimated daily calorie needs Name of formula Method of administration Rate (if using feeding pump) Medical need for feeding pump if one is being used Total number of cans for gravity or bolus feeds or Total ml of formula per day if using pump
Why follow MD prescription? Maintain weight Prevent dehydration Prevent skin issues Prevent aspiration risk Allow for appropriate growth in children Prevent complications from associated diseases
KMP Enteral Program Enhancements Follow-up for new patients and on a scheduled basis to monitor Dietitian will be liaison between KMP branch staff and referrals Resource for KMP staff
Follow-up Changes Dietitian will conduct 24 hr. follow up with all new enteral patients (within 2 business days) Please add item # KMP1033 (FOLLOW-UP ENTERAL INITIAL) to all new enteral set ups to start this process 7 and 30 day follow-ups will be completed by dietitian Monthly follow-ups will be completed by the branch in conjunction with the monthly order process