Mini Guidelines: Enteral Nutrition Support & Protocol
T Fujii, B Phillips
Citation
T Fujii, B Phillips. Mini Guidelines: Enteral Nutrition Support & Protocol. The Internet Journal of Nutrition and Wellness. 2004 Volume 1 Number 1.
Abstract
This is a brief description of the guidelines regarding enteral nutrition through feeding tube administration.
General Guidelines for Enteral Support
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Use appropriate-size feeding tube
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Verify tube position before initiating feedings by radiological confirmation (KUB: abdominal film).
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Specify tube type and feeding site (gastric vs. duodenal)
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Specify formula by strength, category, and route
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Initiate feedings at 20 cc/hour and advance by 20 cc/hour q 6 hours until goal rate is achieved
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If receiving gastric feedings, monitor residuals q 4 hours; hold feedings if residuals are greater than 150 cc: hold for one hour and recheck, if less than 150 cc at time of recheck, restart at 1/2 of previous rate.
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For increased residuals or GI intolerance (abdominal distension, etc.) administer Reglan 5-10 mg IVP q 6 hours.
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Maintain Head of Bed (HOB) at least 30 degrees at all times.
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Confirm gastric tube placement every 4 hours (via auscultation).
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If there is any question regarding tube displacement, verify with a radiological exam before continuing feedings (i.e. KUB).
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Review stress ulcer prophylaxis medications when patient is tolerating enteral nutrition
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Monitor glucose levels with accuchecks q 6 hours and sliding scale insulin as necessary to maintain normoglycemia (Blood Glucose 80-110)
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Monitor weight, fluid balance daily
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Monitor electrolytes, Phosphate, Magnesium, Calcium, BUN, Cr, CBC, triglyceride
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levels biweekly
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Monitor liver function weekly
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Monitor prealbumin and UUN baseline values, then q 1-2 weeks.
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For drug administration:
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Flush tube with at least 30 cc H2O initially
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Flush tube after each medication - and each medication should be given separately
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Crush all tablets to a fine powder, except for enteric coated or sustained release
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Medications
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Dilute hyperosmolar or irritating medications
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Change to liquid formulations if possible.
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TPN must be administered through a central venous catheter via a dedicated port, and with strict adherence to central line care and signs of infection.