All three macronutrients in the right amounts provide balanced and adequate nutrition support to positively affect clinical outcomes such as infection rates, length of hospital stay or mortality. Nutritional support is not restricted to the exclusive administration of EN or PN. In fact, PN and EN complement each other, e. Enteral Versus Parenteral Nutrition. Enteral Nutrition Enteral nutrition EN includes oral nutritional supplements ONS and enteral tube feeding via nasogastric, nasoenteral or percutaneous tubes.
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Guillermo Carlos Contreras and Dr. Alfredo Matos Adames. For older children feeds given as a bolus should be removed from the fridge minutes before administration to bring them to room temperature. Feeds given as a bolus may be warmed in an approved bottle warmer. This would be appropriate for all infants and older children who experience discomfort with cooler feeds.
This is the second edition of a multiauthored book that is recognized as the premier text on enteral nutrition. The two editors are major contributors in the field . This definitive reference presents the most comprehensive, clinically relevant coverage of nutrition in enteral and tube feeding. The New Edition has been.
Continuous feeds should NOT be warmed. They may be removed from the fridge minutes prior to administration to bring it to room temperature and should not hung for longer than 4 hours — use the dose limit function on the feed pump to ensure this occurs. Caution should be taken if titrating feeds up and down in patients with a metabolic condition.
The decision for which type of enteral feed a child should receive should be made in consultation with the dietician, medical team, nursing staff and family, taking into account the nutritional needs, clinical status and tolerance of feeds of the child. Enteral feeds can be ordered from the RCH formula room. The family should be offered a dietician review while they are an inpatient to ensure the current feeding regime meets the ongoing nutritional needs of the child. Consult your ward pharmacist or call Medicines Information ext: for advice on how to prepare a drug for enteral administration.
Flushing is the single most effective action that prolongs the life of nasogastric tubes. Nurses should consider titrating feeds down or ceasing feeds for a short period of time depending on the clinical status and nutritional needs of the child. High acuity and intensive care patients may require management of Gastric Residual Volumes GRV to assist in management of gastric emptying delays, feeding intolerance, electrolyte balance and patient comfort.
Patients who have a non-functioning GIT i. Published December The Royal Children's Hospital Melbourne. Clinical Guidelines Nursing Toggle section navigation. Enteral feeding and medication administration.
Enteral feeding and medication administration Introduction Aim Definition of Terms Assessment Management Adverse Effects Companion Documents References Evidence Table Introduction Enteral feeding is a method of supplying nutrients directly into the gastrointestinal tract. Aim This guideline aims to support nurses in administering feeds and medications via a nasogastric, orogastric or gastrostomy tube in a safe and appropriate manner. Gastrostomy tube - a feeding tube which is inserted endoscopically or surgically through the abdominal wall and directly into the stomach.
Once removed it may be returned to the patient or discarded. Trans-Anastomotic Tube TAT tube - Utilised after surgery to repair oesophageal atresia inserted by surgeons in the Neonatal patient population. Utilising pH indicator strips a reading of between should be obtained and documented. Small-bore tubes can be difficult to aspirate therefore the following are suggested techniques to try enhance the ability to obtain aspirate: Turn the patient onto their side. This may move the tube away from the wall of the stomach. It will also clear the tube of any residual fluid.
If a child belches immediately following air insufflation, the tip of the tube may be in the oesophagus Wait for minutes. This will allow fluid to accumulate in the stomach and try aspirating again.
If it is safe to do so and the child is able to tolerate oral intake consider providing them with a drink and attempt aspirate in minutes If no aspirate obtained, advance the tube by cm and try aspirating again If aspirate not obtained discuss with senior nursing staff or medical staff and consider removing the tube or checking position by x-ray. Gastrostomy tube Correct placement of the tube should be confirmed prior to administration of an enteral feed by checking insertion site at the abdominal wall and observing the child for abdominal pain or discomfort.
The position of the tube needs to be checked 4 hourly with change of feeds It is recommended that the feed be ceased, withdraw aspirate and test pH. If reading greater than 5, cease the feed for 30 minutes, aspirate and test pH Should there be any dispute as to the position of the tube, do not recommence feeds. Discuss with senior nursing staff or medical staff. The following needs to be checked 2 hourly during the feed: Taping Marker on NGT Observe child for signs of respiratory distress.
Check infusion hourly and document intake.
https://renetwellcomso.ga Flushing is not routine on the Neonatal unit and flushing with air is the preferred method. Enteral feeding tubes should be flushed regularly with water or sterile water if appropriate : Prior to and after feeding Prior to, in-between and after medications Regularly in between tube use Modify flush volumes throughout as needed for infants and children with fluid restrictions — these patients may require minimal volume 0.
However in shorter tubes 1. Venting Feeding tubes may be used to facilitate venting or decompression of the stomach from the accumulation of air during such interventions as High Flow Nasal Prongs, Non-Invasive or Invasive Ventilation. Feeds Feeds can be administered via syringe, gravity feeding set or feeding pump. Consider providing education regarding expressed breast milk Breastfeeding support and promotion clinical guideline.
Administration of Feeds When preparing to administer feeds nursing staff must confirm the position of the enteral tube.
Prior to and after feeds nurses should adequately flush the enteral tube. If unable to sit up for a bolus feed or if receiving continuous feeding, the head of the bed should be elevated degrees during feeding and for at least 30 minutes after the feed to reduce the risk of aspiration. Using a syringe for a bolus feed Remove the plunger from the syringe and place the tip of the syringe into the enteral tube connector at end of the enteral tube. Holding the syringe and enteral tube straight, pour the prescribed amount of feed into the syringe.
Let it flow slowly through the tube e. Pour the prescribed amount of water into the syringe and allow to flow through to flush the feeding tube appropriately. Using gravity feeding for bolus, intermittent feeds and continuous feeds. Using a gravity feeding set with the roller clamp closed, attach the set to the feeding container with the correct prescribed amount of feed and hang the container on the pole.
Squeeze the drip chamber until it is one third full of the feeding solution. Remove the protective cap from the end of the giving set and open the roller clamp, allowing the feed to run down to the end of the giving set to prime the line , then close the roller clamp.
Connect the giving set to the enteral tube connector at the end of the enteral tube. Open the roller clamp and set the flow rate by counting the drops per minute. As a guide, 20 drops of standard feed is approximately 1ml. Check the drip rate regularly to ensure the feed is still running at the required rate.
Using an enteral feeding pump for bolus or intermittent enteral feeding An enteral feeding pump can be used intermittent, bolus or continuous administration of feeds, but is best suited for continuous feeding when tolerance to rate of feeding is an issue. Completion of feed The tube must be flushed with water air in neonates to prevent tube from blocking see above. Giving sets: Rinsed out with warm water tap or sterile.
Ensure tip of giving set is covered between uses. Only prime the giving set with formula immediately prior to feeding time. The set should be changed every 24 hours or as per manufactures instructions. Types of feeds The decision for which type of enteral feed a child should receive should be made in consultation with the dietician, medical team, nursing staff and family, taking into account the nutritional needs, clinical status and tolerance of feeds of the child. Do not administer drugs through tubes used for aspiration or on free drainage unless specifically directed by medical staff.