Nutritional status refers to the condition of the body attributed to dietary input, levels of nutrients and the body’s ability to maintain and balance nutrient levels to function normally. Meeting basic nutrition needs is therefore crucial to the maintenance of health and quality of life.
While most people are fully capable of meeting their own nutritional needs, others may be challenged in this aspect by undesirable health conditions. Seniors, for example, are more likely to experience poor nutritional status due to aging. In such cases, enteral nutrition (tube feeding) will be used to assist patients in meeting nutritional needs.
Enteral nutrition refers to the method of feeding which uses the gastrointestinal tract to deliver a person’s nutritional supplements directly into the body. There are several different enteral feeding routes; the most common method used locally is Nasogastric Tube (NGT) feeding.
While NGT insertions are usually performed by medical professionals in a hospital setting, caregivers can learn to administer daily NG feeding at home.
Care and monitoring of patient and tube
For a successful enteral administration, caregivers need to follow standard procedures when handling and monitoring both patients and NGTs. Although enteral feeding improves patients’ nutritional status, it may sometimes result in psychological distress. Hence, family members and caregivers play a crucial role in providing not just physical but also mental and emotional support to ensure patient’s well-being.
Positioning of tube
To prevent accidental removal or mispositioning, an adhesive is usually used to fasten the tube to patient’s nose. This nasal tape should be changed daily or as and when it loosens.
Patients that require NGT feeding are commonly bed-ridden. Since these patients will be assisted in changing positions frequently, caregivers need to ensure that the tube is not pulled out in this process. Some patients may also accidentally remove the NGT in their sleep. In such cases, caregivers should never attempt to reinsert the NGT at home. Instead, consult a doctor for further directions.
Caring for tube
Flushing the tube before and after each feed prevents clogging and infections. After administering medication, an additional flush should also be given to ensure that the full dose is delivered. Warm water can be used for flushing.
While PVC tubes can be used up to only 2 weeks, polyurethane tubes can be used for up to 6 weeks (if cared for properly) since they are unaffected by gastric acid. Caregivers should engage a trained medical professional to assess and change the feeding tube on a regular basis.
Patient complication and prevention
Complications from enteral feeding include tube displacement, leakages, blockages, gastric problems, infection, aspiration etc. To avoid these, caregivers need to monitor and assess patients and the condition of the tube closely and regularly.
Patients who receive enteral feeding are at high risks of developing oral infections. They may also experience dry mouth since there is no fluid intake through the mouth. Caregivers should therefore, assist patients in maintaining good oral hygiene and also help to ease patients’ oral dryness using prescribed oral gels or sprays.
Patients with feeding tube may suffer gastric pains and discomforts due to constipation, build-up of gas in abdomen etc. However, these can be prevented with good control of rate, volume and concentration of feed as well as the provision of fibrous supplements and adequate fluids. Caregivers should also closely monitor patients’ bowel movements and functions.
Precautions before feeding
Caregivers should always complete a thorough hand wash before contacting the tube, liquid food or medication. Caregivers should also clean the skin around the nose with an aseptic cloth before and after each feed. It is also important to prepare every feed according to the prescription of a physician.
Patients with a feeding tube may also experience nose blockage and dryness. Hence, caregivers should check and clean patients’ nostrils frequently to make them comfortable. If redness or swelling around the nose is observed, caregivers should seek medical advice.
Aspiration refers to foreign substances such as food, water, saliva moving through the respiratory tract instead of the digestive tract. This is the most severe complication of enteral feeding which, in serious cases, may result in death. To prevent this, caregivers need to pay attention to patients’ positioning during and after feeding. The patient’s head needs to be kept elevated at 30 to 40 degrees during feeding and should remain in this position for another hour to minimize the possibility of reflux. In addition, caregivers should also assess tube condition and position while feeding to avoid the formation of boluses.
WHEN TO SEEK MEDICAL HELP?
- If the patient is vomiting
- If the tube gets blocked
- If the tube dislodges (do not reinsert the tube on your own)
- Aspiration – if patient chokes or have difficulty breathing
- pH level change