Download Prevention or correction of tube-feeding complications

常見管灌餵食之問題與對策
萬芳醫院 金美雲
Complications of enteral nutrition

Access problems
Pressure necrosis/ulceration/stenosis
Tube displacement/migration
Tube obstruction
Leakage from ostomy /stoma site
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Complications of enteral nutrition

Administration problems
Regurgitation
Aspiration
Microbial contamination
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Complications of enteral nutrition

Gastrointestinal complications
Nausea/vomiting
Diarrhea
Distention/bloating/cramping Osmotic
Delayed gastric emptying
Secretory
Constipation
Drugs/medications
High gastric residuals
Treatment/therapies
Hypoalbuminemia
Maldigestion/malabsorption
Formula choice/rate
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Complications of enteral nutrition

Metabolic complications
Refeeding syndrome
Drug-nutrient interactions
Glucose intolerance/hyperglycemia/hypoglycemia
Hydration status-dehydration/overhydration
Hyponatremia
Hyperkalemia/hypokalemia
Hyperphosphatemia/hypophosphatemia
Micronutrient deficiencies
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Prevention or correction of tube-feeding complications
Aspiration pneumonia
Possible causescompromised gastroesophageal sphincter, delayed gastric emptying,
gastric obstruction

Preventive/corrective measuresnasoenteric, gastrostomy, or jejunostomy feeding in high-risk clients
small-diameter transnasal tube
elevate head of bed during and 30 minutes after feeding
continuous drip method of delivery
check gastric residual
＊Stable patients, especially those on long-term feeding, do not need
residuals checked regularly.
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Prevention or correction of tube-feeding complications
Clogged feeding tube
Possible causesformula too thick for tube
medications
Preventive/corrective measuresselect appropriate tube size, dilute formula with water, flush
tubing with water before and after giving formula
use oral, liquid, or injectable drugs whenever possible; dilute thick
or sticky liquid drugs with water before administering; crush
tablets to a fine powder and mix with water; flush tubing with
water before and after drugs are given; give drugs individually;
do not mix drugs with formula

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Prevention or correction of tube-feeding complications
Dehydration and electrolyte imbalance
Possible causesexcessive diarrhea
inadequate fluid intake
carbohydrate intolerance
excessive protein intake
Preventive/corrective measuresprovide additional fluid
use continuous drip administration of formula; monitior blood
glucose; consider administering insulin; change amount or
type of carbohydrate
monitor blood electrolyte levels; reduce protein intake

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Prevention or correction of tube-feeding complications

Diarrhea, cramps, distention
Possible causesbacterial contamination; lactose intolerance; hypertonic formula;
rapid formula administration; malnutrition/low serum albumin;
drug therapy
＊hyperosomolar medicationsmagnesium-containing antacids, sorbital-containing elixirs,
electrolyte replacement supplements
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Prevention or correction of tube-feeding complications

Diarrhea, cramps, distention
Preventive/corrective measuresuse fresh formula every 24 hours; store opened or mixed formula in a
refrigerator; rinse feeding bag and tubing before adding fresh formula;
change feeding bag every 24 hours; prepare formula with clean hands using
clean equpment in a clean environment.
use lactose-free formula in lactose-intolerant and high-risk clients
use a small volume of formula and increase volume gradually; dilute formula;
use isotonic formula.
slow administration rate or use continuous drip feedings
use a small volume of dilute formula and increase volume and concentration
gradually.
use antidiarrheal agents; change drug, drug form, or dosage; if possible.
soy polysaccharide, pectin, other fibers, bulking agents
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Prevention or correction of tube-feeding complications
Constipation
Possible causeslow-fiber formula
lack of exercise
drug therapy
Preventive/corrective measuresprovide additional fluids; use high-fiber formula
encourage walking and other activities
change drug therapy if possible; give laxatives or enemas if
indicated
＊Diarrhea can coexist with constipation, usually when a patient is
impacted.

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Prevention or correction of tube-feeding complications
Hyperglycemia
Possible causesprimary medical condition
diabetes, hypermetabolism, drug therapy

Preventive/corrective measurestreat disorder
check blood glucose; slow administration rate; provide
adequate fluid; limit type or amount of carbohydrate;
consider administering insulin.
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Prevention or correction of tube-feeding complications
Nausea and vomiting
Possible causesobstruction; delayed gastric emptying; intolerance to concentration
or volume of formula; drug therapy; psychological reaction to
tube feeding
Preventive/corrective measuresdiscontinue tube feeding
check gastric residual; slow administration rate, use continuous
drip feedings, or discontinue tube feeding .
use small volume of dilute formula and increase volume and
concentration gradually; use continuous drip feeding.
change drug, drug form, or dosage if possible; use antinausea and
antiemetic drugs.
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
Prevention or correction of tube-feeding complications
Skin irritation at enterostomy site
Possible causesleakage of GI secretions and friction caused by the tube

Preventive/corrective measureskeep site clean; inspect area for redness, tenderness, and
drainage; use protective skin cream.
Note: Many of the complications presented here can be caused by the
client’s primary disorder rather than the tube feeding.
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Nutrition Assessment
Functional GI tract
Yes
No
Parenteral nutrition
Enteral Nutrition
Short-term
Nasogastric
Nasodeudenol
Nasojejunal
Long-term
Gastrostomy
Jejunostomy
Diffuse Peritonitis,
intestinal abstruction,
intractable vomiting, ileus,
intractable diarrhea,
gestrointestinal schemia
Short-term
Long-term or Fluid Restrition
GI function
Peripheral PN
Normal
Compromised
Standard Nutrients
Speciality Formulas
Nutrient Tolerance
Adequate
Progress to
Oral Feedings
Gastral PN
Indequate
PN Supplementation
Progress to Total
Enteral Feedings
GI function Returns
Yes
No
Adequate
Progress to More Complex
Diet and Oral Feedings as
Tolerated
Route of Administration of Specialized Nutrition Support
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敬請指教
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