Feeding tube nutrition

Compatibility of medications with an enteral nutrition (EN) formula and, conversely, an enteral nutrition (EN) formula with administered medications is of concern when administering medications through feeding tubes. 

Enteral nutrition Delivery of nutrients via the gastrointestinal tract, either by mouth or by feeding tube. 

Enteral nutrition (EN) is the delivery of nutrients by tube or mouth into the GI tract. This chapter focuses on delivery through a feeding tube. 

Enteral nutritional support therapy occurs when food is administered by mouth or a feeding tube that leads directly into the stomach or small intestine. 

Enteral nutrition may be administered by continuous, cyclic, bolus, or intermittent methods and may be accomplished by bolus, gravity, or infusion pump-controlled techniques. The method of delivery depends on the location of the tip of the feeding tube, the clinical condition and intestinal function of the patient, the environment in which the patient resides, and the patient s tolerance to the tube feeding. 

Levothyroxine Concurrent continuous enteral nutrition reduced the absorption of levothyroxine in 13 adults with hypothyroidism, who were given levothyroxine via the feeding tube at their usual dose [46 ]. Two developed subcfinical hj othy-roidism and six developed overt hj othy-roidism within 2-3 weeks five remained euthyroid. 

This paper summarises this development work which has resulted in a comprehensive range of extraction resistant flexible PVC compounds and discusses application areas ranging from stomach feeding tubes and nutritional fluid bags to blood contact devices such as dialysis sets and blood bags. 

L-Fohc acid is available as a crystalline dihydrate containing 8% water. Approximately 80% of the commercial production is consumed for feed enrichment in animal nutrition. FoHc acid is being offered by the pharmaceutical industry for therapeutic and prophylactic use (see Pharmaceuticals). Pharmacological doses of fohc acid are commonly used as a rescue dose during cancer chemotherapy, in women using oral contraceptives, and alcohoHcs. Several studies have provided evidence that multivitamins or foHc acid (0.8—4 mg/day) supplementation prevent the majority of neural tube defects (101). 

When tube feeding alone cannot provide adequate nutrition... 

Assess nutritional status. Is the patient gaining or maintaining weight according to age Are any oral supplements or tube feedings being used ... 

It is common practice to discontinue oral feedings during an attack of acute pancreatitis. In theory, discontinuation of oral intake will decrease the secretory functions of the pancreas and minimize further complications from the disease. Some patients can be fed with minimal oral intake. Tube feeding delivered via a nasojejunal tube will feed the patient beyond the ampulla of Vater, minimizing stimulation of the pancreas.15,16 If oral intake is discontinued for a protracted period, total parenteral nutrition must be used to maintain adequate nutrition.17,18... 

Enteral nutrition (EN) is broadly defined as delivery of nutrients via the gastrointestinal (GI) tract. This could include normal oral feeding as well as delivery of nutrients in a liquid form by a tube. Sometimes when the term enteral nutrition is used, only tube feedings are included hence the terms enteral nutrition and tube feedings are often used synonymously. The bulk of this chapter will include information regarding delivery of feedings via tubes. Formulas for EN usually are delivered in the form of commercially prepared liquid preparations, although some products are produced as powders for reconstitution. 

It might be expected that EN via tubes would have been used widely before the development of parenteral nutrition (PN) however, this was not actually the case. EN via tubes inserted down the mouth or nose into the stomach and also via rectal tubes was used occasionally in the decades before the development of PN in the 1960s.1 However, modern techniques for enteral access, both the placement of the tubes themselves and the materials for making pliable, comfortable tubes, had not yet been developed. Before the PN era, the formulas delivered by the tube route often were blenderized foods. The National Aeronautics and Space Administration effort in the United States in the 1960s led to the development of low-residue (monomeric) diets for astronauts. These diets were adapted for use in sick patients requiring EN. Nonvolitional feedings in patients who cannot meet nutritional requirements by oral intake thus include EN and PN these techniques are collectively known as specialized nutrition support (SNS). 

FIGURE 98-2. Access sites for tube feeding. (From KumpfVJ, Chessman KH. Enteral nutrition. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 

Start the tube feeding at full strength and at a low rate, and increase the rate as tolerated to the goal that will meet the patient s nutritional requirements. 

Rollins C, Thomson C, Crane T. Pharmacotherapeutic issues. In Rolandelli RH, Bankhead R, Boullata JI, Compher CW, eds. Enteral and Tube Feeding. 4th ed. Philadelphia Elsevier 2005 291-305. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. New Engl J Med 2001 345 1359-1367. Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. Perioperative total parenteral nutrition in surgical patients. New Engl J Med 1991 325 525-532. 

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