Gastric feeding

For patients intolerant of gastric feedings or in whom the risk of aspiration is high, feedings delivered with the tip of the tube past the pylorus into the duodenum or, preferably, the jejunum are preferred. 

Gastrostomy tubes, where an incision is made directly through the abdominal wall, are indicated for patients who can tolerate gastric feedings but in whom long-term... 

Does the patient have any condition precluding gastric feeding If so, then postpyloric feeding should be started. 

Percutaneous endoscopic gastrostomy Gastric feeding tube placed via endoscopic technique. 

Excretion of -hexane after oral exposure in humans can be inferred from the appearance of -hexane in exhaled air and 2,5-hexanedione in urine of volunteers receiving 0.24 or 0.81 mg/kg via a gastric feeding tube (Baelum et al. 1998). No studies were located regarding excretion of -hexane or -hexane metabolites following oral exposure to -hexane in animals. 

The interaction of /2-hexane with toluene and trichloroethylene has also been examined in volunteers (Baelum et al. 1998). Exposure in these experiments was via a gastric feeding tube at controlled rates equivalent to what the authors stated would be delivered to the liver by inhalation exposure at Danish occupational exposure limits (50 ppm /7-hexane. 50 ppm toluene, and 30 ppm trichloroethylene). Coexposure to toluene and trichloroethylene slightly increased the area under the curve (AUC) representing concentration versus time for end exhaled /2-hexane air concentration, but urinary excretion of 2,5-hexanedione was unchanged. The only statistically significant interaction observed with /2-hexane was an 18% decrease in the urinary excretion of hippuric acid, a toluene metabolite. 

As commercial interest grows in this area and more cost-effective microbial enzymes become available, it is inevitable that the application of enzymes in feed will further expand. In areas where feed enzymes are already widely applied, they have been acclaimed as the most important development in mono-gastric feeding this decade. 

Chronic effects are not known and diketene was not found to be carcinogenic on skin application, injection beneath the skin, or gastric feeding in mice and rats (132—134). It is not listed as a carcinogen by International Agency for Research on Cancer (LA.RC), the National Toxicology Program (U.S.),... 

Measurement of gastric residual volumes can be used to monitor Gl tolerance in patients receiving gastric feeding. Although not always reliable, excessive residual volumes may be associated with nausea, abdominal distention, and increased risk for aspiration. 

The relationship between small bowel feeding compared with gastric feeding and risk ot pneumonia in critically ill patients has been evaluated. Nineteen trials with 1394 participants were included in the meta-analysis. Compared to gastric feeding, small bowel feeding was associated with a reduced risk of pneumonia (RR=0.70 95% C3 0.55-0.90) and ventilator-associated pneumonia (RR=0.68 95% Cl 0.53-0.89) [134 ]. The overall quality of the evidence for pneumonia as an outcome was rated as low. 

---