What is a Continuous Tube Feeding Schedule?
A continuous tube feeding schedule, also known as continuous enteral nutrition (CEN), involves the slow, uninterrupted administration of a liquid formula into the gastrointestinal tract over a prolonged period, typically between 8 and 24 hours. This method uses an enteral feeding pump to control the rate and volume of the formula, ensuring a constant delivery of nutrition. It is often prescribed for individuals who cannot tolerate large volumes of formula at once, have poor gastric emptying, or are receiving formula into the small intestine.
How a Feeding Pump Facilitates Continuous Feeding
The heart of a continuous feeding schedule is the feeding pump, a programmable device that regulates the flow of formula.
- Controlled Rate: The pump ensures the formula is delivered at a precise and consistent rate, measured in milliliters per hour (mL/hr). This prevents the stomach from being overwhelmed by large volumes of formula at once, which can lead to gastrointestinal distress such as nausea, bloating, and diarrhea.
- Adjustable Duration: The pump can be programmed to run for a specific number of hours. Some patients may receive feedings around the clock (24 hours), while others may have cyclic feedings, often overnight for 8 to 18 hours, to allow for greater daytime mobility.
- Safety Features: Modern feeding pumps include safety features like alarms that alert users to issues such as a kinked tube, an empty feeding bag, or a power failure. This ensures a reliable and secure feeding process, especially during nocturnal feedings.
Benefits of a Continuous Tube Feeding Schedule
The continuous method offers several significant advantages for patients who are critically ill, have sensitive digestive systems, or require long-term nutritional support.
- Improved Gastrointestinal Tolerance: The slow, steady infusion is easier for the digestive system to handle, minimizing complications such as diarrhea, bloating, and abdominal cramping. This is particularly beneficial for patients with gastrointestinal motility issues.
- Reduced Aspiration Risk: Aspiration, where formula is inhaled into the lungs, is a dangerous complication of tube feeding. By delivering small, consistent amounts of formula, the continuous method reduces the risk of stomach contents backing up into the esophagus and being aspirated.
- Enhanced Nutrient Absorption: A constant supply of nutrients allows for more efficient and thorough absorption by the body, which is vital for patients with decreased absorptive surface area, such as those with short bowel syndrome.
- Stable Blood Glucose Levels: For patients who require strict blood sugar management, continuous delivery helps maintain stable blood glucose levels by avoiding the spikes and drops that can occur with larger, intermittent feedings.
Comparing Continuous, Intermittent, and Bolus Feeding
Understanding the differences between feeding schedules is key to choosing the right method, which is always determined by a healthcare team.
| Feature | Continuous Feeding | Intermittent Feeding | Bolus Feeding |
|---|---|---|---|
| Delivery Method | Slow, steady infusion via a pump. | Infused at intervals (e.g., several times daily). | Administered rapidly via a syringe or gravity. |
| Duration | 8-24 hours per day. | 15-60 minutes per feeding. | 5-15 minutes per feeding. |
| Equipment | Requires a programmable feeding pump. | Can use a pump, gravity bag, or large syringe. | Typically uses a large syringe or gravity. |
| Tolerance | Best for patients with poor tolerance or high risk of aspiration. | Better for patients who can tolerate larger volumes. | May cause discomfort, bloating, or diarrhea in some. |
| Mobility | Restricts mobility, especially during daytime feedings. | Offers greater flexibility and mobility between feedings. | Most convenient for active patients and lifestyle. |
| Cost | More expensive due to the feeding pump. | Less expensive, as a pump is not always required. | Least expensive, requiring only basic supplies. |
| Physiological Similarity | Less like a natural eating pattern. | Closer to normal meal patterns. | Closest to a typical mealtime experience. |
Potential Challenges and Management
While a continuous tube feeding schedule offers many advantages, potential challenges must be managed effectively.
- Clogged Tubes: The smaller bore of some tubes and the continuous flow can increase the risk of clogging. Regularly flushing the tube with water before and after feedings and medication is crucial for prevention.
- Infection: Improper handling of formula and equipment can lead to infection. Using clean equipment, washing hands, and not allowing formula to hang for more than 8 hours (or 24 hours for a ready-to-hang bag) are essential hygiene practices.
- Restricted Mobility: Being connected to a pump for extended periods can limit movement. This can be mitigated by using a portable pump or transitioning to a nocturnal schedule, allowing for daytime activity.
- Skin Irritation: The continuous presence of a tube can cause skin irritation at the insertion site. Daily cleaning of the stoma site is necessary to prevent infection and irritation.
How to Manage a Continuous Feeding Schedule at Home
Managing a continuous feeding schedule requires attention to detail and a commitment to safety and hygiene.
- Preparation: Always wash your hands thoroughly. Check the expiration date of the formula and ensure all equipment is clean. For decanted formula, only prepare enough for 8 hours at a time; for ready-to-hang formula, do not use for more than 24 hours.
- Positioning: The patient must be positioned at an angle of at least 30 to 45 degrees during the entire feeding, and for at least an hour afterward, to minimize aspiration risk.
- Pump Setup: Follow the specific instructions for your feeding pump model. Fill the feeding bag with the prescribed amount of formula, prime the tubing to remove air, and set the correct infusion rate.
- Monitoring: Monitor the patient for signs of intolerance, such as bloating, vomiting, or diarrhea. Check the tube insertion site for any redness or irritation.
- Flushing: Flush the tube with the recommended amount of water every 4 to 6 hours during continuous feeding to prevent blockages. This is also necessary before and after administering medications.
Conclusion
Understanding what a continuous tube feeding schedule is is crucial for effective enteral nutrition. This method provides a steady, controlled delivery of nutrients, minimizing gastrointestinal complications and aspiration risk, particularly for those with compromised digestive function. While it requires the use of a feeding pump and careful management, the benefits of improved tolerance, stable nutrient levels, and enhanced absorption make it a cornerstone of nutritional support for many patients. Proper hygiene, vigilant monitoring, and regular flushing are essential practices to ensure safety and success. National Institute for Health and Care Excellence Guideline: Nutrition support in adults
