What is Enteral Feeding Administration?
Enteral feeding administration is the process of providing liquid nutrition, calories, and fluids to a patient directly into the gastrointestinal (GI) tract when they cannot meet their nutritional needs by mouth. This can be due to various medical conditions, including neurological disorders that impair swallowing (dysphagia), certain cancers affecting the head or neck, or during critical illness. Unlike parenteral nutrition, which bypasses the GI tract by delivering nutrients intravenously, enteral feeding is physiologically more natural and helps maintain gut integrity and immune function.
The administration of enteral feeds requires a functioning GI tract and is a collaborative process involving a multidisciplinary healthcare team, including doctors, dietitians, and nurses. The specific method of administration and the type of formula used depend on the patient's condition, nutritional requirements, and the expected duration of the feeding.
Types of Enteral Feeding Tubes
For tube feeding, various types of access devices are available, categorized by their insertion site and intended use. The choice of tube depends on factors such as feeding duration and patient tolerance.
Short-term Feeding Tubes (Less than 4-6 weeks)
These tubes are typically placed through the nose or mouth.
- Nasogastric (NG) tube: Inserted through the nose, down the esophagus, and into the stomach. Often used for temporary feeding.
- Nasoenteric tubes: Also inserted through the nose but extend past the stomach into the small intestine (duodenum or jejunum). This is used for patients with gastric reflux or poor stomach emptying.
- Orogastric (OG) tube: Inserted through the mouth into the stomach. Used primarily in infants or for short durations.
Long-term Feeding Tubes (More than 4-6 weeks)
These tubes are placed directly into the GI tract through the abdominal wall.
- Percutaneous Endoscopic Gastrostomy (PEG) tube: Inserted into the stomach via endoscopy. It is a common choice for long-term feeding due to its relative stability.
- Radiologically Inserted Gastrostomy (RIG) tube: Similar to a PEG, but placement is guided by X-ray rather than an endoscope.
- Jejunostomy (J-tube) tube: Inserted directly into the jejunum (small intestine). This is an option for patients who cannot tolerate feeds in the stomach.
Methods of Delivery
There are several ways to deliver the enteral formula through the feeding tube, selected based on the patient's health and feeding tube location.
- Continuous Feeding: Administers the formula at a constant, slow rate over a full 24-hour period using a feeding pump. This method is often used for critically ill or bedridden patients and those with small intestine feeding tubes, as it reduces the risk of aspiration and intolerance.
- Bolus Feeding: Delivers a specific volume of formula over a short period (5-10 minutes) several times a day, typically via a syringe. This mimics a natural meal schedule and is mostly used for patients with gastric feeding tubes who are medically stable and mobile.
- Intermittent Feeding: A scheduled method that delivers formula over a longer period (e.g., 30-60 minutes) multiple times daily, often with a pump or gravity drip. It is often used for home enteral feeding and offers more freedom of movement than continuous feeding.
- Cyclic Feeding: Delivers formula via a pump over a specific, limited time frame each day, such as overnight. This is used for patients transitioning back to oral intake and for increased mobility during the day.
Enteral vs. Parenteral Feeding: A Comparison
| Feature | Enteral Feeding Administration | Parenteral Feeding (Intravenous) |
|---|---|---|
| Route of Administration | Into the GI tract (via tube to stomach or intestine) | Directly into the bloodstream (via IV line) |
| Primary Requirement | Functioning GI tract | Non-functional GI tract or inability to access it |
| Associated Risks | Aspiration, tube blockage, dislodgement, GI intolerance (diarrhea, nausea) | Higher infection rates, hyperglycemia, electrolyte imbalances, liver complications |
| Cost | Generally less expensive | Higher due to specialized solutions and central line access |
| Physiological Effect | Supports gut integrity and immune function | Can cause gut atrophy over time |
Managing Enteral Feeding Administration
Proper management is crucial for patient safety and comfort. Key responsibilities include checking tube placement, maintaining the tube site, and preventing complications.
- Tube Placement Verification: For NG tubes, initial placement must be confirmed by an X-ray. Routine checks involve measuring the visible tube length and testing the pH of gastric aspirate.
- Tube Maintenance: Flushing the tube with warm water before and after feeds and medications is essential to prevent blockages. If a clog occurs, warm water is the first line of intervention, followed by enzymatic solutions or mechanical devices.
- Monitoring Patient Tolerance: Healthcare professionals must monitor for signs of intolerance such as nausea, vomiting, cramping, and distention. The head of the bed should be elevated 30–45 degrees during feeding to reduce aspiration risk.
Conclusion
Enteral feeding administration is a vital medical process for delivering essential nutrition and hydration when oral intake is compromised but the gastrointestinal tract remains functional. It encompasses a variety of techniques and tube types tailored to each patient's specific needs, whether for short-term support during recovery or long-term management of chronic conditions. While generally safe, careful administration and management are critical to prevent complications such as aspiration and tube blockages, ultimately helping to improve a patient's nutritional status and overall outcome. For comprehensive resources on patient nutrition, visit Cleveland Clinic on Tube Feeding.
