If a nurse is administering nutritional supplements through a tube surgically placed directly into a patient's stomach, the route of nutritional delivery is known as enteral nutrition. This method is also commonly referred to as tube feeding. Enteral nutrition utilizes the body's gastrointestinal (GI) tract to deliver a specially formulated liquid diet, which is considered the most natural and optimal form of nutritional support when a patient is unable to eat or swallow safely.
Understanding Enteral Nutrition and Gastrostomy Tubes
When nutritional delivery bypasses the mouth and esophagus by using a tube that enters the digestive system directly, it is classified as enteral nutrition. This contrasts with parenteral nutrition, which provides nutrients intravenously, bypassing the GI tract entirely. The specific tube inserted into the stomach through a surgically created opening in the abdomen is called a gastrostomy tube, or G-tube. One of the most common types of gastrostomy tube is a percutaneous endoscopic gastrostomy (PEG) tube, which is placed using an endoscope.
For patients requiring long-term feeding support (typically longer than 4-6 weeks), a gastrostomy tube is often the preferred choice over a nasogastric (NG) tube, which is inserted through the nose and used for short-term feeding. This surgical placement offers greater patient comfort, is less visible, and has a lower risk of accidental dislodgement.
Indications for Gastrostomy Tube Feeding
Patients require a gastrostomy tube for a variety of medical conditions that prevent adequate oral intake. These can include:
- Neurological disorders: Conditions like stroke, Parkinson's disease, or ALS can cause dysphagia (difficulty swallowing).
- Head and neck cancers: Tumors or treatments like radiation therapy can make swallowing painful or impossible.
- Gastrointestinal issues: Obstructions or other problems that don't allow for oral intake.
- Critical illness or trauma: For patients in a coma, or those recovering from severe burns or injuries, tube feeding ensures necessary nutrients are received.
- Anorexia nervosa: For severe cases where oral intake is insufficient to restore health.
Nursing Responsibilities and Administration Methods
Nurses play a critical role in the management of gastrostomy tube feeding, ensuring patient safety and effective nutritional delivery. Their responsibilities include assessing tube placement, monitoring for complications, and administering the feed. Before each use, a nurse must verify the tube is in the correct position to prevent aspiration.
Enteral feeding can be administered through a gastrostomy tube using different methods:
- Bolus feeding: A prescribed amount of formula is delivered several times a day over 10 to 20 minutes, mimicking a typical meal schedule. This is done using a large syringe to push the feed in slowly.
- Continuous feeding: A slow, continuous drip of formula is delivered over several hours, often via an electronic pump. This method is often used for patients who do not tolerate large volumes of formula at once.
- Intermittent drip: A set amount of formula is given over a specific period, typically 8 to 16 hours overnight, allowing the patient mobility during the day.
Complications and Care Considerations
Proper care is essential to minimize complications associated with gastrostomy tubes. Some potential issues include:
- Infection at the stoma site: The opening in the abdomen requires regular cleaning to prevent infection.
- Tube displacement or blockage: The tube can accidentally come out or become clogged if not flushed regularly with water.
- Gastrointestinal intolerance: Patients may experience cramping, nausea, vomiting, or diarrhea if the formula or feeding rate is not well-tolerated.
- Aspiration: Though less common than with nasogastric tubes, there is still a risk of stomach contents entering the lungs if the patient is not positioned correctly.
Comparison: Enteral (Gastrostomy) vs. Parenteral Nutrition
| Feature | Enteral (Gastrostomy) Nutrition | Parenteral Nutrition |
|---|---|---|
| Route | Directly into the gastrointestinal (GI) tract via a tube. | Directly into the bloodstream via an intravenous (IV) catheter. |
| GI Tract Involvement | Requires a functional GI tract for digestion and absorption. | Bypasses the GI tract completely. |
| Cost | Generally less expensive. | More expensive due to specialized formula and administration. |
| Infection Risk | Lower risk of systemic infection because it avoids the bloodstream. | Higher risk of systemic infections, especially with central lines. |
| Complications | Associated with digestive issues (e.g., diarrhea) and tube site problems. | Can cause blood clots, liver complications, and metabolic imbalances. |
| Best for | Patients with a functional gut but unable to eat. | Patients with a non-functional gut or needing complete bowel rest. |
Conclusion
In conclusion, when a nurse provides nutritional supplements through a surgically placed tube in the stomach, they are using the enteral route via a gastrostomy tube. This method is a safe, effective, and physiological way to deliver necessary nutrients for patients who cannot consume adequate food orally. By understanding the proper administration techniques, monitoring for complications, and providing comprehensive care, nurses ensure patients receive vital nutritional support while promoting comfort and recovery. Enteral feeding is a cornerstone of modern medical nutrition therapy, preserving gut function and providing numerous benefits over intravenous alternatives when the gastrointestinal tract is working correctly.
[Authoritative Link]: American Society for Parenteral and Enteral Nutrition (ASPEN)
