常見管灌餵食之問題與對策 萬芳醫院 金美雲

2 Complications of enteral nutrition Access problems Pressure necrosis/ulceration/stenosis Tube displacement/migration Tube obstruction Leakage from ostomy /stoma site

3 Complications of enteral nutrition Administration problems Regurgitation Aspiration Microbial contamination

4 Complications of enteral nutrition Gastrointestinal complications Nausea/vomiting Diarrhea Distention/bloating/cramping Osmotic Delayed gastric emptying Secretory Constipation Drugs/medications High gastric residuals Treatment/therapies Hypoalbuminemia Maldigestion/malabsorption Formula choice/rate

5 Complications of enteral nutrition Metabolic complications Refeeding syndrome Drug-nutrient interactions Glucose intolerance/hyperglycemia/hypoglycemia Hydration status-dehydration/overhydration Hyponatremia Hyperkalemia/hypokalemia Hyperphosphatemia/hypophosphatemia Micronutrient deficiencies

6 Prevention or correction of tube-feeding complications Aspiration pneumonia Possible causes- compromised gastroesophageal sphincter, delayed gastric emptying, gastric obstruction Preventive/corrective measures- nasoenteric, gastrostomy, or jejunostomy feeding in high-risk clients small-diameter transnasal tube elevate head of bed during and 30 minutes after feeding continuous drip method of delivery check gastric residual ＊ Stable patients, especially those on long-term feeding, do not need residuals checked regularly.

7 Prevention or correction of tube-feeding complications Clogged feeding tube Possible causes- formula too thick for tube medications Preventive/corrective measures- select appropriate tube size, dilute formula with water, flush tubing with water before and after giving formula use oral, liquid, or injectable drugs whenever possible; dilute thick or sticky liquid drugs with water before administering; crush tablets to a fine powder and mix with water; flush tubing with water before and after drugs are given; give drugs individually; do not mix drugs with formula

8 Prevention or correction of tube-feeding complications Dehydration and electrolyte imbalance Possible causes- excessive diarrhea inadequate fluid intake carbohydrate intolerance excessive protein intake Preventive/corrective measures- provide additional fluid use continuous drip administration of formula; monitior blood glucose; consider administering insulin; change amount or type of carbohydrate monitor blood electrolyte levels; reduce protein intake

9 Prevention or correction of tube-feeding complications Diarrhea, cramps, distention Possible causes- bacterial contamination; lactose intolerance; hypertonic formula; rapid formula administration; malnutrition/low serum albumin; drug therapy ＊ hyperosomolar medications- magnesium-containing antacids, sorbital-containing elixirs, electrolyte replacement supplements

10 Prevention or correction of tube-feeding complications Diarrhea, cramps, distention Preventive/corrective measures- use fresh formula every 24 hours; store opened or mixed formula in a refrigerator; rinse feeding bag and tubing before adding fresh formula; change feeding bag every 24 hours; prepare formula with clean hands using clean equpment in a clean environment. use lactose-free formula in lactose-intolerant and high-risk clients use a small volume of formula and increase volume gradually; dilute formula; use isotonic formula. slow administration rate or use continuous drip feedings use a small volume of dilute formula and increase volume and concentration gradually. use antidiarrheal agents; change drug, drug form, or dosage; if possible. soy polysaccharide, pectin, other fibers, bulking agents

11 Prevention or correction of tube-feeding complications Constipation Possible causes- low-fiber formula lack of exercise drug therapy Preventive/corrective measures- provide additional fluids; use high-fiber formula encourage walking and other activities change drug therapy if possible; give laxatives or enemas if indicated ＊ Diarrhea can coexist with constipation, usually when a patient is impacted.

12 Prevention or correction of tube-feeding complications Hyperglycemia Possible causes- primary medical condition diabetes, hypermetabolism, drug therapy Preventive/corrective measures- treat disorder check blood glucose; slow administration rate; provide adequate fluid; limit type or amount of carbohydrate; consider administering insulin.

13 Prevention or correction of tube-feeding complications Nausea and vomiting Possible causes- obstruction; delayed gastric emptying; intolerance to concentration or volume of formula; drug therapy; psychological reaction to tube feeding Preventive/corrective measures- discontinue tube feeding check gastric residual; slow administration rate, use continuous drip feedings, or discontinue tube feeding. use small volume of dilute formula and increase volume and concentration gradually; use continuous drip feeding. change drug, drug form, or dosage if possible; use antinausea and antiemetic drugs.

14 Prevention or correction of tube-feeding complications Skin irritation at enterostomy site Possible causes- leakage of GI secretions and friction caused by the tube Preventive/corrective measures- keep site clean; inspect area for redness, tenderness, and drainage; use protective skin cream. Note: Many of the complications presented here can be caused by the client’s primary disorder rather than the tube feeding.

Nutrition Assessment Functional GI tract No Yes Diffuse Peritonitis, intestinal abstruction, intractable vomiting, ileus, intractable diarrhea, gestrointestinal schemia Enteral Nutrition Parenteral nutrition GI function Long-term Gastrostomy Jejunostomy Short-term Nasogastric Nasodeudenol Nasojejunal Short-term Long-term or Fluid Restrition Peripheral PN Gastral PN GI function Returns YesNo Normal Compromised Standard Nutrients Speciality Formulas Nutrient Tolerance Adequate Progress to Oral Feedings Indequate PN Supplementation Adequate Progress to More Complex Diet and Oral Feedings as Tolerated Progress to Total Enteral Feedings Route of Administration of Specialized Nutrition Support

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