Question

Nutritional support is instituted when a person is unable to meet nutritional needs orally. Identify two problems that can occur with tube feeding and discuss the causes and the actions that are needed to resolve the problem.

Answer 1

Tube feeding plays an important role in patients who can’t take food orally, with a neurological dysphagia or gut dysfunction, or in critical patients. In addition to benefits, there are some problems associated with tube feeding which are as follows:

1. Aspiration: many factors like high gastric residual volume, Supine positioning or presence of Tracheostomy  tube can lead to increased risk for aspiration. to reduce this risk, monitor gastric residual volume every four hourly, stopping feed in case of more gastric aspirate, elevating The head of the bed while feeding the patient.
2. tube malpositioning: to reduce this problem, tube should be placed by experienced personnel  and position should be confirmed radio graphically.
3. Refeeding syndrome: it is body‘s reaction to the digestion after depleted electrolytes shift from the serum to the intra cellular space, it may cause life-threatening arrhythmias and multisystem dysfunction. patients with sustained malnutrition are at risk for this syndrome. To reduce the risk of re-feeding syndrome, supplements may be ordered for parental administration before tube feeding begin. Taper micronutrient supplements as the tube feeding goal rate is achieved.
4. Fluid imbalance: most patients need supplemental free water flushes to maintain adequate hydration. Be aware that some patients are at high risk for fluid overload so Care should be taken while flushing the tube depending on fluid status of patient.
5. Medication related complication: some drugs containing sorbitol can cause hyperosmolarity and diarrhoea. Some medications may cause clogging.
   To prevent clogging, maintain proper tube maintenance and flushing.