Enteral feeding: how can nutrition professionals help

Enteral nutrition can be used when patients cannot meet their nutritional needs through oral intake. Here’s how dietitians can provide nutrition support through tube feeding.

Nutritional support can be delivered in multiple ways, but this isn’t always the case for everyone. Some people may require more specialized nutrition care, and in these situations, patients will need parenteral nutrition (TPN) or enteral nutrition (tube feeds) to satisfy their needs. 

Many people on the healthcare team play a key role in providing support to someone on enteral feedings. This includes dietitians, as they ensure the patient gets the nutrition they need to support their overall health. 

Here’s how dietitians can provide nutrition support for patients on enteral feeding. 

Note: if you don’t have experience with enteral nutrition, it’s important to work with someone who is more skilled in this area.

What is enteral nutrition?

Enteral nutrition is when nutritional support is given directly into the stomach or intestine through a feeding tube. In cases where enteral nutrition is used for a short period of time (less than 4 weeks), a nasogastric (stomach) or nasoenteral (intestines) can be placed by a trained medical staff member. Patients with long-term nutritional support needs will have a permanent tube placed while under general anesthesia.

Who would benefit from enteral nutrition?

Enteral nutrition is indicated for those patients who are unable to meet some or all of their nutritional needs from oral intake. This includes patients undergoing treatment for head and neck cancers, those who have been diagnosed with neurological conditions, patients who have suffered a stroke, those with amyotrophic lateral sclerosis (ALS), and patients with dysphagia. It can also be used in trauma situations where the patient is unconscious for an extended period of time or there is an injury to the gastrointestinal system. 

Parenteral nutrition can provide support as well, however, it is not the preferred delivery method. Parenteral nutrition is generally only used for short periods of time (2-3 days), or in situations where there is trauma to the GI tract or it is not functioning.

How is tube feeding supplied?

In a hospital setting, there are typically more options available for feeding methods. Having access to a pump means that feedings can be given continuously or intermittently at slower rates. Hospitals also have multiple formulas available specific to certain disease states and patient needs. Most commonly, tube feeding is a special liquid food mixture that contains protein, carbohydrates (sugar), fats, vitamins, and minerals, and is given through a tube into the stomach or small intestine.

For those using enteral nutrition at home, they will most likely have to use gravity or bolus feeds as insurance may not cover a pump. Clients may also be limited in what formula they are able to get and some may choose home-blenderized formulas. 

In those patients using home enteral nutrition, the role of the dietitian is vital to ensure the feeding methods are safe and effective, well tolerated, and fit into their daily routines and schedules.  

How can you help as a nutrition professional?

People need food to live, so as a dietitian, you can help patients get the nutrition they need to support their overall health. Here are some ways in which you can help. 

Identify patients who would benefit from nutrition support

People who are at nutritional risk or are malnourished and have a functioning GI tract are the most likely candidates for enteral nutrition. 

Be sure to consult with the rest of the care team, as they will help determine which patients would benefit from nutritional support and their specific needs. This would involve physicians, speech-language pathologists, and occupational and physical therapists. 

Monitor people regularly

Patients should be monitored regularly to ensure that they are getting enough calories, are not malnourished, are tolerating the prescribed formula, and are maintaining the feeding tube. 

Improve knowledge

Dietitians should regularly review enteral feeding products, systems, and medical literature to stay on top of the most current recommendations. Furthermore, nutrition science is constantly evolving, so dietitians play an important role in the new discoveries and development of new products. 

TIP: Check out this article to get to know how to stay up-to-date as science and trend evolve

Offer education materials

Providing education for clients and caregivers gives them the best opportunity to be successful. The only way patients can safely use home tube feeds is if they have been well educated on the proper use and care. After providing the patient or caregiver with enteral nutrition education, it is a good idea to have them demonstrate how they will use the pump. 

Advocate for your patients

Standardization of feeding systems and hospital procedures should be reviewed and evaluated regularly. As new formulas come to the market, you should determine if a change would benefit your patients and if a switch would be cost-effective for the facility. As a nutrition professional, you should be part of the decision-making process.

What are the complications of enteral nutrition?

Even though enteral nutrition is generally well tolerated and can meet nutritional needs, some patients may experience gastrointestinal discomfort, nausea, or diarrhea. It is important to rule out other potential causes such as medications before changing or discontinuing tube feeding. 

However, some people may experience more serious complications, like aspiration, refeeding syndrome, and infection. Other complications can include a clogged tube, which can be remedied by flushing the tube with warm water.

As such, it’s essential to check for proper tube placement and monitor lab values, especially when first starting a patient on tube feeds. 

Summary

Enteral nutrition can be used when patients cannot meet their nutritional needs through oral intake. These patients should be identified by dietitians and the entire care team and monitored carefully by the entire staff. The dietitian plays an important role in ensuring the patient gets the nutrition they need to support their overall health.

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References

1. What is Enteral Nutrition. Retrieved November 16, 2022 from http://www.nutritioncare.org. 
   
   
2. Enteral Feeding: How it works and when it’s used. Retrieved November 16, 2022 from http://www.healthline.com. 
   
   
3. Parenteral Nutrition. Retrieved November 16, 2022 from http://www.my.clevelandclinic.org. 
   
   
4. The Ultimate Nutrition Support Guide for Dietitians. Retrieved November 16, 2022 from http://www.dietitiansondemand.com. 
   
   
5. ESPEN guideline on Home Enteral Nutrition. Retrieved November 16, 2022 from http://www.espen.org.