Enteral nutrition

Enteral nutrition is the administration of special food preparations directly to the digestive tract through the use of systems that avoid swallowing. These systems are usually tubes that go from the nose to the stomach (nasogastric tube), from the nose to the small intestine (nasojejunal tube), or directly to the stomach from the outside (gastrostomy).

These systems are used when swallowing has become impossible or dangerous, due to tumor problems (obstruction, fistulas, etc.), neurological problems in swallowing coordination, prolonged unconsciousness, great nutritional needs (large burns, for example). Enteral nutrition can be partial, with nocturnal administration, when oral feeding is maintained, or complete, when it cannot be carried out.

Enteral feeding is the artificial food administration system that most preserves the natural mechanism, maintains digestive and liver function, and is therefore the most appropriate type of assisted feeding for geriatric patients.

Nasogastric and nasojejunal tubes are used when their use is expected to be less than 6 weeks; in recoveries from surgery, burns, cerebrovascular accidents or severe malnutrition. When it is predicted that the swallowing problem or the need that has led to the placement of the tube will last beyond 6 weeks, it is advisable to place a gastrostomy tube, since it is less bothersome for the patient (avoids the sensation of a foreign body in the pharynx and reduces the risk of aspiration of oropharyngeal secretions).

In both cases, the foods that are administered through the tube are special preparations, with a liquid texture so that the tube is not blocked. They can be complete, ready for the digestive system to digest (as if it were a regular grind, only much finer and more homogeneous); elementals, which are already predigested; modular, which only have one type of nutrient (carbohydrates, proteins). There are also diets designed for specific needs: diabetics, kidney failure, rich in fiber, liver failure, hypercaloric, etc. Food can be given in several ways: intermittently by syringe or by gravity (like serum), in the case of tubes going to the stomach, or by continuous passage regulated by an administration pump, if the tube is going to stop. to jejunum.

Complications that can occur in enteral feeding are usually:

• Vomiting and diarrhea in the case of inadequate rate and quantity of administration.
• Aspiration of secretions from the mouth and pharynx into the bronchi, in the case of nasal tubes.
• Irritation of the skin in the area of ​​introduction of the tube (abdominal stoma in gastrostomies, or wings of the nose or palate in those of nasal passage).

To avoid them, it is important to follow some tips and rules of use:

• For nasogastric or nasojejunal tubes:
  • Clean the nose and tube with soap and water, dry well, moisturize with creams to avoid pressure injuries (decubitus).
  • Daily change of the fixing tape.
• For gastrostomies:
  • Clean with soap and water and apply povidone iodine around the tube, drying well.
  • Gently rotate the tube to avoid lying on the stomach.
  • Change dressings daily.
• General rules:
  • Maintain mouth and teeth hygiene (brushing, rinsing, removal of secretions). Moisturize lips with petroleum jelly or cocoa butter.
  • Pass 50cc of water before and after each food administration.
  • Check that the feed rate is slow, approximately 30cc per minute, or that recommended by the medical team in the case of gravity feeding or infusion pump.
  • Incorporate the patient about 45º or sit him down, keep him in this position for at least one hour (avoid reflux of food).
  • Give medication separately from food. Use only liquid presentations (not effervescent).

It is important in all cases to respect the feeding administration guidelines, individualized in each case, and to administer the recommended amount of water and increase it in situations of high heat or feverish processes. And if you have any doubts, ask the medical team to monitor the patient.