Term
| What are contraindications to EN? |
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Definition
- Expected duration of EN therapy <5-7 days in malnourished adult or <7-9 days in adequately nourished adult
- EN support is not desired or warranted
- Non-functional GI tract
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Term
| How should GI bleeds be handled with enteral nutrition? |
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Definition
| Patients with severe GI bleeds should not receive enteral nutrition support |
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Term
| Patients should be considered for a permanent EN access (as opposed to temporary access) if duration of EN feeding is expected to be longer than what duration? |
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Definition
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Term
| What are the required components of an EN order set? |
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Definition
- Patient identifier
- Formula name
- Enteral access device and site
- Administration method and rate
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Term
| What are important components of an EN protocol? |
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Definition
- Strategies to minimize risk of feed contamination and risk of regurgitation and aspiration
- What nurse should do in specific situations (management of residuals, initiation and advancement, etc)
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Term
| For which types of patients is continuous feeding the method of choice? |
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Definition
- Critically ill
- Intubated for respiratory failure
- At risk of refeeding syndrome
- Porr glycemic control
- Jejunal feedings
- Intolerance to bolus feeds
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Term
| What is the minimum infusion time for cycled feeds? |
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Definition
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Term
| What differentiates intermittent feeding vs bolus and gravity drip feeding? |
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Definition
| Intermittent feeds are given over 20 to 60 minutes. Bolus or gravity drip feeds are given over a very short period of time (4 to 10 minutes). |
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Term
| Do patients on intermittent feedings need to receive feeds at night? |
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Definition
| No. They can receive all of their feeds during the day. |
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Term
| Should medications or modulars be added directly to the tube feeding formula? |
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Definition
| No. They should be administered separately. |
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Term
| How should tube feeding placement be confirmed prior to feeding initiation? |
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Definition
| Radiography is the only reliable method. Ausculatory method is not recommended. |
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Term
| What should be done after the initial radiograph to determine if the tube placement should be re-checked after a patient vomits or pulls the tube? |
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Definition
| The exit site/length of the feeding tube should be marked |
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Term
| What is the recommended routine flush volume and frequency to prevent tube feeding occlusions? |
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Definition
| 20 to 40 mL water every four hours during continuous feeds or before and after each bolus feed |
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Term
| What is the superior solution for flushing feeding tubes? |
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Definition
| Water (and more specifically sterile water) |
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Term
| Why is flushing a tube with cranberry juice or soda inferior to using water? |
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Definition
| The acidic pH can alter the consistency of the formula's proteins and promote clogging |
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Term
| What is the optimal medium for attempting to clear tube occlusions? |
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Definition
| Warm water. Other solutions can damage the feeding tube. |
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Term
| What is are the preferred diluents for EN medication administration and why? |
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Definition
| Purified water or saline are preferred. Tap water can contain contaminants that can react with medications. |
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Term
| Is cessation of enteral feeds while repositioning patients necessary? |
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Definition
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Term
| How long should EN feeding be delayed after PEG placement? |
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Definition
| 2 hours rather than the routine 24-hour delay |
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Term
| What is the recommended positioning for patients on EN to prvent aspiration? |
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Definition
Head of bed elevation of 30-45 degrees or reverse Trendeleburg if patient is unable to tolerate elevation of back rest
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Term
| How can tube placement be altered to prevent risk of aspiration? |
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Definition
| Post-pyloric feeds likely reduces risk of aspiration |
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Term
| How does the hang-time for reconstituted enteral formulas compare with the hang time for conventional formulas? |
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Definition
| Hang time is 4 hours for formulas reconstituted from powder and 8 hours for formulas reconstituted from liquid |
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