ARTIFICIAL FEEDING

Artificial feeding refers to

• Feeding by NGT
• Parenteral nutrition
• Preparation and administration of fluids to an infant
via a bottle
Enteral feeding / nutrition – commonly called tube feeding is
the administration of nutrients through the GIT when a
patient cannot ingest, chew or swallow but can digest and
absorb nutrients
Nasogastric or nasoenteric feeding – done for short periods
of time (usually less than 30 days)
 Passed through the nose /mouth with end in either stomach
or small bowel
• Gastrostomy or jejunostomy feeding – for patients
with long term needs/ who do not have easy access to
GIT through the mouth or nose or who have
contraindications for oral or nasal insertion
• Methods of placement – endoscopy / radiological
placement/surgery
INDICATIONS FOR ENTERAL FEEDING
• Nutritional deficit resulting from reduced food
ingestion even when physically capable of eating
(confused patients/ patients with head injury)
• Patients with impaired gag reflex (suffered a stroke)
• Obstruction of oesophagus eg neoplasm
• Oesophageal fistula
• Preoperative preparation of malnourished patients
• During radiotherapy treatment
• Postoperatively for patients who have had some types of
oral or oesophageal surgery
• Unconscious patients
• Patients with severe burns
TYPES OF FEEDING TUBES
 NGT : These can either be inserted for each feeding or
remain in place for a set period of time.
 GT: Gastrostomy Tube: surgically inserted through the
stomach wall, leaving one end accessible on the
abdomen and the other in the stomach
 Gastrostomy button – useful for person wanting
minimal alteration in body image
• Gastro-Jejunostomy Tube : surgically inserted through
the stomach wall, entering the stomach, passing
through the pylorus, and ending in the jejunal
segment of the small intestine. Are generally indicated
for children who cannot tolerate food in their stomach
• Jejunostomy Tube : Similar to the GT, except it is
surgically inserted through the abdominal wall directly
into the jejunal section of the small intestine
 Naso gastric tube feeding
• It is the administration of feed directly into the stomach through the
nose or mouth

• Purpose
• To provide adequate nourishment to patients who cannot feed
themselves
• To administer medication
• To provide nourishment to patients who cannot be fed through the
mouth eg surgery in oral cavity, unconscious or comatose state
Jejunostomy Tube
Gastrostomy Tube
• Indication
• Head and neck injury
• Coma
• Severe anorexia nervosa
• Recurrent episodes of aspiration
• Increased metabolic needs – burns, cancer
• Poor oral intake
• Requisites
• The required feed
• Graduated container
• Large syringe (30-60 ml)
• Water in a container
• Stethoscope
• Kidney tray
• Towel
• Gloves
• Procedure
• Identify patient, explain procedure and that feeding will take around
10-20 minutes to complete
• Assess time of last feed
• Assist patient to fowler’s position
• Wash hands
• Spread towel over patient’s chest
• Wear gloves and attach syringe to NGT
• Check tube placement
• Aspirate stomach contents
• If residual contents are within normal limits return gastric contents to
stomach
• Pinch the feeding tube and attach barrel of feeding syringe to tube
• Fill syringe barrel with 30 ml of water and allow the fluid to flow by
gravity by raising barrel above patient’s head
• Pour feed into barrel and allow to flow by gravity. Pinch tube when
pouring feed
• When feeding is completed flush tube with at least 30 ml water
• After tube is cleared close end of feeding tube
• Keep head of bed elevated for 30-60 minutes after feeding
• Care of equipment. Wash hands
• Document type and amount of feeding, amount of water given and
tolerance of feed
• Monitor for breath sounds, bowel sounds, gastric
distension, diarrhoea, and constipation
• Instruct patient to inform nurse if experiencing
sensation of fullness, nausea and vomiting
Feeding through gastrostomy/jejunostomy tube
Also known as percutaneous gatrostomy tube
 Definition
• The administration of food in fluid form through a gastrostomy or
jejunostomy tube which is placed through a surgical opening into the
stomach or jejunum
 Purpose
• To maintain nutritional status of a patient whose upper
gastrointestinal tract is bypassed
 Requisites
• Disposable gavage bag and tubing
• 60 ml syringe
• Stethoscope
• Feeding formula
• IV pole
• Administration set
 Procedure
• Identify patient and patient’s need / assess for allergies / explain
procedure
• Check physician’s order for formula, rate and frequency
• Assess gastrostomy site for skin breakdown and irritation
• Wash hands
• Prepare bag and tubing to administer feed
• Connect tubing and bag and fill bag and tubing with feed
• Fowler’s position or elevate head of bed 30 degrees
• Check placement of gastric tube. Aspirate gastric secretions and check
gastric residual contents
• Start feeding (i) bolus or intermittent feeding
-pinch proximal end of gastrostomy tube
- attach syringe to end of tube and elevate to 18 inches above the
patient’s abdomen
- fill syringe with formula. Allow syringe to empty gradually and refill it
until prescribed amount has been delivered to the patient
• If gavage bag is used attach bag to the end of the feeding tube and
raise bag 18 inches above patient’s abdomen. Fill bag with prescribed
amount of feed, allow bag to empty gradually over 30 minutes
(ii) continuous drip method
- hang gavage bag to IV pole
- connect end of bag to the proximal end of the gastrostomy tube
- connect infusion pump and set rate
• When tube feedings are not being administered, clamp the proximal
end of the gastrostomy tube
• Administer water via the feeding tube as ordered with or between
feedings
• Rinse bag and tubing with warm water after bolus feeding
• Change gastrostomy exit site dressing as needed. Every shift to
inspect exit site. Clean ostomy site dailywith soap and warm water. A
small gauze dressing may be applied to exit site
• Dispose of supplies and wash hands
• Evaluate patient’s tolerance of tube feeding
• Monitor intake and output on every shift
• Observe stoma site for skin integrity
• Record amount and type of feeding, patency of tube and any
untoward effects
• Report to charge nurse the type of feeding, status of
gastrostomy tube, patient’s tolerance and adverse effects
COMPLICATIONS OF TUBE FEEDING
NG tube
• This may cause nasopharyngeal discomfort and later nasal erosions,
abscesses and sinusitis
• Acute complications such as pharyngeal or oesophageal perforation
and bronchial insertion
• If longer use oesophagitis, oesophageal ulceration and stricture
• Percutaneous gastrostomy or jejunostomy tubes - can lead to
complications related to endoscopy plus bowel perforation and
abdominal wall or intraperitoneal bleeding.
• Post-insertion complications include stoma site infections, peritonitis,
septicaemia, peristomal leaks, dislodgement and gastrocolic fistula
formation.
• Infection
Bacterial contamination of enteral feed can cause serious infection.
Administration sets and feed containers should be discarded every 24
hours to minimise the risk of infection. Feeds should never be decanted
and equipment should not be handled.
 Gastro-oesophageal reflux and aspiration
Reflux occurs frequently with enteral feeding, particularly in
patients with impaired consciousness, poor gag reflex and
when fed in the supine position. Patients should be propped
up by at least 30° whilst feeding and should remain in that
position for a further 30 minutes to minimise the risk of
aspiration. Post-pyloric tubes should be used in unconscious
patients who need to be nursed flat.
• Gastrointestinal symptoms - such as abdominal bloating, cramps,
nausea, diarrhoea and constipation are common.
REFERENCES
• American Society for Parenteral and Enteral Nutrition, 2011).
THANK YOU