Background

A survey completed in 2004 by the National Nursing Home Survey suggested that approximately 1.5 million patients have used feeding tubes. According to the National Center for Health Statistics in 2000, tube feedings were given during approximately 245,000 hospital stays to a range of age groups, from newborn to older adults. Enteral nutrition is often administered in the home setting and in the 2000 NHHC survey, nearly 31,000 patients received tube feeding in this setting.[2]

 

This course will review the following topics related to managing home tube feeding patients:

 

1. Indicators or criteria for home enteral nutrition.

2. Potential complications of home enteral nutrition.

3. Prevention and management of potential complications in home enteral nutrition, including things that patients and their caregivers can do to prevent and solve minor problems that may occur.

 

We will limit this presentation to the discussion of adult patients. This presentation will provide a general summary on tube feeding indications, nutritional needs, formula selection, and tube placement. We will concentrate on potential complications, patient and caregiver training and education, and the prevention and solutions for complications.

 

Indications for Home Enteral Nutrition

We already know the criteria for choosing tube feeding as a means to deliver hydration and nutrients to the body. As a review, the criteria includes a functioning gastrointestinal or “GI” tract with sufficient length and absorptive capacity as well as the inability to consume adequate nutrition through the oral route. It should be noted that patients who have less than 100 cm of jejunum and 150 cm of ileum functioning, or the lack of an intact ileocecal valve may not be candidates for enteral feeding. If a patient is expected to eat adequately within about 5 days or has a condition that makes any form of enteral nutrition unreasonable (such as high output proximal fistula, mechanical obstruction of the GI tract, the inability to gain enteral access, intractable vomiting or diarrhea, or severe acute pancreatitis), then they may not be a candidate for enteral nutrition. Enteral nutrition may be considered aggressive therapy and in cases where such therapy is not warranted, it may be contraindicated.

If a patient is a candidate for tube feeding, in many circumstances this can be achieved in the home setting.

Now, let’s discuss the indications for home tube feeding and patient selection. An assessment of the following are important prior to initiating or transitioning tube feeding into the home setting:

 

 

More specifically, a patient’s home environment needs to be clean with a sanitary water supply, electricity, refrigeration, storage space, and access to a telephone. The patient and/or caregiver should be willing and able to perform the therapy and any associated procedures. They should be well-informed, able to demonstrate their knowledge, and agree on the rational, goals and options, risks and benefits, and all responsibilities (including financial ones). And should be able to troubleshoot minor problems and call for assistance with complications happen. Any patient who is deemed not to be a candidate for home tube feeding should be provided with alternative settings and choices to receive needed nutrition support.

The patient should also be medically stable, not requiring hospitalization or institutionalization, though that may be an intermittent need in some cases. Rehabilitative potential can be related to cognitive function, medical status, motivation, social support, economic resources, and the potential for withstanding therapies and achieving a positive response to therapy. Overall, appropriate goals and objectives should be set for the therapy or therapies administered.

 

 

2. Bercovitz A, Decker FH, Jones A, Remsburg RE. End-of-Life Care in Nursing Homes: 2004  National Nursing Home Survey. National Health Statistics Reports. No. 9. Hyattsville, MD:National Health Statistics Report. 2008. Available at: http://www.cdc.gov/nchs/data/nhsr/nhsr009.pdf.