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This course was written by Cade Fields-Gardner, MS, RD, LDN, CD, a registered dietitian with over 25 years experience in dietetics and nutrition. Ms. Fields-Gardner has worked with tube fed patients in all settings from acute care to home care, working as a member of the Nutrition Support Team and acting as a patient liaison. This program has been edited for presentation by Hi-R-Ed Online, a continuing education program development company. Hi-R-Ed Online is an accredited provider of continuing education courses for nurses, case managers, social workers and registered dietitians.

 

The focus of today’s program is a discussion of the management of the home tube feeding patient. We will examine initiating tube feeds in the home, as well as potential complications and .

Let's begin with our learning objectives.

Learning Objectives

The Learning Objectives for this course are fairly straightforward. While we will assume you may have some knowledge of tube feeding, we will cover some of the basics as we delve a little deeper into initiating feedings and managing patients.

 

The purpose of setting learning objectives at the beginning of the course is to set the framework and goals for the information that we will cover.

 

Once the course is completed you should be able to

1. List at least 2 criteria for home enteral nutrition

2. List at least 2 potential complications of home enteral nutrition

3. Provide management suggestions for at least 1 complication that can be performed by the home enteral patient or caregiver

 

Introduction

Tube feeding can be a life-saving, life-sustaining therapy. It can be used as a supplement for children or adults who cannot consume enough regular foods to survive well. Good nutrition and hydration can be provided through tube feeding during recovery phases, pre-procedure restoration of nutrition and hydration status, to specifically address nutrient needs during diseases or other conditions, or while overcoming other barriers to adequate consumption, absorption, and/or the utilization of nutrients from foods.

Let’s start with definitions of some of the terms we will be using, including enteral nutrition, tube feeding, medical foods, and transitional feeding. According to the American Society for Parenteral and Enteral Nutrition (ASPEN), enteral nutrition is the consumption (or enteral administration) of nutrients through a tube, catheter, or stoma. This is sometimes called “tube feeding”, which may be more specific to feeding through a tube that is inserted into the esophagus, stomach, duodenum, or jejunum. Other terms may include enteral tube feeding, nasogastric feeding (a tube placed in the nose that is inserted into the stomach), gastrostomy or jejunostomy (a tube placed through a stoma into the stomach or jejunum), or other terms that can more specifically describe the placement of the tube and method of feeding.[1]

Medical foods are those formulas that are designed to assist in the management of specific diseases or conditions that are administered orally or enterally (beyond the mouth).

Definitions and terminology

Enteral nutrition (EN)/tube feeding (TF): Nutrition provided to the GI tract via a tube, catheter, or stoma beyond the mouth.

Medical food: A formulation consumed or administered enterally under the supervision of a physician, intended for dietary management of disease or condition. (Orphan Drug Act, section 5(b))

Transitional feeding: Progression of feeding methods with continuous  levels of nutrients.

 

There are a number of ways to describe feeding methods, including nocturnal feeding – which is feeding during sleeping hours. In the case of transitional feeding, tube feeding may be used to transition from parenteral feeds (which are nutrients directly infused into the bloodstream) or as supplemental feeding support while transitioning to oral intake of foods.

 

1. Enteral Nutrition Practice Recommendations Task Force. Enteral Nutrition Practive Recommendations. JPEN. 2009;33(2):122-167.

 

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