Skill 25

Enteral Nutrition via a Nasoenteric Feeding Tube

Enteral nutrition, or tube feeding, is a method for providing nutrients to patients who are not able to meet their nutritional requirements orally. As a rule, candidates for enteral nutrition must have a sufficiently functional gastrointestinal (GI) tract to absorb nutrients. Examples of indications for enteral feeding include the following:

• Situations in which normal eating is not safe because of high risk for aspiration.

• Clinical conditions that interfere with normal ingestion or absorption of nutrients or create hypermetabolic states: surgical resection of oropharynx, proximal intestinal obstruction or fistula, pancreatitis, burns, and severe pressure ulcers.

• Conditions in which disease or treatment-related symptoms reduce oral intake: anorexia, nausea, pain, fatigue, shortness of breath, or depression.

Gastric feedings are the most common type of enteral nutrition, allowing tube-feeding formulas to enter the stomach and then pass gradually through the intestinal tract to ensure absorption. In contrast, small bowel feeding occurs beyond the pyloric sphincter of the stomach, which theoretically reduces the risk for pulmonary aspiration, provided that feedings do not reflux into the stomach (Metheny et al., 2011).

Delegation Considerations

The skill of administration of nasoenteric tube feeding can be delegated to nursing assistive personnel (NAP). However, a registered nurse (RN) or licensed practical nurse (LPN) must first verify tube placement and patency. The nurse directs the NAP to: