Administration of enteral nutrition (EN) has long been considered the standard of care for nutrition support among patients unable to meet energy and protein requirements orally. Enteral nutrition (EN) is defined as nutrition provided through the gastrointestinal (GI) tract via a tube, catheter, or stoma that delivers nutrients distal to the oral cavity. Normal digestion occurs when food is broken down in the stomach and bowel, then absorbed in the bowel. These absorbed products are carried by the blood to all parts of the body.
Tube feeding or enteral nutrition is when a special liquid food mixture containing protein, carbohydrates (sugar), fats, vitamins and minerals, is given through a tube into the stomach or small bowel.
Water is the most abundant substance in the body, accounting for 50%-60% of body weight. The goal of fluid management is to maintain adequate hydration, tissue perfusion, and electrolyte balance.
Today, more than 100 enteral formulas are available for use in the United States and vary greatly with respect to concentration, macronutrient and micronutrient composition, fiber content, and the addition of substances intended to balance the immune response.
Enteral nutrition formulas are available in liquid or powder form (which is reconstituted with water). The liquid solution is administered through a tube, which is threaded through the patient’s nose or a surgical opening that leads directly to the stomach or intestine. Liquid enteral nutrition formulas are packaged in cans and pre-filled sterile containers. A canned formula is emptied into a plastic bag or container, which is then connected to tubing and hung from an IV pole for administration. Unlike cans, the pre-filled sterile systems do not require transfer of formula from one container to another. A pre-filled container is “spiked” with tubing and then hung from an IV pole for administration.
Nutrition delivered by enteral tubes can cause the following complications: food entering the lungs, constipation, diarrhea, improper absorption of nutrients, nausea, vomiting, dehydration, electrolyte abnormalities, high blood sugar, vitamin and mineral deficiencies, and decreased liver proteins. Feeding tubes inserted through the nose, such as nasogastric or nasoenteric tubes, can cause irritation of the nose or throat, acute sinus infections, and ulceration of the larynx or esophagus. Feeding tubes inserted through the skin of the abdominal wall, such as gastrostomy or jejunostomy tubes, can become clogged (occluded) or displaced, and wound infections can occur.
It is important to routinely monitor patients at risk for malnutrition and to initiate safe, timely, and adequate Enteral Nutrition therapy when indicated.
Department of Health and Human Services
ASPEN American Society of Parenteral and Enteral Nutrition
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