Gastric Feeding

Gastric feedings are used commonly. They require an intact gag reflex and normal gastric emptying for safety and success. Certain patients, such as those who have suffered head trauma, may not empty their stomachs efficiently and therefore may not be good candidates for gastric feedings. In these patients, it may be impossible to achieve a gastric tube feeding rate to provide adequate nutrients. In addition, pooling of formula in the stomach could increase risk of aspirating feeding formula into the lungs.

The NG route is used most commonly for short-term (less than 1 month) enteral access. The major advantage of this route is that the tube can be placed quickly and inexpensively by the nurse at the bedside.

Gastrostomy tubes, where an incision is made directly through the abdominal wall, are indicated for patients who can tolerate gastric feedings but in whom long-term (greater than 1 month) feedings are anticipated. The most commonly placed gast-rostomy tubes are PEG tubes placed endoscopically. Gastrostomy tubes also can be placed laparoscopically or during an open procedure by a surgeon. Placement of a gastrostomy tube either endoscopically or surgically is more expensive than bedside OG or NG placement but does result in placement of a larger bore tube.

An advantage of feeding into the stomach is that the feedings can be delivered either intermittently or continuously.

FIGURE 101-2. Access sites for tube feeding. (From Kumpf VJ, Chessman KH. Enteral nutrition. In DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy: A Pathophysiologic Approach, 7th ed, New York: McGraw-Hill, 2008:2403.)

Table 101-4 Options and Considerations in the Selection of Enteral Access

Indication»

Tube Plnccmfnt Opt^ri*_

Naiogastric or oro^Blric

^hüfttefm tuat! yjy iefk?K

um plying ymfl-term knpaktd gastric metikly a plying INqTi ffcltcfGEAqf jyjiuliufi

Manually al bids*)!'

Manual« bixJiids f I i lOt (>K<ififJify Ertioittipitdllv t Jio of pl.v.iirtonc Alkjm fin jll nncthoch of

^niHftijllgn taiipaiibe

Mnlrii W Jvjiljt^t

PtKcnLial rrducod dspiutbn list AJk>*ri lot <-.li[y poitoper Jliw Iccding HuHifit commeitüiiy jvMiidfe mlio*. ,irni sr?n hit«j1ial tut» diipläcpnicnl i'llhi iltjl inCTL^IK-d Ji|JilJtlOfl I iil(

Manual rrjnupjtdic PkM^wjo wiulr^f gi(v>H itijfl PoWliJl (ufct displace™™ or clogging

Goluf (X nilCTiliil [HrrVI feeding not talpialpd

GaitfOitomy

JejulWilüffiy loog-teim

HCiinjliKnilrii em plying

L[>Vj-t<?iirt knpefced gastric ii>ui ilily □< (jjslrit flim pi yi nq Hiijh rükofGfRor jivirjriofi

Swgcally EnttoitopKafly

RadMoi^iy

Lap^oscoocally

Surgically

FtaRrtxjkally

Allows for all methods ct fttituurim

I arge-bcie tut**: le« Mil/ 1q < kyi Multiple commercially available tubes aiyi tize-i low- profile buttons available AlKwi föitiily [jjllii'ijui'v <x poitgperaiiw* feeding PWential reduced asuiution risk Multiple L'iMïlitlMi i.llly av.ïil.lHi tubes, and ürei

Attfndant n^k: Associated nimcathTifpeaf procedure Potential Increased aspiration iiJi Requires stoma site cae AïKiidam liiki with each Tflje of procedure1 (jctii 01 ¡mofmitwm feeding not tolerated IkHjuirCv itortu il w tt K. qj1?! lot-jdrluyiiil lefhut

Fiom Kumpt it, Chciwnan Kit. interjl nulrition. In DiPiio JT, falbtrl RL. VeeiiCet jl. eds. Ftarmacoihcrjuy: A PaUioptiyMnlogt Appicuth. 7th ed. Nm YMeMoGtw<HllL ^atui

This is unlike feeding directly into the small bowel, where continuous feedings must be used. Intermittent feedings into the small bowel result in GI intolerance in most patients.

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