Laboratory

Electrolytes, BUN/S,, giucose Calcium, magnesium, phosphorus Liver function tests Trace elements, vitamins

Prior to parting, then ongoing

Daily

Daily Daity Daiiy

As needed when delayed gastric emptying suspected Ongoing

Every 1 3 months

3 -I times/week Every 1 3 months

Weekly If deficiency/ toxicity suspected

Every 1 3 months If deficiency/ toxicity buspected

BUN, biood urea nitrogen; S |r, serum creatinine.

From Knopf VS. Chessman KH. Enteral nutrition. In DiPiroJT, Talbert rl , Yee gc,et aLr eds. Pharmacotherapy^ a pathophysiologic Approach, 7th ed. New York. McGraw-Hill, 200S.

Impaired gastric emptying is seen commonly in EN patients receiving gastric feedings and may be associated with nausea and vomiting. Impaired gastric emptying may be related to a disease process (e.g., diabetic gastroparesis or sequelae to head injury) or to drug therapy, most notably narcotics. Gastric residual checks frequently are measured in patients receiving gastric feedings (see Table 101-9). To accomplish such a check, a syringe is attached to the feeding device, and as much liquid as possible is aspirated into the syringe. Much debate is ongoing as to what constitutes a significant gastric aspirate, with numbers between 100 and 500 mL most commonly defended.4,38-40 Approaches to the patient with delayed gastric emptying might include changing to an enteral formula containing less fat because dietary fat is associated with slower gastric emptying. Metoclopramide often is given to patients receiving gastric feedings to facilitate gastric emptying. Erythromycin is an alternative medication that may be useful in stimulating gastric motility, although it also can be associated with potentially serious drug-drug interactions. Feedings by a PEG tube may be associated with a decreased risk of aspiration compared to NG feedings.40 Patients with consistently high gastric aspirates are considered to be at higher risk of aspirating feedings into their lungs and should be considered for transition to post-pyloric feedings. Postpyloric feedings may help relieve EN-related nausea and vomiting and are preferred for patients without an intact gag reflex. An important practice to help prevent aspiration is elevation of the head of the bed to at least 30 degrees during continuous feedings and during and for 30 to 60 minutes after intermittent and bolus feedings. Adding blue food coloring to tube feeding formulas to help detect aspiration in bronchial or tracheal aspirates has been largely abandoned due to reports of absorption of this supposedly-nonabsorbable substance in patients with sepsis.41

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