NUTRITION IN SURGICAL CONDITIONS: TUBE FEEDINGS

NUTRITION IN SURGICAL CONDITIONS: TUBE FEEDINGS
A tube feeding is a nutritionally adequate allowance of liquefied foods that can be administered through a tube in the stomach or duodenum. A tube feeding is used in paralysis or obstruction of the esophagus, in anorexia nervosa, following mouth or gastric surgery, in severe burns, for unconscious patients, or in any situation where the patient is unable to chew or swallow.
Most hospitals now use commercial tube feedings, including blenderized feedings, milk-base formulas, lactose-free formulas, and synthetic residue-free formulas.
A milk-base formula may be prepared in the hospital or home. It is a calculated recipe that consists of whole or skim milk, eggs, some form of carbohydrate such as strained cooked cereal, sugar, or molasses, and vitamin supplements.
The protein content is sometimes increased by adding nonfat dry milk, and the calories can be increased by substituting cream for part of the milk.
A blenderized formula consists of strained baby meats, fruits, and vegetables in addition to the foods used in a milk-based formula. These formulas are generally better tolerated than milk-based formulas. They may also be varied from day to day to change the flavor, which many patients say they can taste. When there is intolerance to milk, an adequate formula can be developed that is milk-free.
Tube feedings are generally planned to supply one kilocalorie per milliliter. Thus a daily intake of 2 liters will furnish 2000 kcal.
The nurse should observe the patient carefully for the first few days after initiating a tube feeding, and be aware of complaints such as a feeling of fullness, gas, regurgitation, cramping, and diarrhea. Most if not all of these can be avoided by taking certain precautions. Initially tube feedings should be given at half to two-thirds strength, and in small volumes such as 30 to 60 ml every hour. When it is evident that the patient tolerates the feeding, the concentration and the volume can be gradually increased until the desired calorie level is reached.
Some tube feedings are not well tolerated because they contain excess sugars, amino acids, and electrolytes that draw fluid from the blood circulation into the intestine. The patient complains of weakness and distention. When the protein intake needs to be high it is important that adequate fluids be supplied so that the nitrogenous wastes can be efficiently excreted by the kidney. Some patients do not tolerate lactose and require feedings that do not contain milk.
Tube feedings are an excellent medium for bacterial growth. Feedings should be kept under constant refrigeration once they have been prepared or when a proprietary product has been opened. Any formula remaining at the end of a 24-hour period should be discarded. The tubes must be thoroughly flushed out.
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GENERAL HEALTH

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