NVQ evidence

Tube feeding

Sometimes, individuals are able to eat and drink using the normal method. Continue to be nourished and hydrated, without resorting to intravenous chemotherapy, enteral feeding is considered. This involves the insertion of a tube attached to a bottle of specially formulated nutritional liquid. This is usually delivered using a specially designed electric pump.

There are two main routes by which enteral feeding can be delivered. These include:-

• Nasogastric
• Percutaneous endoscopic gastrostomy (PEG)

Nasogastric feeding

A fine bore tube with a counterweight on the end of it and a small hole at the end is inserted through the nose. When the client feels it at the back their throat they are encouraged to swallow it. It then enters stomach. Its position needs to be confirmed by X-ray.

This method can be a good way of delivering nutrition to a compromised person. However, despite being as non invasive as a peg tube, it has two major disadvantages. Firstly, it cannot be used on individuals who cannot not swallow or have scoring difficulties. Nor can it be used with individuals who are disorientated and unable to follow instructions. Secondly, due to the fine poor nature of the tube, feed may become encrusted with him the tube.

PEG Feeding

Percutaneous endoscopic gastrostomy or PEG tube is inserted directly into the stomach through the walls of the abdomen. The tube is of a wider lumen thus is less susceptible to blocking than nasogastric tubing. The client does not need to be as orientated, although total disorientation in a client who has a peg may result in accidental removal of the tube, and an inability to swallow may not preclude the insertion of a peg tube.

With peg tubing, The client has to be fit enough to undergo a general anaesthetic, which is not a problem of nasogastric feeding. Unto require peg feeding are usually quite compromised anyway so a general anaesthetic can be quite traumatic to an individual.

Another issue with peg feeding is to to goes directly through a wall of the abdomen into the stomach. This is a portal of infection. Due to the compromised nature of individuals who usually require peg feeding, this can be another problem for them to deal with. The side around the port of entry of the peg tube should be kept clean and dry. Research has shown that unless there is actual clinical need for it, such as a wound or infection, no dressing should be applied to the site as this is more likely to harbour infection. Care should be taken to observed daily for redness of swelling around the site.

In my present role, I have a very limited role with regard to enteral feeding. It at present, this constitutes observing around the peg site for signs of infection etc and noting to see if a clients feed has finished. If the latter is the case, my role is to go and summon the assistance of a qualified nurse who will decide whether the client needs to receive more food or fluid from the feeding system.

When I worked for west of Cornwall Primary Care Trust, I had a greater role with dealing with enteral feeding. I used to work and elder care rehabilitation setting. Many clients had peg tubes. I was required to change feeds as well as flush the tubing and required. It is very important to flush the tubing pre-and post delivery of feed as this helps to keep the tubing patent. The nature of the feed compound, although this contains some water, does not contain sufficient water for a clients needs. To this end, extra delivery of water helps to keep the client a hydrated.

posted by alanpjack  # 10:40 PM