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Enteral
Nutrition
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What is Enteral Nutrition?
Enteral nutrition is a meal full of nutrients, proteins, vitamins and minerals, taken in through a tube, which helps the patient’s recovery and well-being. Know More

What is Enteral Nutrition?

What it is

Enteral nutrition is a method of feeding that substitutes or supplements conventional feeding, providing the body with energy and strength. Through its nutrients similar to those found in food, it assists in patient recovery and prevents weight loss. 

In addition to enteral nutrition through a tube, the patient can also receive enteral nutrition feeding orally, as prescribed by a health professional. Oral nutrition can supplement the diet of a patient who is taking inadequate food and fluid to meet their requirements.

Digestive Processes

The difference between conventional feeding and enteral feeding is in the digestion stages. In the case of enteral feeding, food is already mushed, ready to be digested, facilitating the patient’s needed day to day nutrition intake.


 

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First day at home
Check out our instructions and tips for full recovery at home. Know More

First day at home

Starting a Feeding Tube at Home

It’s not always easy to understand all precautions required for enteral nutrition. It’s natural to have questions or to need help once at home. 

It is important to follow the guidelines of the patient’s health professional with regard to administration times, the amount of formula for each meal, most suggested formula, and amount of water per day needed by the patient.

What you will need:

 

Preparation of Tube feeding

  1. First of all, check that the product is within its validity period;
  2. Sanitize your hands before handling the product;
  3. Sanitize the packaging before opening;
  4. If opting for enteral nutrition powder, use filtered or boiled water (at room temperature) to dissolve the product;
  5. Use the amount of water and powder as advised by the health professional;
  6. Mix the formula in the blender or mixer for approximately 5 minutes or until complete homogenization;
  7. It is important to shake the formula well before administerin
  8. Pour the enteral nutrition formula into the container.

Management of Tube feeding

  1. Connect the Enteral Feeding Set to the container;
  2. Hang the container at a higher level than the patient;
  3. Open the clamp until the Enteral Feeding Set is filled with the formula;
  4. After completely filled, close the clamp and then connect the Enteral Feeding Set to the tube;
  5. Open the clamp until it starts to drip (between 60 and 120 drops per minute, or as per instructions);
  6. When the contents of the container end (this will take about 1 to 2 hours), it is necessary to inject 20 to 40 ml of filtered or boiled water (room temperature) with the help of a disposable syringe.

Cleaning of tube feeding

After each meal, inject a filtered water syringe, at room temperature, to remove any remaining residue, avoiding clogging of the tube.

Administration of drugs via enteral
feeding tubes

Preferably use liquid medication, if tablets are needed, knead the medication until a fine powder is produced and dissolve it in water. With the help of a syringe, apply the medication, slowly, into the tube. Before and after administration, use a syringe with water for cleaning.

Caution: not all tablets may be kneaded. Always seek guidance from the health professional.

Storage of enteral nutrition formulas

Formulas are like food, so they should be handled and stored correctly, as recommended below:

  1. Store closed formulas in a clean, dry place at room temperature;
  2. Use liquid formulas within 24 hours of opening. If not used after 24 hours, discard it;
  3. 30 minutes before administration, remove the formula from the refrigerator;
  4. Do not heat the formula in a microwave or stove;
  5. Powdered product, after opened, should be consumed within 30 days.
  6. When prepared, the validity of the powdered formula is 12 hours if refrigerated between 2 °C to 8 °C, and 4 hours at room temperature;

Clogged feeding tubes

If you notice differences in tube function, it may be bent, the formula may be dry or some medication may be blocking the passage. Apply a syringe with water to try to unblock it. If the tube remains blocked, consult your health care professional for advice.

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Myths and Truths
Not everything you hear is true or false. Get to know some of the myths and truths of enteral nutrition and be prepared for everything. Know More

Myths and Truths

To end all doubts and speculation, know what the myths and the truths are.

  • Enteral feeding can be administered at home.

    Enteral feeding can be done at home: it is called nutritional home therapy. With assistance from the health team, the patient or caregiver can prepare and administer enteral formulas at home.

  • The tube is permanent.

    The tube is only used when the patient is unable to feed orally.  During this period, enteral nutrition is essential to assist in the recovery and maintenance of the nutritional state of the patient, improving their quality of life and well-being.

  • Enteral diet is sufficient for feeding the patient properly.

    Yes, the enteral diet is equal to an ordinary diet; the patient will ingest the recommended amount given by the health professional and, with it, the patient will feel full.  If the patient complains of hunger or does not want to eat at certain meal times, talk to the health team for possible changes.

  • The tube hurts or causes pain.

    The tube is a thin, malleable tube that does not hurt or cause the patient pain. On the day the tube is fitted, the patient may feel mild discomfort but, in normal situations, they will not feel pain.

  • Only a doctor or dietitian can tell you what the best formula for the patient is, how much they need to eat, and feeding times.

    The amount and timing should be prescribed by the health professional monitoring the patient. Each patient is unique and has specific needs, so only the health professional can recommend the ideal amount of food intake.

  • A patient with a tube does not need to drink water.

    A patient on an enteral diet should have the same water intake as someone on a normal diet. Water will contribute to the patient’s hydration. Talk to your health professional about how much water the patient should ingest in a day.

  • When I go to the store, I can buy any formula.

    There are several types of formula: with fiber, with more calories or more protein. There are also oral supplements that can supplement the formula. A professional will be able to indicate the best option.

  • Enteral nutrition formulas are the same as milk in a carton.

    Enteral nutrition formulas are very different from milk as they are complete and can be used as the sole source of food, while milk is only one kind of food that makes up a diet.

  • I buy a liquid diet formula that’s ready, and to make it last longer I can dilute it in water.

    Do not dilute a ready-to-consume formula.  Diluting the formula may lead to a decrease in the nutrients present in it, harming the patient. Only the powdered formula should have water added in its preparation.

  • The patient can’t lie down while ingesting the formula.

    During administration of the formula, the patient should be sitting or tilted, so that the liquid does not go to the lungs, causing aspiration and discomfort.

  • The patient loves soda, so it’s okay to put a small amount of soda in the tube so the patient can have a taste.

    Putting any food through the tube that has not been prescribed by the health professional is not recommended.  During administration of the formula via the tube, the patient will not taste the food being ingested, as the tube goes straight into the stomach or intestine.

  • I can’t heat the enteral diet formula in the microwave or in a water-bath.

    Heating the enteral diet formula is not recommended so that its vitamins and minerals are not lost. The formula should be administered at room temperature. If it is stored in the refrigerator, it should be removed about 30 minutes before administration until it reaches room temperature.

  • I need to clean the tube with water every time it is used.

    It is recommended that, before and after each administration of food or drugs, the tube is flushed with a syringe filled with water. This procedure prevents the tube from being blocked.

  • When the tube is blocked, I can unblock it with soda.

    To unblock the tube, you should slowly inject filtered or boiled water through a syringe. The water should be injected slowly so that there is no rupture of the tube or discomfort to the patient.  Do not use soda, warm water, or other liquids to unblock the tube. This can cause the patient discomfort and bring unwanted reactions.

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Complications and how to avoid them
Learn what to do to avoid possible complications during enteral nutrition administration. Know More

Complications and how to avoid them

Some punctual problems may occur during enteral feeding. Learn what you can do to avoid these situations:

Vomit

Possible causes:
  1. 1. Incorrect position of the patient in the bed or of the tube;
  2. 2. Dripping of the formula being too fast;
  3. 3. Administration of a high volume of formula at the same time.
What to do:
  1. 1. Keep the patient sitting while the head of the bed is raised;
  2. 2. Diminish drip speed until the end of the formula;
  3. 3. Monitor the next administration and if the issue repeats, contact your health professional.

Diarrhea

Possible causes:
  1. 1. Administration is too fast or too cold;
  2. 2. Reaction to medication;
  3. 3. Patient has recently changed formula.
What to do:
  1. 1. Talk to your health professional about the proportion of the formula administered;
  2. 2. Remove the formula from the refrigerator at least 30 minutes before administering it, allowing it to reach room temperature;
  3. 3. Do not use a formula that has been left at room temperature for longer than the manufacturer’s recommended period, or that has been in the refrigerator for more than 48 hours;
  4. 4. Contact the health professional to switch to a formula that has easier absorption and digestion ingredients;
  5. 5. Ask your health professional if the medication you use can cause diarrhea.

Abdominal distension

Possible causes:
  1. 1. Administration is too fast or too cold;
  2. 2. Patient is lying down during administration of the formula, or exerting effort immediately after feeding;
  3. 3. Patient may be intolerant to the formula.
What to do:
  1. 1. Ask your health professional to decrease the amount of formula administered;
  2. 2. Keep the formula at room temperature before administering it;
  3. 3. Check if you are following the correct formula administration guidelines;
  4. 4. Keep the head of the bed elevated during the administration of the formula and until 30-60 minutes before the end.

Dehydration

Possible causes:
  1. 1. Lack of water;
  2. 2. Frequent diarrhea;
  3. 3. Prolonged fever;
  4. 4. Excessive sweating.
What to do:
  1. 1. Proper water intake as recommended and before and after meals.
  2. 2. Consult your health professional to adjust recommended amount of water.

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Videos
Get all your questions about enteral nutrition answered with the videos we have prepared for you. Know More

Videos

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