The data used is accurate as of February , but may change with time. Show AMA citation. Press 'Calculate' to view calculation results. Load an Example. At risk for refeeding syndrome Pediatrics. Concurrent parenteral nutrition Special nutritional needs burns, fistulas, pregnancy.
Accessed February 24, Clin Nutr. PMID Krenitsky J. Adjusted body weight, pro: evidence to support the use of adjusted body weight in calculating calorie requirements. Nutr Clin Pract. Follow Us!
Get Email Updates. Open Menu. To help prevent malpositioning and dislodgment, verify feeding tube integrity at the beginning of each shift. Be aware that verbal patients with dislodged tubes may complain of new-onset pain at or near the insertion site of a percutaneous endoscopic gastrostomy PEG tube, G tube, gastric-jejunal GJ tube, or J tube. Nonverbal patients may respond with vital-sign changes such as increased blood pressure or heart rate , increased agitation, and restlessness.
This syndrome may trigger life-threatening arrhythmias and multisystemic dysfunction. Serum electrolytes then move into the intracellular space to help satisfy the higher demands, resulting in acute electrolyte abnormalities.
In patients with long-term malnutrition, monitor for intolerance at the onset of enteral feedings by checking heart rate and rhythm and electrolyte levels. Although refeeding syndrome incidence is low, failure to recognize the sudden drop in potassium and magnesium levels can have catastrophic consequences.
To reduce the risk of refeeding syndrome in patients with vitamin and mineral deficiencies, supplements may be ordered for parenteral administration before enteral feedings begin. Refer to specific guidelines based on total energy needs and specific micronutrient deficiencies; thiamine and other B-vitamin deficiencies are the most pressing ones to address before initiating enteral feeding. As the tube-feeding goal rate is achieved, taper micronutrient supplement dosages as indicated. Note: Be aware that some patients are at high risk for fluid overload and depend on a concentrated feeding formula to meet dietary needs.
Until recently, clinicians assumed diarrhea in patients receiving enteral feedings stemmed from malabsorption and feeding intolerance. But more recent research points to medications, especially those high in sorbitol, as the main culprit. So be sure to rule out medications as the cause of diarrhea before looking for other causes, including malabsorption and rapid delivery rates.
The sorbitol content of certain premade liquid drugs such as potassium chloride, acetaminophen, and theophylline can cause a rapid fluid shift into the intestines, leading to hyperosmolarity and diarrhea. This effect increases when sorbitolbased liquid medications are given through a J tube. Gastric acid in the stomach acts as a buffer to medications and reduces osmolarity of fluid entering the small intestine. Changing the administration time as appropriate or switching to a non-sorbitol-based alternative may relieve diarrhea without necessitating feeding-rate adjustment.
Take additional precautions with medications linked to a higher clogging risk, including psyllium, ciprofloxacin suspension, sevelamer, and potassium chloride tablets that can be dissolved in water. Know that tube replacement due to clogging is costly and subjects the patient to anesthesia.
Clinical Nutrition E-Book: Enteral and Tube Feeding, Text with CD-ROM
To help prevent clogging, maintain proper tube maintenance and flushing. Be aware that some medications must be given on an empty stomach to ensure effective absorption, including phenytoin, carbama zepine, alendronate, carbidopa levodopa, and levothyroxine. You may need to withhold tube feedings for 1 to 2 hours before and after administering these medications. Keep in mind that patients receiving multiple drugs may have absorption problems due to extended withholding of feedings, causing dehydration and malnutrition. When beginning enteral feedings, monitor the patient for feeding tolerance.
Assess the abdomen by auscultating for bowel sounds and palpating for rigidity, distention, and tenderness. Know that patients who complain of fullness or nausea after a feeding starts may have higher a GRV. On an ongoing basis, monitor patients for gastric distention, nausea, bloating, and vomiting. Stop the infusion and notify the provider if the patient experiences acute abdominal pain, abdominal rigidity, or vomiting. Caloric requirements calculated by a dietitian must be ordered by a healthcare provider and delivered and monitored by a nurse. However, some states permit dietitians to initiate nutritional interventions.
Nursing assistants can help with patient positioning and comfort care as well as behavioral monitoring. Consult additional specialists, such as a wound ostomy nurse, about the risk of pressure injuries compounded by malnutrition or dehydration.
Enteral tube feeding
Keep the goal of care in mind. For terminally ill patients, palliative care specialists can help evaluate the benefits and risks of continuing enteral feeding and help clinicians navigate ethical issues, such as whether to continue enteral feedings and other life-prolonging measures. Enteral feedings have the potential to advance patient care.
Also, trials currently are underway in critical care units to study the use of feeding tubes with magnetic components at the end, which could allow confirmation of correct tube placement with a magnet instead of radiography. As technology progresses, enteral feeding efficiency will progress as well.
For the best outcomes, healthcare providers must work as a team to treat the patient holistically. Paul Fuldauer is a clinical nutritional coordinator. Tube feeding troubleshooting guide. The Oley Foundation. March American Geriatrics Society feeding tubes in advanced dementia position statement.
J Am Geriatr Soc. Permissive underfeeding or standard enteral feeding in critically ill adults.
Clinical Nutrition: Enteral and Tube Feeding
N Engl J Med. Board of Directors. Enteral nutrition practice recommendations. Clinical guideline: management of gastroparesis. Am J Gastroenterol. Risk of regurgitation and aspiration in patients infused with different volumes of enteral nutrition. Asia Pac J Clin Nutr. Case study: Nutritional management of a patient at high risk of developing refeeding syndrome. S Afr J Clin Nutr. Recognizing malnutrition in adults: definitions and characteristics, screening, assessment, and team approach. Nutrition in the elderly. Frequently asked questions.
Permissive underfeeding or standard enteral feeding in critical illness.
Dysphagia after stroke and its management. Elimination of radiographic confirmation for small-bowel feeding tubes in critical care. Am J Crit Care. Romano MM. Medicines and tube feeding formula.