What and how to feed a patient through a feeding tube?
This is how the tube passes through the nose into the stomach.
When a patient with a nasogastric tube is discharged from the hospital, the discharge summary often contains dry words like: «Feed with enteral nutrition: Nutridrink, Nutrizon.» However, no one considers that the amount of food given through the tube and the number of feedings per day are extremely important. All these issues are decided individually, taking into account a huge number of factors: the patient’s weight, body temperature, respiratory rate, and the degree of dehydration at the time the tube was placed. Even after the tube is inserted, adjustments are made to the initial feeding plan during the process. Nevertheless, general principles can be formulated.
What and how to feed a patient through a tube?
Store-bought enteral nutrition is by no means the cornerstone of feeding. In essence, tube feeding is not much different from regular baby food. However, you end up paying at least twice as much just for the word «enteral.» Here is your first hint: you can use all types of baby food — both powdered formulas and ready-made fruit purées. Just keep in mind that the consistency must be such that it can be easily drawn into a Janet syringe and passed smoothly through the tube.
However, what we have just discussed is pre-made, canned food. Tell me, would you enjoy eating only canned food, even if it tastes very good? That brings us to the point that the patient can and should be gradually transitioned to freshly prepared, «live» food. This includes all kinds of broths — fish, meat, vegetable, or simply broth from the soup you made for the whole family. There is no need to insist on red fish or turkey meat. The only requirement is that the broth should not be fatty.
Once you have mastered feeding with broth, you can (and should) further diversify the diet. As you know, nutrition should be varied. The next step is to use the thick part of the cooked soup. How does this work? Separate about 300 grams of broth. Then, use a blender to purée about 200 grams of the soup solids into a smooth paste. After that, dilute the resulting paste with broth from the same soup. Remember, the final consistency should allow the mixture to pass freely into the Janet syringe and then through the tube. Now we have excellent freshly prepared tube feeding! Using the same principle, you can also make fruit purée. The main thing is that the prepared food contains no solid particles that could clog the tube. If the tube does get clogged, you can call a doctor from our center to replace the nasogastric tube at home.
I haven’t mentioned that you can also give the patient tea, coffee, cocoa, and even juice. Just in case, let me remind you: if you enthusiastically decide to make freshly squeezed juice, be sure to dilute it with plain water or mineral water. As I always say, feed and give the patient the things they loved when they were healthy.
So what is the purpose of using enteral or baby food? In my opinion, it can be used when it’s time for a feeding, but you haven’t had time to prepare anything.
Now the most difficult question: the amount of food and the frequency of feedings. Let’s agree right away that we do not separate food and drink in terms of volume. Even the «food» we prepare is about 80% water. You need to keep a diary where you record how many grams you have administered through the tube (again, regardless of whether it was food or drink). For a bedridden patient weighing 60–80 kg, you need to give 1400–1600 ml of fluid per day. If the weight is higher, more nutrition is needed. If the patient has a fever, more fluids are also required. However, these calculations should be made by the doctor managing the patient.
How many times a day should you feed? When I insert the tube, I recommend feeding every hour for the first 1–2 days — that is, 12 times a day. Accordingly, the daily volume is divided by 12. After a couple of days, you can divide the daily volume by 8 — which means 8 feedings per day. After about a week, I suggest moving to 6 meals a day and continuing with that schedule.
Let me remind you that the tube should be replaced with a new one every 30 days.
One very important point: our tube feeding consists of two components — we introduce nutrition, and the body must accept it. When the patient’s blood pressure drops to 80 mmHg or lower, a situation may arise where we give nutrition, but the intestines do not accept it from the stomach. As a result, the stomach becomes overfilled like a bucket. How can you tell whether the body has accepted the food or not? Very simply: before each feeding, attach the syringe and pull the plunger back (without excessive force). No more than 10 ml of fluid should be aspirated. If you withdraw more, the next feeding should be skipped. Unfortunately, the situation described above occurs when the body has exhausted all its reserves and is preparing to leave us within the next few days.