ENTERAL FEEDING COMPLICATIONS AND PROBLEM SOLVING

PROBLEM CAUSE PREVENTION AND TREATMENT

MECHANICAL
Aspiration pneumonia
Pharyngeal irritation otitis
Nasolabial, esophageal, and mucosal Prolonged intubation with large-bore Use small-caliber feeding tubes
irritation and erosion
Irritation and leakage at ostomy site Drainage of digestive juices from
Tube Lumen obstruction
Delayed gastric emptying,
Gastroparesis,
Gastroesophageal reflux
Diminished gag reflex
Prolonged intubation with large-bore Use small-bore feeding tubes
nasogastric tubes
nasogstric tubes
Use of rubber or plastic
stoma site
Thickened formula residue
Formation of insoluble formula-
medication complexes
Initially and regularly check tube
replacement
Regularly check gastric residuals,
tube placements, and abdominal
girth
whenever possible.
Consider gastronomy or jejunostomy
sites for long-term feeding
made of biocompatible materials.
Tape feeding tube properly to avoid
placing pressure on the nostril
Consider gastronomy or jejunostomy
sites for long-term feeding.
Attend to skin and coma care
Use gastronomy tubes with retention
devices to maintain proper tube
placement.
Irrigate feeding tube frequently with
clear water or use an enteral pump
that provides a water flush.
Avoid instilling medications into
feeding tubes, when possible
GASTROINTESTINAL ENTERAL FEEDING COMPLICATIONS & PROB. SOLVING
PROBLEM CAUSE PREVENTION AND TREATMENT
Diarrhea Low-residue formulas Rule out non-formula-related causes
Rapid formula administration Select fiber-supplemental formula
Hyperosmolar formula Initiate feedings at low rate
Bolus feeding using syringe force Temporarily decrease rate
Hypoalbuminemia Reduce rate of administration
Nutrient malabsorption Select isotonic formula or dilute
Microbial contamination formula concentration and gradually
Disuse atrophy of the GI tract transit increase strength.
time Reduce rate of absorption
Prolonged antibiotic treatment or Select alternate method of
other drug therapy administration
Use hydrolyze, peptide-based
formula or parenteral malnutrition
until absorptive
capacity of small intestine is restored
Select a hydrolyzed, peptide-based
formula that restricts offending
nutrients
Avoid prolonged hang times.
Use sanitary handling and
administration techniques
Use enteral nutrition support
whenever possible.
Select fiber-supplemented formula

Cramping, Gas Abdominal Nutrient malabsorption
distention Rapid, intermittent administration of
refrigerated formula
Intermittent feeding using syringe
force
Cramping, Gas Abdominal
distention
(continuation)
Nausea and vomiting Rapid formula administration
Gastric retention
Constipation Inadequate fluid intake
Insufficient bulk inactivity
Review medication profile and
eliminate causative agent if possible
Select a hydrolyzed formula or one
that restricts offending nutrients
Administer formula by continuous
method
Administer formula at room temp.
Advance administration rate
according to patient tolerance
Reduce rate of administration
Select alternate method of
administration
Initiate feedings at low rate and
gradually advance to desired rate
Temporarily decreased rate
Select isotonic or dilute formula
Reduce rate of administration
Select low-fat formula
Consider need for postpyloric
feeding.
Supplement fluid intake
Select fiber-supplemented formula
Encourage ambulation, if possible
 Metabolic ENTERAL FEEDING COMPLICATIONS & PROB. SOLVING
PROBLEM CAUSE PREVENTION AND TREATMENT
Dehydration Elevated fluid needs or losses of GI Supplement intake with appropriate
fluid and electrolytes fluid.
Monitor and intervene to maintain
hydration status
Over hydration Rapid refeeding Use a calorically dense formula.
Excessive fluid intake Reduce rate of administration, esp.
in patients with severe malnutrition
or major organ failure.
Hyperglycemia Inadequate insulin production for the Select low-carbohydrate formula
amount of formula being given Initiate feedings at low rate
Metabolic Stress Monitor blood glucose
Diabetes Mellitus Use insulin if necessary

Hypernatremia Inadequate fluid intake or excessive
loses
Hyponatremia Fluid overload
Syndrome of inappropriate anti-
diuretic hormone secretion (SIADH)
Excessive GI fluid losses from
diarrhea, vomiting
Chronic feeding with relatively low-
sodium enteral formulas as the sole
source of dietary sodium
Assess fluid and electrolyte status
Increase water intake
Assess fluid and electrolyte status
Restrict fluids, if necessary
Use diuretics, if necessary
Use a re-hydration solution such as
equaLYTE Enteral Rehdration
Solution to replace water and
electrolytes
Supplement sodium intake, if
necessary
Hypophosphatemia Aggressive re-feeding of Monitor serum levels
malnourished patients Replenish phosphorus levels before
Insulin therapy re-feeding
Hypercapnia Excessive carbohydrate loads given Select low-carbohydrate, high-fat
patients with respiratory dysfunction formula
and CO2 retention
Hypokalemia Aggressive re-feeding of Monitor serum levels
malnourished patient Provide adequate potassium
Hyperkalemia Excessive potassium intake Reduce potassium intake
Decreased excretion Monitor serum levels