What is Enteral Feeding?
Enteral feeding refers to the delivery of food or nutrition via the gastrointestinal tract. This could mean the intake of food via the mouth or through medical procedures that create direct access to the stomach or intestines. In patients unable to feed themselves, whether due to disability or chronic medical conditions, enteral feeding via feeding tubes may provide the necessary nutritional support to sustain these patients and prevent the onset of malnutrition. Enteral feeding also allows healthcare physicians to accurately measure caloric requirements and the corresponding appropriate nutritional supplementation needed by a patient.
What are the indications of Enteral Feeding?
Enteral feeding or tubing feeding is generally required when a patient is no longer able to sufficiently intake their needed daily caloric intake by themselves. There are several medical conditions that can prevent a patient from feeding themselves such as:
- Neurologic disorders such as strokes or spinal degenerative conditions which lead to patients physically not being able to feed themselves.
- Chronic disease conditions such as most cancers would require an increased caloric intake which enteral feeding would be more beneficial
- Advanced age can be associated with the onset of dementia or senile conditions which makes oral feeding difficult
- Neonates with congenital syndromes or early-onset disease conditions may also require enteral feeding to prevent nutritional wasting
What are the types of Enteral Feeding?
There are several types and routes of enteral feeding available. Many factors have to be considered in determining which type would be most beneficial to a patient such as age, the length of time a patient will require enteral feeding, the amount of nutritional supplementation to be delivered, and if the patient will remain in the hospital or be discharged with enteral feeding for homecare. All these are best discussed with a healthcare physician who will assess which type would be the safest and most appropriate for a specific patient.
The most favored form of enteral feeding is still oral feeding. Whenever possible, if a patient is still able to tolerate receiving caloric-rich nutritional support via the mouth, this would still be the best route. However, when this is no longer possible these are some examples of other enteral feeding routes:
- Nasogastric Tubes (NGT): Nasogastric Tubes (NGTs) are thin slender feeding tubes that are passed through the nose and ends at the level of the stomach. The procedure for inserting the tube can be done with local anesthesia or minimal sedation. There is some patient discomfort during the procedure but can provide minimally invasive access for enteral feeding.
- Orogastric Tubes (OGT): Orogastric Tubes (OGTs) are similar to NGTs except the feeding tube is passed through the mouth and ends at the level of the stomach. The procedure is also considered to be minimally invasive and requires minimal sedation. However, due to the feeding tube being in the mouth this could cause some difficulty for patients to communicate. This route may also be difficult to access in patients who need oxygen support and are intubated.
- Gastrostomy Tubes: The use of gastrostomy tubes require a minor surgical approach. Incisions are made through the abdomen and the tube is placed within the stomach. This route is more beneficial for patients requiring long-term enteral feeding or those requiring increased caloric intake.
- Jejunostomy Tubes: Similar to Gastrostomy Tubes, Jejunostomy Tubes also require a surgical approach in which access is created through the abdomen to the intestines. This form of enteral feeding is usually required for patients who have undergone gastrointestinal surgery in which digestion and absorption through the stomach may not be possible.
What is given during Enteral Feeding?
In most cases of enteral feeding, normal solid foods cannot be given. The use of solid foods may not be compatible with the access and route created and cannot provide the sufficient required caloric needs of the patient. As such, there are several nutritional enteral feeding formulas that are currently available. These products usually come as either a milk-like substance or powdered-and-mixed formulations that are carefully and accurately produced to contain a set amount of calories, proteins, fats, and carbohydrates. Certain disease conditions may require strict monitoring and control of these formulations and are taken into special consideration by healthcare physicians. The amount and rate of feeding can also be closely monitored and controlled by feeding pumps and other enteral feeding devices.
The use of enteral feeding is now considered to be generally safe and beneficial for patients who may require them. The different techniques and routes that are available provide both healthcare physicians, as well as, patients options that would best suit their specific needs. There is now also a variety of devices and formulas currently on the market that can help cater to the immediate demands associated with enteral feeding in both the hospital setting and homecare.
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