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Enteral Feeding - Frequently Asked Questions
Home enteral feeding can be routine without issues, but difficulties may arise now and then. Below you can find a brief description of common problems, possible causes and some steps you can ask your patient to take to troubleshoot these issues.
TUBE FEEDING AT HOME: WHAT TO EXPECT
While the transition to home tube feeding requires some adjustments, there are ways to make this adaptation easier. If your patient, or their caregiver, is worried, you can put them at ease by assuring them there are ways to help. For example, talking to friends and family about their loved one’s enteral feeding may make them more comfortable with the transition. Or, you can recommend scheduling feeding during a family meal time. If your patient or their caregiver chooses to administer feeds at other times, be sure to continue to engage in family and other social activities. The adjustment may require time and patience, but soon it will become a routine.
FAQs by Condition
Home tube feeding can be trouble-free. However, it’s not unusual to experience problems now and then. Below you can find a brief description of common problems, possible causes and some steps you can take to troubleshoot problems.
During tube feeding, bowel movements may be less frequent than usual. Constipation — meaning difficult to pass and very infrequent bowel movements — can sometimes occur on a home tube feeding program.
Possible causes:
- Not enough water is being given with the feed
- No fibre, or not enough fibre, in the formula
- Unable to engage in enough physical activity
- Medications
- Your patient could take additional water through the feeding tube
- Changing your patients' formula to one that contains adequate fibre
- Increasing physical activity if suitable for your patient
- Review medications to see if any may cause constipation
Frequent loose and watery stools can sometimes occur on a home tube feeding program.
Possible causes:
- Medications
- Formula is being fed too fast
- Formula is not being stored as per instructions on the packaging. The packaging should give information about storage conditions if this can affect quality/functionality of the product
- No fibre, or not enough fibre, in your formula
- Intolerance to the formula
- Review medications
- Assess feeding rate
- Remove the formula from the refrigerator at least 30 minutes prior to feeding, allowing it to warm to room temperature, before opening
- Do not use formula that has been opened and left at room temperature or in the refrigerator for longer than the manufacturer’s recommendation
- Changing your patients' formula to one that contains adequate fibre
- Advise your patient to try to relax during feeding
Your patient may be receiving too little fluid or losing too much fluid. Some symptoms of dehydration may include: dry mouth and tongue, sleepiness or tiredness, thirst, decreased urine output, dry skin, headache, constipation, dizziness or lightheadedness.
Possible causes:
- Not taking enough water
- Frequent diarrhoea and/or vomiting
- Prolonged fever
- Wound is draining large amounts of fluid
- Sweating heavily
- Review how much water your patient should take before and after their feed
- If your patient is experiencing fever, diarrhoea, vomiting, excessive wound drainage, or heavy sweating, a change in their daily water intake may be required
Your patient may be receiving too much fluid or retaining too much fluid. Some symptoms of fluid overload/fluid retention may include: swelling of the skin, stretched and shiny skin, skin may retain a dimple after being pressed for about ten seconds, puffiness of the ankles, face or eyes, aching body parts, stiff joints, weight gain, raised pulse rate, raised blood pressure, bloated abdomen.
Possible causes:
- Taking too much water before or after feeding
- Fluid volume is too high due to diluted formula
- Medications
- Determine if your patient should adjust the amount of water they take before or after feeding
- Ensure that your patient is using the prescribed volume and strength of the feeding formula
- Review your patients' formula. You may need to switch to a formula that has more calories in a lower volume
- Review medications
Feeling queasy or have an upset stomach during or after tube feeding.
Possible causes:
- Formula is being fed too fast
- Formula is too cold
- Lying flat while taking a feed
- Exercising or engaging in too much activity right after feeding
- Intolerance to the formula
- Assess feeding rate
- Allow the formula to warm to room temperature before administering
- Make sure your patient is following directions for the prescribed amount of formula and/or correct flow rate
- Sit or lie at least at a 45 degree angle (about the height of two pillows) during feeding and for 30-60 minutes after feeding to help prevent nausea or reflux
Formula is not easily flowing through your patients' feeding tube.
Possible causes:
- Kink or bend in the feeding tube
- Dried formula or medication is blocking the feeding tube
- The connector has not been unclamped
- Check for kinks or bends in the feeding tube
- Flush the tube before and after each feeding
- Ensure medications are administered correctly in order to minimise the risk of blockages
- Make sure the tubing has been unclamped
- PEN Group. 2007. A Pocket Guide to Clinical Nutrition. 3rd Ed. United Kingdom: Selectprint Ltd..
- Dietitians Association of Australia. 2015. Enteral nutritional manual for adults in health care facilities. New Zealand. Available at: https://daa.asn.au/wp-content/uploads/2015/04/Enteral-nutrition-manual-January-2015.pdf
- Webster-Gandy, J., et al, 2006. Oxford Handbook of Nutrition and Dietetics. Oxford handbooks. Oxford: Oxford University Press.
- NHS Choices. 2017. Dehydration. NHS UK. Available at: https://www.nhs.uk/conditions/Dehydration/
Types of Feeding Tube
