Tube feedings: To pause or not to pause?

Nursing Students Student Assist

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Good evening!

I am working on a research paper for my Honor's program at my school. My topic is about patient positioning and pausing during enteral feedings.

For quite some time, it has been believed that when performing basic patient care that only take a few minutes, the enteral tube feedings should be paused to prevent aspiration. According to new evidence based research, pausing these feedings may be counterproductive and may actually contribute to the patient becoming malnourished.

I am still working on my research, but I would like some help from some experienced nurses if possible! This is a quick survey with some basic questions to help me with my research paper. Please take a couple of minutes to fill it out!

[h=4]1. When providing basic patient care (turning, perineal care, dressing change, etc), I always pause the patient's parenteral nutrition.[/h]True

False

[h=4]2. On average, in the last 3 months, I have forgotten to restart the parenteral nutrition...[/h]1-3 times

3-6 times

Never

[h=4]3. I pause the parenteral position when providing quick patient care because[/h]my hospital policy mandate us to do so.

it is the way I was taught in nursing school.

it is the way I have been doing it for years.

not sure.

[h=4]4. I'm aware that there is new evidence based research that says pausing tube feedings when providing basic patient care is not necessary.[/h]No

Yes

I have heard, but not looked into it

[h=4]5. I would stop pausing tube feedings for brief periods of time when providing basic patient care if evidence based research showed it was counterproductive.[/h]Absolutely.

No. One must always pause tube feedings.

Maybe. It would be a difficult adjustment, but I would try.

Also, feel free to share your thoughts on this matter!

Thank you so much for your time! :)

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Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.

I assume you mean 'pausing the tube feed' because the HOB is lowered to under 30 degrees to provide care? If so, then yes I do. Would I stop doing it if EBP shows it's not necessary? I doubt it because I don't see the harm in extra airway protection. No, I've never forgotten to restart the feeding when I was done. Heck the machine beeps at you if you don't restart. BTW, I'm an old schooler that still aspirates with IM injections because after all my years of nursing, I have gotten blood return once. And that once was enough for me to believe it's a good idea. Plus the reasoning not to aspirate that I received straight from the mouth of the CDC was ridiculous.

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Specializes in Critical Care.
I assume you mean 'pausing the tube feed' because the HOB is lowered to under 30 degrees to provide care? If so then yes I do. Would I stop doing it if EBP shows it's not necessary? [b']I doubt it because I don't see the harm in extra airway protection.[/b] No, I've never forgotten to restart the feeding when I was done. Heck the machine beeps at you if you don't restart. BTW, I'm an old schooler that still aspirates with IM injections because after all my years of nursing, I have gotten blood return once. And that once was enough for me to believe it's a good idea. Plus the reasoning not to aspirate that I received straight from the mouth of the CDC was ridiculous.

I've never paused TF because I've never seen the logic in doing so, out of curiosity, what's rationale that pausing provides airway protection?

If normal gastric volumes can be around 250ml, then how does pausing a TF going at 60ml/hr for 5 minutes provide any benefit, since you're only changing the gastric volume by up to 5mls which isn't really significant given the 250ml or more that might already be in the stomach?

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Specializes in Critical care.
I've never paused TF because I've never seen the logic in doing so, out of curiosity, what's rationale that pausing provides airway protection?

If normal gastric volumes can be around 250ml, then how does pausing a TF going at 60ml/hr for 5 minutes provide any benefit, since you're only changing the gastric volume by up to 5mls which isn't really significant given the 250ml or more that might already be in the stomach?

Eggzacary.

Years ago (maybe 5 or so), I also quit pausing feedings during normal pt care/repositioning under the same rationale.

When tracked, the frequency of pauses in a typical day added up to a several hundred calories per day undershoot of the caloric goals set by nutrition. Therefore, pausing wasn't just found to be unnecessary, rather we were actually under-feeding these sick patients. Let that sink in...it's been proven to not increase safety, but instead cause potential harm...and we're just going to keep doing it anyway because that's just the way we've always done it?

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Specializes in Nephrology, Cardiology, ER, ICU.

Moved to nursing student assistance and survey edited

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Specializes in Emergency.

This is definitely an interesting topic that I'd like to see more thought on. I currently pause the tube feeds 1) because a policy mandates that we do so, and 2) I want to prevent aspiration.

We've had many patients in the last year have tube feed aspiration because their HOB was 30 (and for those patients who slump >45). Constant reinforcement for the families is also required.

I think this topic is going to have many variables at a statistical standpoint. How much does the patient weigh? Are they complete care? GTube versus NG/NJ? How long does it take to provide said care?

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Has anybody ever studied this using one of those little gadgets they use to look at post-void badder volume? Think it'd work? I'd think you'd have to look at a bunch of people longitudinally to get a baseline, then see what happens when they get paused. The idea of significantly undershooting calories is important, too.

No extra charge, LOL.

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Specializes in Burn, ICU.

Our hospital policy says not to pause. Our Kangaroo pumps take about 15-20 minutes to alarm if you forget to re-start; if you pause every 2 hours and forget to restart around 25% of the time, the pt is losing an hour or more of feeding...especially when you count the other necessary pauses during the day (giving meds, changing the tubing, etc...). I work in an ICU but the policy doesn't differentiate between vented and non-vented pts.

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1. When providing basic patient care (turning, perineal care, dressing change, etc), I always pause the patient's parenteral nutrition.

False - I don't see the point. The residual in the stomach isn't going to magically go away because you paused the TF. It took me a few years and some cases of TF aspiration to figure that out.

2. On average, in the last 3 months, I have forgotten to restart the parenteral nutrition...

Never - I don't get TF patients much any more. When I did, I would forget to restart them all the time until I stopped pausing them in the first place. I honestly think it's more important to keep up with checking the residual.

3. I pause the parenteral position when providing quick patient care because

NA - I don't

4. I'm aware that there is new evidence based research that says pausing tube feedings when providing basic patient care is not necessary.

No - I wasn't, but I am now.

5. I would stop pausing tube feedings for brief periods of time when providing basic patient care if evidence based research showed it was counterproductive.

Again, N/A.

My thoughts on the matter: a) a survey redesign would be beneficial to reflect that some nurses don't pause, b) if your project is also about positioning, you may want to add some questions about that, c) tube feeds need to be carefully managed and stopped at any sign of reflux. Make sure your doc knows if the patient has any GI history, especially GERD or bariatric surgery. Always, always, always check residual, especially on patients that are new to tube feeding. If there is too much in there, it's going to go up, not out.

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Specializes in Emergency.

OP, can you please post the new EBP about how it's not necessary? I know it often gets forgotten to be resumed at my hospital and lost calories is difficult to get back unless supplemented.

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Deleted.

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We've had many patients in the last year have tube feed aspiration because their HOB was 30 (and for those patients who slump >45). Constant reinforcement for the families is also required

Response..

How can you be sure that is why they aspirated? Could it be the families slipping them drinks and food they aren't capable of swallowing properly or aspirating on the saliva they also can't swallow? Maybe you are assuming it is the tube feed because they were always taught that is what it must be when in fact it isn't really possible when the patient is tolerating the feeds? Something to think about. I have a gut feeling it isn't necessary to keep at 30 or more all the time. too busy to look into it right now. in the meanwhile I will keep at 30. we switch to bolus feedings when it becomes a problem and I think the little extra work is worth it sometimes.

good luck with your paper. I would love to read it

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