Enteral feeding patients in hospice/carehome facility

xtxrn, ASN, RN · Dec 13, 2011

I've taken care of either bolus or pump feedings- not free flowing, large volume gravity drips. I don't think those are safe- when you set a clamp, you get the speed in the position the person is in at the time you set it. If they move around, and the tube moves (maybe up against the stomach wall), the rate changes- or if you set it and the end of the tube was partially against the stomach wall, and they more, they can get "overloaded" when they turn.....

Bolus- one can while I stood there watching.

Pump- safest (though not perfect)

Flow-meter (which this device sounds like) were VERY positional - they were better than nothing, but if you get a blockage because of positional issues- you're in deep doodoo.

IMO, a gravity regulator is bad news for tube feeding formulas. And I would never "catch up" a "large" volume of formula - to much risk for vomiting/aspiration.

sapphire18 · Dec 13, 2011

I agree with xtxrn, this doesn't sound the safest...I also have never seen a pt on tube feeds at above like 75/80cc/hr, usually they're even lower; but we do continuous feedings, not boluses or scheduled or anything. And yes we do adjust them frequently but that is because these pts are usually just starting on tube feedings or have an illness where they need to be stopped or decreased temporarily, surgery, etc.

leslie :-D · Dec 13, 2011

are these hospice pts?

if so, please administer these fdgs cautiously.

more often than not, tube fdgs cause more discomfort to the (dying) pt than comfort.

and do not worry about playing catch up with this population.

i'd much prefer to see either bolus fdgs tid or on a pump.

be alerted to distention, bloating, cramping, diarrhea, n/v, etc.

and of course, hob up.

*sigh*

leslie

mercurysmom · Dec 13, 2011

I'm a bit confused...are you referring to gravity feeds or bolus feeds? Most of the folks I work with are fed via an enteral feeding pump. A pump can be programmed to feed Xml/hour continuously, or intermittently (xml/hour for 1 hour, then pause for 3 hrs and deliver x volume again.) Some pumps can be programmed to deliver formula at Xml/hr for a stretch of time, and then deliver a bolus of H2O, all without disconnecting the tube or touching the pump. Many pumps that are used in homecare don't have a drip chamber, so they don't need to stay upright. These ambulatory pumps fit in backpacks and can be taken just about everywhere.

The Oley Foundation is a great place to start reading about ways to increase or maintain your patient's quality of life. Here's the link: http://www.oley.org

mm

Double-Helix, BSN, RN · Dec 13, 2011

I agree with everything said above. We only feed with pumps (inpatient) and I'd be wary of feeding with a flow rate controller, as they can easily get moved or adjusted by accident.

If a tube becomes blocked, I've had some success unclogging them with Coke or ginger ale.

Whether or not I catch up on a feed depends on how much was missed. If the patient is on bolus feeds, it might be possible to increase the frequency of the feeds slightly to make up the calories. But if it's a matter of 100 cc's, it wouldn't really be a big deal.

i.care · Dec 13, 2011

Thanks for all your responses. I am currently working with both bolus and pump fed patients but to be honest it's still all a bit new to me !

The new product they were showing me was a low cost electronic gravity fed flow controller aimed at overnight / continuous feeders. They mentioned two options, one that was set at a fixed flow rate and another that offered limited adjustment to different rates. They were asking me what were the best rates to select and I wasn't sure. This thing was disposable after 6 months too !!

PS. Thx for the link to Oley, that's a great website !!