PO Reg diet for pt w/ enteral tube?!

[Lenap]

Just recently I had a pt w/ enteral feeding tube. Right at the begining of shift even before I took (taped) report on this patient, he vomited and his ENtube got dislodged, to be exact large part of the tube came out of pt's mouth. Of course I pulled the tube out immediately. Then the next thing I find out is that the pt is on a regular diet, but get supplemental continous 24 hr feeding via enteral feeding tube! Now I am new to this hospital where everyone is telling me this is normal practice here! At my previous hospital job I had never seen a pt with enteral or ng tube to be allowed POs. And I took care of many patients w/ ng, dubhoff, g/j tubes..etc. I had seen pts allowed POs w/ G/J tubes. I am concerned with all the risks, like aspiration for example. I normally see pts getting TPN as a supplement in hospitals or just a BOOST/ensure drink works well as a supplement. Am I just paranoid or is this is a normal practice? Any input will be greatly appreciated!Thanks.

[RN92]

It isnt that often that I see this either. Why does he have the NGT to begin with? Could they be trying him on a regular diet before pulling the NGT? If he does well with po feedings, then maybe he doesnt need the NGT. Also, this could just be just an oversite on the Doctors part.

Maybe you're supposed to be pushing that regular diet down the NGT? HAHA, just kidding.

[Tweety, BSN, RN]

I don't see it that often. But it's not unheard of. Patients with high nutrition needs and poor p.o. intake often get supplemental tube feedings. What's more common is that the tube feeding is off during the day, and on at night. The most recent example I've seen was an anorexic patient admitted with dehydration/tachycardia. Had one patient also with healing decubiti with very high nutrition needs, and poor po intake.

Good luck.

[Lenap]

Thanks for replies. I guess this is more common than I thought possible. I agree 3rdShiftGuy that a lot of patients often get a 12hr continous feeding through the night (most often seen in pts on TPN) or even q6h feeding boluses via Gtube would be better for this pt. He is malnurished man who is on oncology floor going through course of chemo and radiation at this time, so has poor appetite and frequent period of nausea. It just doesn't make any sense to have feedings through ENtube, especially if that's not going to stop nausea and vomiting! Anyway, if anyone has any good reason why this continous enteral feeding would be the best option for this kind of pt, I would like to hear from you! Thanks again.

[mattsmom81]

I cannot imagine myself trying to eat/swallow around an NG tube but I've seen orders for this too...which I always question. Seems a PEG would be a better alternative for long term supplements not being met by po intake, but some patients do OK with the NG and oral feedings. Go figure.

[CHATSDALE]

we have had peg tube pts who are advancing toward po diets and they are usually put on a percentage basis...if they eat 100% of their meal they require no tube feeding...if they eat 25% of less they get a supplement via peg...if they continue to eat a satisfactory amt the tube is dc

[Lenap]

I could not believe when i came back to work 2 days later and find out the pt was d/c home w/out enteral feeding tube! What was the point of inserting it, checking placement w/ x-ray-all this trouble for 1 day of feeding. What a nonsense. Someone should take away this doc's license 'cause he doesn't have a clue what he's doing. Made me so angry and feel so sorry for this pt.

Thanks for all your replies!

[caroladybelle, BSN, RN]

Cancer (head and neck) patients frequently get PEG tubes placed, in anticipation that they will lose appetite/ may get mucositis/esophagitis during treatment. They will continue to take diet as tolerated until unable to do so. Starting a can a day PEG feeding at beginning of treatment also helps augament intake and help prevent cancer cachexia.