常见管灌餵食之问题与对策

1、常見管灌餵食之問題與對策常見管灌餵食之問題與對策萬芳醫院萬芳醫院 金美雲金美雲2Complications of enteral nutritionnAccess problems Pressure necrosis/ulceration/stenosis Tube displacement/migration Tube obstruction Leakage from ostomy /stoma site 3Complications of enteral nutritionnAdministration problems Regurgitation Aspiration Microbial

2、 contamination4Complications of enteral nutritionnGastrointestinal complications Nausea/vomiting Diarrhea Distention/bloating/cramping Osmotic Delayed gastric emptying Secretory Constipation Drugs/medications High gastric residuals Treatment/therapies Hypoalbuminemia Maldigestion/malabsorption Formu

3、la choice/rate5Complications of enteral nutritionnMetabolic complications Refeeding syndrome Drug-nutrient interactions Glucose intolerance/hyperglycemia/hypoglycemia Hydration status-dehydration/overhydration Hyponatremia Hyperkalemia/hypokalemia Hyperphosphatemia/hypophosphatemia Micronutrient def

4、iciencies6Prevention or correction of tube-feeding complications nAspiration pneumoniaPossible causes- compromised gastroesophageal sphincter, delayed gastric emptying, gastric obstructionPreventive/corrective measures- nasoenteric, gastrostomy, or jejunostomy feeding in high-risk clients small-diam

5、eter transnasal tube elevate head of bed during and 30 minutes after feeding continuous drip method of delivery check gastric residualStable patients, especially those on long-term feeding, do not need residuals checked regularly. 7Prevention or correction of tube-feeding complicationsnClogged feedi

6、ng tubePossible causes- formula too thick for tube medicationsPreventive/corrective measures- select appropriate tube size, dilute formula with water, flush tubing with water before and after giving formula use oral, liquid, or injectable drugs whenever possible; dilute thick or sticky liquid drugs

7、with water before administering; crush tablets to a fine powder and mix with water; flush tubing with water before and after drugs are given; give drugs individually; do not mix drugs with formula 8Prevention or correction of tube-feeding complicationsnDehydration and electrolyte imbalancePossible c

8、auses- excessive diarrhea inadequate fluid intake carbohydrate intolerance excessive protein intakePreventive/corrective measures- provide additional fluid use continuous drip administration of formula; monitior blood glucose; consider administering insulin; change amount or type of carbohydrate mon

9、itor blood electrolyte levels; reduce protein intake 9Prevention or correction of tube-feeding complicationsnDiarrhea, cramps, distentionPossible causes- bacterial contamination; lactose intolerance; hypertonic formula; rapid formula administration; malnutrition/low serum albumin; drug therapyhypero

10、somolar medications- magnesium-containing antacids, sorbital-containing elixirs, electrolyte replacement supplements10Prevention or correction of tube-feeding complicationsnDiarrhea, cramps, distentionPreventive/corrective measures- use fresh formula every 24 hours; store opened or mixed formula in

11、a refrigerator; rinse feeding bag and tubing before adding fresh formula; change feeding bag every 24 hours; prepare formula with clean hands using clean equpment in a clean environment. use lactose-free formula in lactose-intolerant and high-risk clients use a small volume of formula and increase v

12、olume gradually; dilute formula; use isotonic formula. slow administration rate or use continuous drip feedings use a small volume of dilute formula and increase volume and concentration gradually. use antidiarrheal agents; change drug, drug form, or dosage; if possible. soy polysaccharide, pectin,

13、other fibers, bulking agents11Prevention or correction of tube-feeding complicationsnConstipationPossible causes- low-fiber formula lack of exercise drug therapyPreventive/corrective measures- provide additional fluids; use high-fiber formula encourage walking and other activities change drug therap

14、y if possible; give laxatives or enemas if indicatedDiarrhea can coexist with constipation, usually when a patient is impacted. 12Prevention or correction of tube-feeding complicationsnHyperglycemiaPossible causes- primary medical condition diabetes, hypermetabolism, drug therapyPreventive/correctiv

15、e measures- treat disorder check blood glucose; slow administration rate; provide adequate fluid; limit type or amount of carbohydrate; consider administering insulin.13Prevention or correction of tube-feeding complicationsnNausea and vomitingPossible causes- obstruction; delayed gastric emptying; i

16、ntolerance to concentration or volume of formula; drug therapy; psychological reaction to tube feedingPreventive/corrective measures- discontinue tube feeding check gastric residual; slow administration rate, use continuous drip feedings, or discontinue tube feeding . use small volume of dilute form

17、ula and increase volume and concentration gradually; use continuous drip feeding. change drug, drug form, or dosage if possible; use antinausea and antiemetic drugs.14Prevention or correction of tube-feeding complicationsnSkin irritation at enterostomy sitePossible causes- leakage of GI secretions a

18、nd friction caused by the tubePreventive/corrective measures- keep site clean; inspect area for redness, tenderness, and drainage; use protective skin cream.Note: Many of the complications presented here can be caused by the clients primary disorder rather than the tube feeding.Nutrition AssessmentFunctional GI tractNoYesDiffuse Peritonitis,intestinal