Feeding Tubes and Nutritional Supplementation

Liquid nutritional supplements like Boost or Ensure are frequently prescribed for clients experiencing appetite loss, chewing difficulties, meal preparation challenges, or during post-surgery or illness recovery periods. However, it’s essential to recognize that these shakes are not a panacea for nutritional deficiencies. There exists a misconception that they offer complete nutrition or can entirely replace regular meals.

In reality, relying solely on these supplements can lead to digestive issues such as diarrhea. It is preferable to explore traditional food options to maintain a client’s weight and overall health. If a home health aide chooses to incorporate these products, they should be administered between meals as snacks or supplements to augment the client’s calorie and nutrient intake, rather than as complete meal replacements.

Weight loss often indicates frailty, but it is not an inevitable aspect of aging. It is crucial to investigate the root cause of a client’s decreased appetite. A comprehensive medical evaluation conducted by their physician can uncover underlying issues. Various conditions could contribute to reduced appetite, including ulcers, thyroid disorders, dementia, swallowing difficulties, depression, diminished senses of taste or smell, and poorly fitting dentures. Identifying and addressing these factors promptly is essential. Any concerns should be promptly reported to the agency so that the client’s doctor can intervene to address the underlying problem.

Thickened Liquids:
Swallowing disorders can affect individuals of any age but are more prevalent among the elderly. Aging typically leads to diminished muscle tone in the pharynx and esophagus, affecting swallowing function. Very elderly clients, particularly those with dementia, may forget how to perform daily activities like chewing and swallowing.

Special attention is required for clients with conditions complicating eating or swallowing, such as stroke, nerve or muscle damage in the head and neck region, multiple sclerosis, Parkinson’s disease, and Alzheimer’s disease. A common issue among these clients is coughing or choking due to food or liquid entering the windpipe (aspiration), increasing the risk of pneumonia if it occurs frequently.

Thickened liquids are often recommended following a swallow study. These are regular beverages with thickeners added to increase viscosity, making them less likely to cause aspiration. Thicker liquids move more slowly down the throat, making them easier to control. In cases of swallowing difficulties, rapid intake of water, juice, or coffee can overwhelm the swallowing muscles and nerves, leading to liquid entering the lungs. Thickened beverages offer a slower flow, allowing the body more time to manage and guide the fluid toward the stomach. They are typically categorized into three thickness levels, with the severity of the swallowing issue dictating the thickness:

Nectar Thick: Slightly denser than regular liquid, drinkable from a cup.
Honey Thick: Similar to a milkshake, with a consistency akin to honey, pouring slowly without thinning over time.
Pudding Thick: Extra thick, unsuitable for pouring and requiring consumption with a spoon.

Research indicates that thickening agents are generally safe and effective in reducing aspiration. The objective is to strike a balance between effectiveness in reducing aspiration and palatability to ensure adequate fluid intake by the client.

Tube Feedings:
For clients unable to receive nutrition orally due to mouth, swallowing, or digestive problems, physicians may prescribe liquid nutrition via various methods:

Hyperalimentation or Total Parenteral Nutrition (TPN):
This method involves delivering nutrition intravenously, providing nutrients to clients lacking a functional gastrointestinal (GI) tract or requiring complete bowel rest. TPN offers a liquid nutrient solution containing protein, carbohydrates, glucose, fats, vitamins, and minerals. It utilizes vascular access devices like PICC lines, with central lines being the most common.

TPN is suitable for home administration and is often prescribed for conditions such as Crohn’s disease, cancer, short bowel syndrome, or ischemic bowel disease. Critically ill patients unable to receive oral nutrition for an extended period are also candidates for TPN. Other indications include severe pancreatitis, paralytic ileus, and intractable vomiting or diarrhea.

While TPN is effective in delivering essential nutrients directly into the bloodstream, it poses risks such as infection, catheter-related complications, metabolic imbalances, and liver dysfunction. Close monitoring by healthcare professionals is crucial to detect and manage potential complications promptly.

Despite its benefits, TPN is typically considered a temporary measure due to the potential for complications and the desire to restore normal oral feeding whenever possible. Nutritional support teams work closely with healthcare providers to assess the client’s nutritional needs regularly and adjust the TPN regimen accordingly.

In cases where the GI tract remains partially functional, alternative methods of enteral feeding may be preferred to preserve gut function and reduce the risk of complications associated with TPN. These methods involve delivering liquid nutrition directly into the GI tract via a feeding tube.

Enteral feeding offers several advantages over TPN, including preserving gut function, reducing the risk of infection, and promoting normal physiological processes such as digestion and nutrient absorption. However, it also carries risks such as tube displacement, tube blockage, aspiration, and gastrointestinal complications.

Close monitoring by healthcare professionals is essential during enteral feeding to ensure proper tube placement, prevent complications, and adjust the feeding regimen as needed. Nutritional support teams collaborate with healthcare providers to develop individualized enteral feeding plans based on the client’s condition, nutritional needs, and goals of care.

Enteral Feeding:
Enteral feeding involves delivering liquid nutrition directly into the GI tract through a feeding tube. Various types of feeding tubes are available, including nasogastric (NG) tubes, gastrostomy tubes (G-tubes), and jejunostomy tubes (J-tubes).

Nasogastric (NG) Tube:
NG tubes are inserted through the nose and into the stomach, allowing for short-term enteral feeding. They are often used in hospitalized patients who require temporary nutritional support.

Gastrostomy Tube (G-tube):
G-tubes are surgically placed directly into the stomach through the abdominal wall, providing a more secure and long-term means of enteral feeding compared to NG tubes.

Jejunostomy Tube (J-tube):
J-tubes are inserted into the jejunum, the second part of the small intestine, bypassing the stomach altogether. They are used when the stomach is unable to tolerate feeding due to conditions such as gastroparesis, severe reflux, or gastric outlet obstruction.

They find application in a wide range of scenarios, including:
Hydration: Administering fluids to maintain proper hydration levels, especially in clients who have difficulty drinking or swallowing.

Failed Swallowing Study/High Risk of Aspiration: When a client is at risk of aspirating food or liquids into their lungs due to swallowing difficulties.

Nutrition Supplementation: Providing additional calories, nutrients, and hydration to clients who cannot meet their nutritional needs orally.

Bowel Rest: In cases of small bowel obstruction or other gastrointestinal issues, where the digestive system needs to rest and heal.

Mechanical Ventilation Support: Assisting clients who are on mechanical ventilation and unable to eat or drink normally.

Traumatic Injuries: Such as gunshot wounds or other severe injuries where oral intake is not feasible.

Metastatic Gastric Diseases: When cancers or other diseases affect the stomach’s ability to function properly.

Paralytic Ileus: A condition characterized by the paralysis of the intestinal muscles, often resulting in bowel obstruction.

Physicians prescribe specific formula types for NG tube feedings based on the patient’s individual nutritional needs and medical condition. While all formulas contain essential nutrients such as water, carbohydrates, fats, proteins, vitamins, and minerals, each variant may cater to specific purposes. Some formulas may focus on wound healing, while others may be designed to regulate blood glucose levels, optimize respiratory function, or support renal health. Nevertheless, most formulas are formulated to provide complete daily-recommended doses of vitamins and minerals.