From the Guidelines
Pump feeding is indicated for patients who require continuous or intermittent enteral nutrition delivery, particularly those who need precise control over feeding rates, as supported by the 2022 ESPEN practical guideline on home enteral nutrition 1. The indications for pump feeding include patients with impaired gastric emptying, high aspiration risk, limited gastric capacity, or those who experience nausea, vomiting, or diarrhea with bolus feeding.
- Key considerations for pump feeding include:
- Impaired gastric emptying
- High aspiration risk
- Limited gastric capacity
- Nausea, vomiting, or diarrhea with bolus feeding
- Jejunal feeding
- Critical illness requiring careful titration of nutrition
- Diabetes requiring consistent glucose control
- High caloric needs with intolerance to large volume boluses
- Medications requiring consistent absorption rates
- Severe malnutrition requiring gradual refeeding As noted in the 2022 ESPEN guideline, bolus or intermittent continuous or continuous infusion through a pump may be used depending on clinical need, safety, and level of precision required, with a strong consensus of 92% 1. The use of an enteral feeding pump allows for accurate infusion of solutions and safely enables the infusion of small volumes, making it a suitable option for patients who require continuous or intermittent enteral nutrition delivery 1.
- Implementation of pump feeding should start with a low rate and gradually increase as tolerated, monitoring for signs of intolerance throughout the process. Pump feeding provides a steady rate of nutrients, reducing the metabolic demand associated with processing large bolus feeds, decreasing the risk of dumping syndrome, and allowing better absorption of nutrients, as supported by the principle of continuous infusion through a pump 1.
From the Research
Indications for Pump Feeding
- Pump feeding is indicated for patients with gastrointestinal disorders, as it can help control diarrhea 2
- However, pump feeding may not be suitable for patients with poor gastric emptying or impaired swallowing reflexes 2
- Enteral nutrition, which includes pump feeding, is preferred over parenteral nutrition in patients with a functioning gastrointestinal tract who are unable to be fed orally 3, 4
- Pump feeding can be used to administer medications to patients who are unable to swallow safely, but careful consideration must be given to drug interactions and administration methods 3
- The use of a pump for enteral feeding can obviate the need for parenteral nutrition in carefully selected patients 2
Patient Selection
- Patient selection for pump feeding should be based on a thorough assessment of their nutritional needs and gastrointestinal function 5, 4
- Pump feeding may be indicated for patients with intestinal failure who are unable to tolerate enteral feedings, but parenteral nutrition may be necessary in some cases 5
- The choice of enteral access and feeding method should be individualized based on the patient's needs and medical condition 4, 6
Administration and Monitoring
- Pump feeding requires careful monitoring and administration to minimize complications and ensure effective nutrition delivery 4, 6
- Regular quality controls and audits, as well as monitoring by a dedicated nutrition support team, are recommended to minimize the risks associated with enteral nutrition 4