Should we give tube feeds in a patient with ileus?

From the Guidelines

Tube feeding is generally not recommended in patients with ileus, as it can worsen distention, increase the risk of vomiting and aspiration, and potentially exacerbate the underlying condition. Ileus is a temporary cessation of normal bowel motility that prevents the movement of intestinal contents, and providing enteral nutrition through tube feeds can be harmful. Instead, patients with ileus typically require bowel rest, which means nothing by mouth (NPO status) and often necessitates parenteral nutrition if the ileus is prolonged (typically considered after 5-7 days of inadequate oral intake) 1. Management should focus on treating the underlying cause of the ileus, which may include discontinuing medications that decrease gut motility (such as opioids), correcting electrolyte abnormalities (particularly potassium, magnesium, and phosphate), and promoting ambulation when possible. Some key points to consider when managing a patient with ileus include:

• Discontinuing medications that decrease gut motility
• Correcting electrolyte abnormalities
• Promoting ambulation when possible
• Nasogastric tube decompression may be necessary to relieve distention and vomiting. Once bowel function begins to return, as evidenced by the passage of flatus or stool, bowel sounds, or decreased abdominal distention, a cautious trial of clear liquids can be initiated, followed by gradual advancement to tube feeds or oral diet as tolerated 1. This approach allows the gastrointestinal tract time to recover its normal motility patterns before being challenged with nutritional intake.

From the Research

Tube Feeding in Patients with Ileus

• The decision to give tube feeds in a patient with ileus should be made on a case-by-case basis, considering the individual patient's condition and needs 2, 3.
• Ileus is a condition characterized by a temporary halt of the normal contractions of the bowel muscles, which can lead to a buildup of food, fluids, and gas in the digestive system 2.
• Enteral nutrition, including tube feeding, is generally preferred over parenteral nutrition when patients cannot meet their energy and metabolic demands 3.
• However, the use of tube feeding in patients with ileus may be associated with an increased risk of complications, such as diarrhea, metabolic derangements, and aspiration 3, 4.
• The type of tube feeding used, such as gastric or postpyloric feeding, may also impact the risk of complications in patients with ileus 3, 5.

Considerations for Tube Feeding in Ileus

• The patient's overall health status, including the presence of any underlying medical conditions, should be taken into account when deciding whether to use tube feeding in a patient with ileus 2, 4.
• The risk of postoperative ileus, which can occur after elective colorectal surgery, should also be considered when deciding whether to use tube feeding in these patients 4.
• The use of intravenous fluids, which can help to prevent dehydration and electrolyte imbalances, may also impact the risk of complications in patients with ileus who are receiving tube feeding 4, 6.
• Nurses should be aware of the safety aspects around the insertion and maintenance of feeding tubes, and acquaint themselves with safety guidelines and local policies to ensure that patients do not come to any harm 5.