Enteral Feedings
Enteral feedings are defined as nutrition therapy given via a tube or stoma into the intestinal tract distal to the oral cavity, providing nutrients to patients with limited, impaired, or disturbed capacity to take, digest, absorb, or metabolize ordinary food. 1
Types of Enteral Nutrition
Enteral nutrition can be delivered through different methods:
1. Enteral Tube Feeding
- Definition: Nutrition therapy delivered via a tube or stoma into the intestinal tract beyond the oral cavity 1
- Access Routes:
- Nasal routes: Nasogastric (NG), nasojejunal (NJ), or naso-post pyloric tubes
- Stoma routes: Percutaneous endoscopic gastrostomy (PEG), PEG with jejunal extension (PEG-J), percutaneous endoscopic jejunostomy (PEJ), or surgical gastrostomy/jejunostomy 1
2. Categories Based on Coverage
- Total Enteral Tube Feeding (TEN): All nutrient needs provided through a feeding tube without significant oral or parenteral intake 1
- Supplemental Enteral Tube Feeding: Nutrition given to patients whose oral intake is inadequate for reaching their defined nutritional targets 1
Indications for Enteral Feeding
Enteral nutrition should be considered when:
- The patient has at least a partially functioning gastrointestinal tract 2
- Oral intake is insufficient to meet nutritional requirements 1, 2
- The patient has impaired swallowing function due to neurological conditions (stroke, ALS, Parkinson's) 3
- During mechanical ventilation or altered mental status 3
- In cases of malnutrition where oral supplements are insufficient 1
Enteral Formulas
Most enteral formulas are classified as "foods for special medical purposes" (FSMPs) and share these characteristics:
- Nutritionally complete
- Contain whole proteins, long chain triglycerides
- Carbohydrates predominantly as polysaccharides
- Typically lactose and gluten-free 4
Formula Selection Considerations:
- Standard formulas: Appropriate for most patients
- Disease-specific formulas: Available for specific clinical conditions
- Peptide-based formulas: For impaired digestive function
- Blenderized formulas: Alternative options that may be preferred by some patients 3
Administration Methods
Timing and Duration:
- Short-term feeding (up to 4-6 weeks): Usually via nasogastric or nasojejunal tubes 1
- Long-term feeding (exceeding 4-6 weeks): Gastrostomy or jejunostomy preferred 2
Feeding Mode:
- Intermittent feeding: More physiological, preferred for stable patients
- Continuous feeding: Reserved for severely diseased gut
- Postpyloric feeding: Indicated for patients with high risk of aspiration 2
Advantages of Enteral Nutrition
- Maintains gut integrity and function
- Lower risk of infection compared to parenteral nutrition
- More cost-effective than parenteral nutrition 1
- Ability to provide balanced nutrients and specialized formulas 1
- Smaller water load than intravenous feedings 1
Potential Complications
- Pulmonary aspiration
- Fluid overload
- Reflux esophagitis
- Mechanical complications related to feeding tubes 1
- Gastrointestinal issues (diarrhea, constipation, nausea) 2
Special Considerations
- Enteral nutrition should be monitored by a dedicated nutrition support team 2
- For patients at high risk of diarrhea, formulas with lower FODMAP content may be beneficial 4
- Electrolyte profiles of formulas should be considered for patients with specific electrolyte requirements 4
Enteral nutrition represents an essential component of medical care for patients unable to meet their nutritional needs orally while maintaining a functioning gastrointestinal tract, helping to improve nutritional status, reduce complications, and potentially improve survival in various clinical conditions.