What should I do when holding feeding temporarily?

Management of Temporarily Held Enteral Feeding

When enteral feeding needs to be temporarily held, you should monitor gastric residuals, resume feeding gradually starting at 30 ml/hr, check for electrolyte abnormalities, and maintain tube patency with regular water flushes. 1

Assessment During Feeding Interruption

When enteral feeding is temporarily held, several key actions are necessary:

• Check gastric residuals: Aspirate the stomach every four hours during the interruption. If aspirates exceed 200 ml, continue to hold feeding and reassess 1
• Monitor for refeeding syndrome risk: Patients who have been malnourished or had little nutritional intake for >5-10 days are at high risk 2
• Check electrolytes: Monitor potassium, phosphate, magnesium, glucose, and sodium levels, as these can rapidly change when feeding is interrupted and restarted 1, 2
• Maintain tube patency: Flush feeding tubes with water every 4 hours during the hold period to prevent obstruction 1, 3

Resuming Enteral Feeding

For Standard Risk Patients:

1. Resume at moderate rate: Start at approximately 30 ml/kg/day (or about 30 ml/hr) for standard 1 kcal/ml formula 1
2. Advance gradually: Increase to goal rate over 24-48 hours if well tolerated
3. Position patient properly: Keep the patient propped up at 30° or more during feeding and for 30 minutes after resuming feeding to minimize aspiration risk 1

For High-Risk Patients (malnourished or NPO >10 days):

1. Start at lower rate: Begin at 5-15 kcal/kg/day (approximately 10-20 ml/hr) 2
2. Supplement electrolytes: Provide prophylactic phosphate, potassium, and magnesium supplementation before resuming feeding 2
3. Administer thiamine: Give thiamine before restarting nutrition to prevent Wernicke's encephalopathy, especially in alcoholic patients 1, 2
4. Advance slowly: Increase feeding rate gradually over 5-10 days to reach full nutritional requirements 2

Monitoring After Resuming Feeding

• Check blood glucose: Monitor every 6 hours until stable, especially in diabetic patients 1, 4
• Monitor electrolytes: Check daily until stable, particularly phosphate, potassium, and magnesium 1, 2
• Assess fluid status: Monitor intake/output every 8 hours and daily weight 3
• Check for feeding intolerance: Monitor for abdominal distension, vomiting, or diarrhea 5

Special Considerations

• Medication timing: If feeding is held for medication administration, hold for the minimum time necessary and resume immediately after 1
• Procedural holds: For procedures requiring NPO status, resume feeding as soon as clinically appropriate 6
• Diarrhea management: If diarrhea occurs after resuming feeding, consider medication causes before assuming it's formula-related, as medications (particularly antibiotics) are responsible for 61% of diarrhea cases in tube-fed patients 5
• Feeding method selection: Consider intermittent or bolus feeding rather than continuous feeding when appropriate, as this may be more beneficial for muscle protein synthesis 7

Preventing Complications

• Avoid bacterial contamination: Use proper handling techniques when reconnecting feeding systems 1
• Prevent tube obstruction: Flush tubes with water after checking residuals and before reconnecting feeding 1, 3
• Manage gastric motility issues: Consider prokinetic agents like metoclopramide (5-10 mg) if delayed gastric emptying is suspected 2, 8

By following these guidelines, you can safely manage temporary interruptions in enteral feeding while minimizing complications and maintaining optimal nutritional support.