Can nasojejunal (NJ) feeding be given to a patient with nothing by mouth (NPO) status?

Nasojejunal Feeding in NPO Patients

Yes, nasojejunal (NJ) feeding can be given to patients with NPO (nil per os) status, as it bypasses the stomach and delivers nutrition directly to the jejunum, making it appropriate for patients who cannot tolerate oral intake but have functioning intestines. 1

Indications for NJ Feeding in NPO Patients

• NJ feeding is indicated for NPO patients with gastric reflux, delayed gastric emptying, or those who must be nursed flat (such as unconscious patients) 1, 2
• Early post-pyloric enteral tube feeding (ETF) is generally safe and effective in postoperative patients, even if there is apparent ileus 2
• NJ feeding should be considered within 1-2 days of surgery in severely malnourished patients, 3-5 days in moderately malnourished patients, and within seven days in normally or over-nourished patients who are NPO 2

Technical Aspects of NJ Tubes

• All NJ tubes are fine bore (6-10 French gauge) and some have a shorter second lumen for gastric aspiration 2
• The position of an NJ tube should be confirmed by x-ray 8-12 hours after placement, as auscultation and pH aspiration techniques can be inconclusive 2
• Placement techniques include:
  • Initial passage similar to NG tube, then advancing an additional 10 cm after turning patient to right side 2
  • If unsuccessful, repeating the maneuver after inflating the stomach with 500-1000 ml of fluid 2
  • Endoscopic placement, which has a success rate of 94-97.6% 1, 3

Important Considerations and Precautions

• NJ tubes are not designed for the mechanical stress of suction and should not be used for this purpose 1
• For patients requiring both jejunal feeding and gastric decompression, use either a specialized dual-lumen tube or place separate tubes for each function 1
• If a patient with an NJ tube develops distension or vomiting requiring decompression, consider placing a separate NG tube rather than applying suction to the NJ tube 1
• Monitor closely for fluid, electrolyte, and nutritional status, especially in the first few days after initiating enteral tube feeding 4
• Fluid needs can usually be met by giving 30-35 ml/kg body weight, with adjustments for excessive losses 4

Benefits of NJ Feeding vs. NPO Status

• Prolonged NPO status can lead to iatrogenic malnutrition, with studies showing that 22% of hospitalized patients are made NPO or placed on clear liquid diet for prolonged periods 5
• More than a third of diet orders for NPO and two-thirds of orders for clear liquid diet are inappropriate and poorly justified 5
• Early enteral nutrition via NJ tubes can be achieved in 85% of critically ill patients, even when previous gastric feeds were not tolerated 3
• Enteral feeding has many advantages over total parenteral nutrition, including lower risk of sepsis, lower cost, and fewer metabolic problems 6

Potential Complications

• Accidental tube dislodgement or migration (reduced from 38% to 4% when using a nasopharyngeal bridling system) 3
• Applying suction to an NJ tube could damage the jejunal mucosa, cause fluid and electrolyte imbalances, and potentially collapse or damage the tube 1
• Long-term NG and NJ tubes should usually be changed every 4-6 weeks, swapping them to the other nostril 2

Duration Considerations

• If enteral feeding is likely to be needed for more than 4-6 weeks, consider percutaneous gastrostomy or jejunostomy placement 2
• Some evidence suggests considering percutaneous placement as early as 14 days after initiation of enteral feeding 2

Remember that all decisions regarding enteral tube feeding should involve full consultation with the healthcare team and family, with consideration of ethical issues and the patient's best interests 2.