White R., Bradnam V., Handbook of Drug Administration via Enteral Feeding Tubes, Pharmaceutical Press 2007 Thiamine, riboflavin, folic acid, andpyridoxine should be supplemented, including fat-soluble vitamins A, D, E, and K. Percutaneous gastrostomy: Toussaint et al. define this as the ‘establishment of an artificial access in the stomach, through the abdominal wall, which can be performed surgically (PSG), endoscopically (PEG) or with image guidance. Insertion of the gastrostomy tube can be done via the oral or the abdominal route’. (204) Wilkes-Holmes, C 2006,' Safe placement of nasogastric tubes in children', Paediatric Nursing , vol.18 issue 9, pp. 14-17

Nurses who are preparing and administrating medication via an enteral tube must adhere to the Medication Management Procedure. Feeding tubes deliver liquid nutrition directly to your stomach or small intestine. Options may include:This is the most gastrointestinal complication seen in enteral feeding. Diarrhea occurs in about 30% of patients admitted to the medical or surgical wards and about 80% of patients in the ICU. [28] [34] [35]

NICE guidance on Nutrition Support for Adults (CG32) recommends that gastrostomy feeding should be considered in people likely to need long-term (4 weeks or more) enteral tube feeding. Italso states that feeding tubes which terminate in the stomach are preferred unless the patient has upper gastrointestinal dysfunction. An enteral feeding pump can be used intermittent, bolus or continuous administration of feeds, but is best suited for continuous feeding when tolerance to rate of feeding is an issue.PEG tube enters the abdomen and exits in the stomach this can be a fine or a large bore tube Percutaneous jejunostomy (PEJ)

If it is safe to do so and the child is able to tolerate oral intake consider providing them with a drink and attempt aspirate in 15-30minutes Remove the plunger from the syringe and place the tip of the syringe into the enteral tube connector at end of the enteral tube. This new edition covers over 400 drugs and includes 29 new monographs. It aims to support safe and effective prescribing by providing practical recommendations on the administration of drugs via enteral tubes. Information in the book comes from pharmaceutical companies, published information (which is limited), and research undertaken largely by pharmacists.

Flushing enteral tubes

There are four techniques for jejunostomy placement: open surgical technique (longitudinal or transverse Witzel), laparoscopic technique, needle catheter technique, and percutaneous technique. Although the preferred technique depends on the type of patient and the surgeon's expertise, minimally invasive techniques are the standard of care. Patients with AKI and renal failure might be in a non-hypercatabolic or hypercatabolic state with excessive sodium, potassium, and phosphate load. Ina non-hypercatabolicstate, high-energy enteral nutrition with normal protein content and low sodium, potassium, andphosphate load are recommended. [13] [14]In AKI with a hypercatabolic phase, a low protein (2 to 2.5g/kg per day) and low electrolyte enteral nutrition are recommended. Besides monitoring electrolytes like sodium, potassium, phosphorus, andcalcium, clinicians should pay special attention to micronutrients like zinc, selenium, thiamin, folic acid, and vitamins A, C, and D. Continuous venting may be facilitated following administration by securing the distal end of the tube above the head of the child. This may be attached to the end of a 5 or 10mL enteral/oral syringe with the plunger removed to create a reservoir should gastric contents reflux For older children feeds given as a bolus should be removed from the fridge 15-20 minutes before administration to bring them to room temperature. Feeds given as a bolus may be warmed in an approved bottle warmer. This would be appropriate for all infants and older children who experience discomfort with cooler feeds.