When delivering enteral nutrition, there are a number of complications that may arise. Below are some of the most common complications and strategies when assisting a patient who is experiencing them.
Mouth discomfort or infections
The majority of patients on enteral feeding will either be taking minimal oral intake or no oral intake at all. This can lead to issues such as a dry mouth, oral infection and general discomfort. Maintaining good oral hygiene is of upmost importance when oral intake is low in order to avoid infections within the mouth and reduce the risk of chest infections; but also plays a key role in keeping the mouth comfortable. If a patient is suffering with a dry mouth, providing it is appropriate, they may benefit from regular mouth care such as artificial saliva products (e.g. oral gels/sprays etc.) or being offered regular opportunities to rinse their mouth with water.
Reflux and vomiting
In order to prevent reflux or vomiting ensure that the patient is being fed sitting upright or at a minimum of 30-45º angle. If a patient’s vomiting or reflux is caused by acute illness their clinical condition needs assessing. Stopping the feed may need to be considered and if the patient is at risk of dehydration, it may be appropriate to consider hospital admission for intravenous hydration. If vomiting is an ongoing issue, you may want to consider the following:
- Maintain an accurate record documenting the frequency and volume of vomiting and the surrounding events.
- Medical history.
- Appropriateness of feeding regimen, including method, volume, rate and concentration of feed.
- Temperature of feed.
- Medications that may cause vomiting or that may reduce vomiting/reflux.
- Confirming position of the feeding tube especially if naso-jejunal/naso-gastric/jejunal extension via percutaneous endoscopic gastrostomy (PEGJ).
Abdominal pain/distension
Abdominal pain or distension may be caused by constipation, build-up of gas or gastrointestinal obstruction. The following should be considered when seeking to improve or investigate further:
- Check bowel function.
- Minimise any air going into the feeding tube.
- Appropriateness of feeding regimen, including method, volume, rate, fibre content and concentration of feed.
- Gut motility agents.
- Gastric venting. Attach large (60ml) open ended syringe to feeding tube and allow gas to escape.
- Temperature of feed.
Diarrhoea
Diarrhoea may be caused by a number of factors including, infection, medications, rate of feed administration, migration of feeding tube from the stomach to small bowel and poor tolerance to feed. Unless there has been a recent change in the feeding regimen then it should be maintained, whilst investigating the cause of the diarrhoea, unless clearly indicated. The following should be considered when seeking to improve or investigate further:
- hydration and electrolyte replacement.
- a temporary change or break in feeding may help alleviate symptoms.
- Maintain an accurate record of bowel opening frequency and consistency; and surrounding events.
- A stool culture to identify or rule out infective cause.
- Recent changes to the feed.
- Long term changes to the feed regimen that may improve symptoms (rate, volume, or concentration).
- Medical history including any pre-existing bowel disorders.
- Temperature of feed.
- Tube migration.
- Medications that cause diarrhoea (in particular antibiotics) or that assist in reducing it.
- Sorbitol content of medications.
- Hygiene practices around feed administration.
- Faecal impaction causing overflow.
- Malabsorption including bile salt malabsorption.
Constipation
Constipation is typically caused by lack of fluid, lack of fibre, immobility or medications. The following should be considered when seeking to improve or investigate further:
- Regular bowel pattern prior to constipation.
- Medical history including any pre-existing bowel disorders.
- Medications that may be causing constipation (in particular analgesics) or that can relieve it.
- Fibre intake.
- Fluid intake.
- Changes in mobility.
