The precautions for enteral nutrition care are as follows:
1. Ensure that the nutrient solution and infusion equipment are clean and sterile
The nutrient solution should be prepared in a sterile environment, placed in a refrigerator below 4℃ for temporary storage, and used up within 24 hours. The preparation container and infusion equipment should be kept clean and sterile.
2. Protect mucous membranes and skin
Patients with long-term indwelling nasogastric tube or nasointestinal tube are prone to ulcers due to continuous pressure on the nasal and pharyngeal mucosa. They should apply ointment daily to keep the nasal cavity lubricated and keep the skin around the fistula clean and dry.
3. Prevent aspiration
3.1 Displacement of the gastric tube and pay attention to the position; pay special attention to maintaining the position of the nasogastric tube during the infusion of the nutrient solution, and do not move it upwards, the emptying of the stomach is slow, and the nutrient solution is infused from the nasogastric tube or gastrostomy The patient takes a semi-recumbent position to prevent reflux and aspiration.
3.2 Measure the amount of residual fluid in the stomach: during the infusion of the nutrient solution, pump the residual amount in the stomach every 4 hours. If it is greater than 150ml, the infusion should be suspended.
3.3 Observation and treatment: During the infusion of nutrient solution, the patient’s reaction should be closely observed. Once coughing, coughing up of nutrient solution samples, suffocation or shortness of breath occurs, it can be determined as aspiration. Encourage the patient to cough and aspirate. , If necessary, remove the inhaled substance through a bronchoscope.
4. Prevent gastrointestinal complications
4.1 Complications of catheterization:
4.1.1 Nasopharyngeal and esophageal mucosal injury: It is caused by too hard tube, improper operation or too long intubation time;
4.1.2 Pipeline blockage: It is caused by the lumen being too thin, the nutrient solution is too thick, uneven, clotted, and the flow rate is too slow.
4.2 Gastrointestinal complications: nausea, vomiting, abdominal pain, abdominal distension, diarrhea, constipation, etc., which are caused by the temperature, speed and concentration of the nutrient solution and the inappropriate osmotic pressure caused by it; nutrient solution pollution causes intestinal infection ; Drugs cause abdominal pain and diarrhea.
Prevention method:
1) The concentration and osmotic pressure of the prepared nutrient solution: Too high nutrient solution concentration and osmotic pressure can easily cause nausea, vomiting, abdominal pain and diarrhea. Starting from a low concentration, generally starting from 12% and gradually increasing to 25%, the energy starts from 2.09kJ/ml and increases to 4.18kJ/ml.
2) Control liquid volume and infusion speed: start with a small amount of liquid, the initial volume is 250 ~ 500ml/d, and gradually reach the full volume within 1 week. The infusion rate starts from 20ml/h and gradually increases to 120ml/h every day.
3) Control the temperature of the nutrient solution: the temperature of the nutrient solution should not be too high to prevent scalding of the gastrointestinal mucosa. If it is too low, it may cause abdominal distension, abdominal pain, and diarrhea. It can be heated outside the proximal tube of the feeding tube. Generally, the temperature is controlled at about 38°C.
4.3 Infectious complications: Aspiration pneumonia is caused by improper catheter placement or displacement, delayed gastric emptying or nutrient fluid reflux, drugs or neuropsychiatric disorders caused by low reflexes.
4.4 Metabolic complications: hyperglycemia, hypoglycemia, and electrolyte disturbances, caused by uneven nutrient solution or improper component formula.
5. Feeding tube care
5.1 Properly fix
5.2 Prevent twisting, folding, and compression
5.3 Keep clean and sterile
5.4 Wash regularly
Post time: Jul-16-2021