Hospitals & Services

Contra Indications

Absolute

  • Non-functional gut:  anatomical disruption, obstruction, gut ischemia

 

Relative

  • Expected short period of fasting (except trauma patients)

  • Abdominal distension while feeding enterically

  • Localised peritonitis, intra-abdominal abscess, severe pancreatitis

  • Comatose patients at risk of aspiration

  • Extremely short bowel (<30 cm)

  • Severe shock status

 

Feeding Guideline

(see algorithm below)

  • Place a 12F or larger nasogastric tube to allow reliable aspiration (orogastric tubes should be considered in patients with anterior and middle cranial fossa trauma).

  • Check position of feeding tube with abdo X-ray prior to feeding.  It may not be obvious from standard CXR or AXR that the tube is adequately placed, requiring a modified film or both views.  The side hole should be beyond the gastro-oesophageal junction.

  • Nurse the patient at 15-30 degrees head up

  • Commence feeds at 20 ml/hr and feed continuously according to the attached protocol.

  • Aspirate the tube 4 hrly (do not attempt routine aspiration of jejunostomies, naso-duodenal or naso jejunal tubes).

  • Flush jejunostomy or gastrostomy tubes with 10-20 ml of saline 6 hourly if not being used.

Prokinetics

If feeding is persistently not tolerated > 48 hrs, then consider:

  • Reduction in narcotic dosage

  • Use of a prokinetic agent:  Metoclopramide 10 mg orally/NG (NOT IVI) 6 hrly, then if necessary, erythromycin 250 mg IVI bd.

  • Post-pyloric feeding

 

Choice of enteral Feed

Most patients should be commenced on either Jevity® or Glucerna®.

See Nasogastric feeding chart on next page.

rounded corners top

Related Documents

rounded corners bottom
Page last reviewed: 14 May 2014
Contact Us
Image of a Phone By Phone
Image of an Email sign By Email

For a full list of the convenient ways that you can contact us, refer to the Contact Us page