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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
(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.
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.
Most patients should be commenced on either Jevity® or Glucerna®.
See Nasogastric feeding chart on next page.
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