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Nutrition
TUBE FEEDING INTOLERANCE

TUBE FEEDING INTOLERANCE
TROUBLESHOOTING GUIDE
Abdominal bloating or distention

Check for:

Positioning of patient ❯

POSSIBLE SOLUTIONS

Elevate the headboard to 30-45 degrees during continuous feeding unless contraindicated; for intermittent feeding, elevate the headboard to the upright position during feeding and at least 30 minutes after2,3

Delayed Gastric Emptying ❯

POSSIBLE SOLUTIONS

Assess abdomen, review the medical history for any underlying motility disorders, consider prokinetic medications, monitor glucose if relevant3; consider a whey-based formula7-9

Tube position ❯

POSSIBLE SOLUTIONS

Check for proper placement (e.g., nasogastric tube has not migrated into small bowel)

Rapid infusion rate ❯

POSSIBLE SOLUTIONS

Review feeding regime, reduce rate/volume or adjust feeding schedule as needed, use room temperature formula3

Fecal Impaction/Constipation ❯

POSSIBLE SOLUTIONS

Assess abdomen; disimpact as needed using enemas or osmotic laxatives such as macrogol; monitor stool frequency and consistency3

Formula characteristics ❯

POSSIBLE SOLUTIONS

Consider a whey-based formula to facilitate gastric emptying7-9; consider a lower fat, lower osmolality and neutral pH formula

Peptamen

References

  1. Yi D. PGHN, 2018, 21(1):12-19.
  2. Bernard AC, et al. NCP 2004: 19: 481-486.
  3. Boullata J, Carney LN, Guenter P (Eds). ASPEN EN Handbook, 2010.
  4. Rao T et al. Nutrition, 2019, 59: 158-169.
  5. Romano C et al. JPGN, 2017, 65(2): 242-264.
  6. Bankhead R et al. JPEN 2009; 33(2): 122-167.
  7. Fried MD et al. J Pediatr 1992;120: 569–72.
  8. Khoshoo Vet al. Eur J Clin Nutr. 2002, 56: 1-3.
  9. Dangin M. et al. J of Nutr 2002; S3228-3233.
  10. Langmore SE et al Dysphagia, 2002, 17: 298-307.
  11. McClave SA et al. JPEN 2009; 33(3): 277-316.
  12. Btaiche IF et al. NCP 2010, 25(1):32-49.