Name of the Procedure:

Enteral Formula, Nutritionally Complete, Calorically Dense (B4152)

• Common Names: Enteral nutrition, Tube feeding
• Technical Term: Nutritionally complete enteral formula

Summary

This procedure involves the administration of a high-calorie, nutritionally complete liquid formula directly into the gastrointestinal tract via an enteral feeding tube. The formula contains all essential nutrients including proteins, fats, carbohydrates, vitamins, and minerals and is often used when a patient cannot consume food by mouth.

Purpose

• Medical Conditions Addressed: Malnutrition, difficulty swallowing (dysphagia), severe illness, or conditions that inhibit oral intake.
• Goals: To provide essential nutrients and caloric intake, maintain or improve nutritional status, support recovery or ongoing health needs.

Indications

• Specific Symptoms/Conditions: Inability to consume enough food orally, severe malnutrition, chronic illnesses such as cancer, neurological conditions, gastrointestinal disorders.
• Patient Criteria: Patients who are unable to meet nutritional needs through oral intake alone and who have a functioning digestive system.

Preparation

• Pre-procedure Instructions: Generally, no special preparation like fasting is needed. Patients may need medical clearance if there are underlying health issues.
• Diagnostic Tests/Assessments: Nutritional assessment, evaluation of gastrointestinal function, placement confirmation of enteral tube.

Procedure Description

1. Formula Preparation: The high-calorie enteral formula (≥ 1.5 kcal/ml) is prepared in a sterile manner.
2. Feeding Tube: The enteral feeding tube (nasogastric, gastrostomy, or jejunostomy) should be properly placed and confirmed.
3. Administration: The formula is administered using a feeding pump or gravity feed system, typically over several hours (continuous or intermittent feeding).
4. Monitoring: The patient is monitored for tolerance to the formula, signs of aspiration, and proper flow of the formula.

• Tools/Equipment: Enteral feeding pump, feeding bags, enteral feeding tube.
• Anesthesia/Sedation: Generally not needed unless tube placement is part of the procedure.

Duration

The duration varies based on the feeding method (intermittent or continuous) but could range from 30 minutes to several hours daily.

Setting

• Location: Hospital, outpatient clinic, home healthcare (with proper instruction)

Personnel

• Healthcare Professionals: Registered dietitian, nurse, sometimes a physician or a gastroenterologist for tube placement.

Risks and Complications

• Common Risks: Nausea, vomiting, diarrhea, constipation, tube blockage or displacement.
• Rare Risks: Aspiration pneumonia, infection at the tube insertion site, metabolic disturbances.
• Management: Adjusting the formula rate, ensuring proper tube care, regular monitoring.

Benefits

• Expected Benefits: Improved nutritional status, maintenance of weight, enhanced energy levels, support for recovery from illness or surgery.
• Timeline for Benefits: Benefits can be realized fairly quickly with sustained improvement over weeks.

Recovery

• Post-Procedure Care: Regular monitoring of tube site, formula tolerance, and nutritional status.
• Recovery Time: Depending on the cause, some patients may need enteral feeding short-term, while others may require long-term or even lifelong support.
• Follow-Up: Routine follow-up with a healthcare provider to adjust nutrition plans.

Alternatives

• Other Treatment Options: Oral supplements, parenteral nutrition (IV feeding), dietary adjustments.
• Pros and Cons: Oral supplements can be easier but may not be sufficient; parenteral nutrition is more invasive and carries higher risks of complications.

Patient Experience

• During the Procedure: Minimal discomfort; insertion of the feeding tube might be uncomfortable initially.
• After the Procedure: Patients typically adapt to the feeding routine; thorough instruction on managing the tube and formula administration is essential. Pain management generally focuses on addressing tube site discomfort if present.