Name of the Procedure:

Enteral Nutrition for Pediatrics (HCPCS Code B4158) Common names: Pediatric enteral feeding, Nutritionally complete pediatric enteral formula, Tube feeding.

Summary

Enteral nutrition for pediatrics involves using a nutritionally complete formula that contains proteins, fats, carbohydrates, vitamins, and minerals. It often includes fiber and/or iron and is administered through a feeding tube directly into the stomach or small intestine. Each unit of this formula provides 100 calories.

Purpose

Medical Conditions or Problems Addressed:

• Malnutrition
• Failure to thrive
• Chronic illness affecting nutrient intake
• Digestive disorders
• Post-surgical nutrition support

Goals or Expected Outcomes:

• Provide complete nutrition for children unable to eat by mouth
• Support growth and development
• Maintain adequate nutrient intake

Indications

Specific Symptoms or Conditions:

• Inability to consume oral nutrition adequately
• Chronic gastrointestinal disorders
• Neurological impairments affecting swallowing
• Severe food allergies or intolerances

Patient Criteria:

• Pediatric patients requiring long-term or short-term nutritional support
• Children with conditions warranting bypass of the upper GI tract

Preparation

Pre-procedure Instructions:

• Assessment by a pediatric dietitian
• Evaluation by a healthcare provider
• Possible fasting if transitioning from oral to tube feeding
• Review of current medications

Diagnostic Tests:

• Nutritional assessment
• Gastrointestinal evaluation
• Swallowing studies if applicable

Procedure Description

1. Placement of the Feeding Tube: A feeding tube is inserted via the nose (nasogastric) or directly into the stomach (gastrostomy) or small intestine.
2. Formula Preparation: Measure and prepare the enteral formula ensuring it has the correct temperature and consistency.
3. Administration: Connect the formula to the feeding tube. Administer using a feeding pump or gravity method, adhering to prescribed rates.
4. Monitoring: Monitor the patient for signs of intolerance, such as vomiting or diarrhea.

Tools and Equipment:

• Feeding tube (nasogastric or gastrostomy)
• Enteral formula (B4158)
• Feeding pump or gravity set
• Syringes and connecting tubes

Anesthesia or Sedation:

• Local anesthesia for gastrostomy tube placement
• Sedation in some cases for tube placement

Duration

• Tube placement: 20-60 minutes
• Feeding sessions: Duration varies, typically 15-45 minutes per feeding.

Setting

• Hospital
• Outpatient clinic
• Home care setting (after initial setup and training)

Personnel

• Pediatrician
• Pediatric dietitian
• Pediatric nurse
• Gastroenterologist (if surgical placement required)

Risks and Complications

Common Risks:

• Tube dislodgement or blockage
• Gastrointestinal discomfort

Rare Complications:

• Infection at the insertion site
• Aspiration (inhalation of formula into lungs)
• Metabolic imbalances

Management:

• Regular inspection and cleaning of the tube and site
• Careful monitoring during feeds

Benefits

Expected Benefits:

• Improved nutritional status
• Better growth and developmental outcomes
• Enhanced quality of life

Realization Timeline:

• Immediate initiation of proper nutrition support
• Long-term benefits seen over weeks to months

Recovery

Post-procedure Care:

• Regular tube site cleaning
• Monitoring for signs of infection or complications
• Gradual acclimatization to feeding schedule

Recovery Time:

• Varies; tube site healing typically within a week
• Adaptation to enteral feeding in a few days

Follow-up Appointments:

• Regular monitoring by healthcare provider and dietitian

Alternatives

Other Treatment Options:

• Oral nutritional supplements
• Parenteral nutrition (IV feeding)

Pros and Cons:

• Oral supplements are less invasive but may not be feasible.
• Parenteral nutrition bypasses the GI tract but involves more risk and cost.

Patient Experience

During the Procedure:

• Discomfort during tube placement
• Sensation of the feeding tube

Post-procedure:

• Possible minor pain or discomfort at the tube site
• Adaptation to feeding schedule

Pain Management and Comfort:

• Mild pain relievers if needed
• Regularly adjusting the feeding regimen to enhance comfort