Home Therapy; Enteral Nutrition via Gravity (S9341)

Name of the Procedure:

Common Name(s): Home Enteral Nutrition Technical/Medical Terms: Enteral Nutrition via Gravity

Summary

Home enteral nutrition via gravity is a method of providing liquid nutrition directly to the stomach or intestines through a tube, utilizing gravity to control the flow rate. This procedure includes the administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment. Enteral formula and nursing visits are billed separately and the service is provided on a per diem basis.

Purpose

Home enteral nutrition addresses medical conditions that prevent adequate oral intake or digestion. It aims to maintain nutritional status or improve it when oral feeding is not sufficient or possible.

Indications

• Inability to take oral nutrition due to conditions like stroke, severe neurological disorders, or cancers of the head and neck.
• Severe malnutrition or chronic illness requiring nutritional support.
• Patients with a functioning gastrointestinal tract who cannot meet their nutritional needs through oral intake alone.

Preparation

• Patients are instructed on proper tube care and maintenance.
• Patients or caregivers receive training on how to administer the enteral nutrition.
• Pre-procedure assessments may include nutritional evaluations and placement checks of the feeding tube.

Procedure Description

1. Setup: Gather all necessary supplies and equipment.
2. Formula Preparation: Prepare the enteral formula as per the given instructions.
3. Tube Check: Ensure the feeding tube is correctly placed and functional.
4. Administration:
   1. Connect the feeding bag to the feeding tube.
   2. Hang the feeding bag on a pole, allowing gravity to govern the flow.
   3. Open the flow regulator to start the feeding.
5. Monitoring: Monitor the patient for signs of discomfort or complications during feeding.

Duration

The feeding duration varies, usually lasting between 30 minutes to a few hours, depending on the patient's tolerance and prescribed feeding schedule.

Setting

This procedure is performed in the patient’s home, facilitated by healthcare professionals and support from telehealth services if necessary.

Personnel

• Registered Dietitian
• Home Health Nurse
• Pharmacy Services
• Care Coordinator

Risks and Complications

• Infection at the tube site.
• Gastrointestinal complications such as nausea, vomiting, or diarrhea.
• Tube dislodgment or blockage.
• Aspiration (food entering the lungs).

Benefits

• Ensures adequate nutritional intake for those unable to eat orally.
• Supports recovery and maintains strength and health.
• Performed in the comfort of the patient’s home, contributing to better overall quality of life.

Recovery

• Follow the guidance for daily care and maintenance of the feeding tube.
• Regular follow-up visits with healthcare providers.
• Nutritional adjustments and monitoring to ensure balanced intake.

Alternatives

• Total Parenteral Nutrition (TPN): Nutrient solution given intravenously; more complex and riskier.
• Oral Supplements: Liquid or high-calorie food supplements; dependent on partial oral intake capability.
• Dietary Changes: Tailored oral diets; appropriate for those still able to eat but need nutritional enhancements.

Patient Experience

Patients may feel some discomfort during feedings initially as they adjust to the new form of nutrition. Proper training and gradual adaptation usually alleviate initial discomfort. Pain management measures may include prescribed topical anesthetics and regular site care. Most patients progressively feel more comfortable as they adapt to the routine.