All patients are weighed regularly (1–2 times each week). This is a prerequisite to being able to register changes in the nutritional status.
Tube feeding is given continuously with a low drop rate or by interval/bolus administration (individually adapted meals with high drop rate).
When the patient's energy and fluid requirements are fulfilled, it will be decided whether the patient will be given bolus or continuous supply at night, in order to increase mobilization during the day. However, this requires that the patient does not have diarrhea, nausea or other complaints associated with the supply of nutrition.
For a running feeding tube:
Every 4-8 hours, it should be aspirated in order to monitor the gastric emptying. This applies especially to immobile and weak patients.
Weekly or more often, the nutrition program/fluid balance, evaluation, edema control, blood tests (albumin, K, Mg, P, blood glucose) should be monitored weekly or more often.
Every 6 weeks, the tube should be changed. Alternate nostrils avoid irritation in the nose through prolonged feeding.
If it is not possible to administer drugs orally, it can be done via a tube. It is recommended to use drugs available in fluid form. Tablets can also be crushed and dissolved in water or gluocose water.
Experience shows that the use of infusion pumps causes fewer side effects and ensures correct volume and rate.
Initiation of tube feeding with bolus supply is only recommended
- if the patient been taking any food until the last 24 hours
- if the patient is taking some food and requires tube feeding for additional nourishment
It is recommended to use pumps for bolus supply for the first 1–2 days.
If the patient cannot tolerate bolus supply (vomiting, abdominal discomfort, nausea, diarrhea), reverting to continuous supply should be considered.
Tube feeding should always be administered continuously to very malnourished patients or if the tube end is located distally to the pylorus.
If the patient has a satisfactory nourishment status, begin with 100% of the requirement. If the patient is seriously malnourished and at risk for refeeding syndrome, renourishment should start slowly (10 kcal/kg/day), thereafter increasing slowly to 100% over 4-7 days.
The patient must be monitored closely in relation to
- electrolytes (potassium, phosphate and magnesium).
- infusion rate.
- twenty-four hour urine sample and fluid balance should be calculated daily.
- glucose in the blood and urine, and electrolyte in the blood should be examined daily at the start.
- liver tests, kidney function tests and triglycerides should be taken examined at least once every week.
For TPN treatment longer than 1 month, vitamins and trace elements should be examined.