Enteral (NG/PEG) Nutrition
Weeks of vomiting and nausea can leave you very depleted.
Nutrients can be replaced either through and IV (parenteral
nutrition) or a gastric (stomach) feeding tube (enteral
nutrition). A NG tube is passed through the nose, down the
throat, to
the stomach or jejunum, and the PEG requires an outpatient
surgical procedure to implant it through the abdomen into
the stomach. Sometimes, the tube will be advanced further,
into the jejunum for added safety and tolerance. Both procedures
are somewhat uncomfortable, but steps are taken to decrease
any discomfort.
Safety of Enteral Feedings
Your doctor may suggest enteral
feedings because it is often assumed this route is safer
and better for the body than
parenteral nutrition. A few medical research studies have
shown benefits to enteral feeding for some women with HG,
but it is not yet clear as to which women can tolerate it.
There are some risks that women with HG are more prone to,
and these should be discussed with your doctor. The most
common risks include tube displacement, pulmonary (lung)
aspiration and poor tolerance. Aspiration is one of the most
concerning complications because it can cause pneumonia or
other problems in the lungs. Many women with HG have slow
emptying of their stomachs, reflux, extremely sensitive gag
reflexes, and frequent vomiting which may make NG feedings
less tolerable and somewhat risky. The smell of formula also
may cause vomiting. Some women report repeated tube dislodgements
due to vomiting, which may make them reluctant to continue
this therapy.
If you try this route of nutritional support,
make sure you are educated in the care of a gastric tube
and able to identify
signs of aspiration or other potential complications. Online
resources are listed to the right for your reference. If
despite this therapy, you continue to vomit or have severe
nausea,
you may benefit greatly from a period of rest for your stomach
(i.e. no food intake for several days to a week). However,
you will still require nutritional support due to weeks of
vomiting and limited intake. Intravenous
(IV) nutrition is
another option to discuss with your health professional.
Additionally, if you do not improve, more
aggressive antiemetics or higher doses should be considered.
A second opinion may be necessary in this case if the care
you are receiving does not seem to be helping you. See our
Referral Network for more assistance. Remember, chronic dehydration
and nutrient depletion make vomiting and nausea worse. So
get the help you need so you improve and recover faster.
Risk Factors and Potential Complications
|
Risk Factors for Aspiration:
- Decreased level of consciousness (sedative medication)
- Diminished gag reflex
- Gastric (stomach) reflux
- Supine position (laying down)
- Use of large diameter tubes
- Delayed gastric emptying
- Vomiting or retching
|
|
Risk Factors for Refeeding Syndrome:
- Prolonged fasting
- Repeated IV hydration
- Significant stress
- Nutrient depletion
|
| Electrolyte imbalances (K+,
Na+) |
Due to fluid imbalance, renal
impairment, diarrhea, Refeeding syndrome. |
| Hyperglycemia |
Too many calories or lack of
adequate insulin. |
Dehydration
|
|
Tube clogging
|
|
Tube malposition
|
|
Aspiration
|
|
Nausea and vomiting
|
|
Diarrhea
|
|
Constipation
|
|
| Malabsorption/maldigestion |
|
| Refeeding syndrome |
The metabolic cascade of events
that takes place when a malnourished patient is
refed. |
|
| |
| Adapted from www.rxkinetics.com,
www.medscape.com,
and other sources. |
Updated on:
Aug. 09, 2006 |
