Tube Feeding During Rehabilitation

There is a certain category of diseases in which the patient faces problems eating. This is due to impaired body functions. With a normal diet, you need to chew solid food thoroughly and swallow. But not all patients can do this. In such cases, doctors prescribe tube feeding - feeding the patient through a medical tube system. The patient receives a balanced diet, the menu is calculated based on the general condition of the body and the diagnosis. While taking food, the patient does not make chewing or swallowing movements. With this feeding, food enters the gastrointestinal tract in a state suitable for digestion.

Indications for tube feeding

Tube feeding is a way to provide nutrition to a patient with impaired functional state of the body. With the help of the system, the patient receives an amount of food sufficient for the normal functioning of other systems and organs. For some diagnoses, tube feeding for bedridden patients is the only method of maintaining vital functions.

Indications for the purpose of probe installation:

rehabilitation after a stroke. One of the consequences of a stroke is impaired swallowing function (partial or complete);
head and neck injuries with swelling of the larynx and esophagus. Ordinary food, even thoroughly chewed, does not pass down the swollen throat. Tube feeding becomes the only method of obtaining nutrients;
being in a coma, unconscious. Patients in these conditions need to receive nutrition to maintain the vital functions of all systems and organs;
mental disorders leading to food refusal. One example is a severe form of anorexia;
Alzheimer's disease, multiple sclerosis, Parkinson's disease. One of the manifestations of such conditions is patient refusal to eat or impaired swallowing function;
surgical operations on the larynx and esophagus. During the rehabilitation period after such operations, nutrition in the usual way is excluded.

In some cases, a tube system is installed in bedridden patients to administer medications taken orally. Doctors resort to this method of treatment when diagnosing gastric decompression.

Nutrition for patients in coma
Patients in a comatose state require careful proper care and must be kept completely at rest. For such patients, a nurse is needed who will fully monitor his condition and nutrition. Particular attention is paid to the prevention of the formation of bedsores, for which special devices are used (mattresses, pillows, bandages and creams). The main reasons for their appearance are immobility and loss of sensitivity, as well as involuntary urination. To avoid this, place oilcloth under the body and change bed linen regularly. It should be noted that special attention is required to organize proper nutrition, which should be balanced and nutritious. For example, a special food for coma patients “Nutrizon” contains all the necessary vitamins and minerals and is a nutritious dry mixture with a high protein content. It can be used as a main or additional nutrition and depends on the patient’s condition.

The dry mixture “Nutrizon” can be used for tube feeding or taken orally, and due to the lack of dietary fiber in the composition, it is suitable for people with poor intestinal function. Nutrition is produced and sold in the form of a powder or a ready-made nutritional drink. In addition to patients in a comatose state, this method of nutrition can also be prescribed to patients who are being prepared for operations, as well as those who have suffered severe injuries, burns and infectious diseases. The finished drink is prescribed to patients who cannot chew food on their own, with jaw injuries and problems with the functioning of the digestive system. Patients in a coma are fed through a tube, while a container with a conductor is connected. The instructions for the mixture indicate that about two liters of therapeutic nutrition will be able to fully satisfy the human body’s need for a daily dose of all necessary nutrients.

The mixture is prepared immediately before use, and it is mixed with water at room temperature. The dosage in each individual case is prescribed by the attending physician strictly individually and depends on the patient’s weight and general health. An open package of powder is stored in the refrigerator for a month, and the prepared drink is stored for no more than one day, and freezing it is prohibited. It is not recommended to mix the mixture with medications, and there are also some contraindications, which include a hereditary disease when galactose is not absorbed. The packaging of Nutrizon medical nutrition is made in oxygen-free conditions, which eliminates the penetration of germs and bacteria, and this is important for patients in a coma. It is worth noting that when tube feeding you should flush the system every four hours. Each package contains a special measuring spoon, which makes the process of preparing the finished drink easier. This product contains vitamins such as A, D, E, K, C, folic acid, choline, biotin, as well as B vitamins. Therapeutic nutrition is enriched with minerals such as sodium and calcium, iron and copper, calcium and zinc, manganese and fluorine, magnesium and phosphorus. Dry mixture “Nutrizon” is a complete, balanced therapeutic nutrition, which is the main source of nutrition for patients in a coma. In addition to proper feeding, you should also regularly clean the nose and mouth, constantly change the position of the patient’s body in order to avoid bedsores, and also monitor the hygiene and cleanliness of bedding and clothing.

Features of tube feeding

Prescribing tube feeding requires compliance with certain rules:

compliance with temperature conditions. Food introduced through the tube should be warm (38-39 degrees). Hot foods can cause burns to the larynx and esophagus. Cold food is difficult to digest, which will lead to a worsening of the condition;
compliance with food consistency requirements. It must be liquid;
compliance with the principle of gradualism. When prescribing feeding through a tube, the first meals (2-3 times) should not exceed 100 mg in volume;
If food is prepared at home, each dish must be prepared separately.

The menu for feeding through a tube depends on the specific diagnosis. The feeding regimen and meals suitable for the patient are prescribed by the attending physician. Most often it is recommended for tube feeding of bedridden patients:

broths based on boiled fish, meat, poultry;
kefir;
liquid milk porridge from semolina;
boiled fish, meat, poultry, pureed through a fine sieve, with the addition of broth in which the products were cooked.

In addition to regular products, the doctor may prescribe vitamin mixtures and other formulations produced in industrial conditions and intended for feeding through a tube.

Possible complications during enteral nutrition

The most severe complication is aspiration of vomit, i.e. its rise into the lungs. To prevent such developments, you should carefully select the diet, install an intestinal tube rather than a gastric one, and during feeding, raise the patient’s head.

There are 2 more groups of complications: disruption of the gastrointestinal tract (diarrhea, vomiting, diarrhea, bloating) and disturbance of general metabolism (acid-base balance, ratio of microelements in the blood, etc.). Therefore, it is necessary to conduct a laboratory biochemical blood test once a week to determine the acid-base balance and the number of electrolytes.

If during feeding the patient experiences nausea, vomiting, diarrhea or convulsions, then either the concentration of the mixture or the rate of its administration should be reduced.

How does tube feeding work?

The daily tube feeding regimen includes 3 to 5 meals. A sterile syringe is used for each feeding. Reuse of the syringe is not allowed.

Tube feeding is done as follows:

the bedridden patient is raised to a semi-sitting position;
the end of the probe with the funnel, located outside, is lowered below the neck, clamped with the included clamp;
A syringe with a nutrient mixture is attached to the funnel. The funnel with the syringe rises 50 centimeters above the level of the stomach. The clamp is removed;
The mixture is slowly squeezed out of the syringe into the funnel. The rate of food administration is no more than 150 mg per 5 minutes;
After introducing food, another syringe filled with water is attached to the probe. The amount of water is from 30 to 50 ml. Water flushes the system, freeing the tube from food debris;
A clamp is attached to the probe, the end of the probe is lowered down. A plug is installed on it.

One probe system can be used for up to 3 weeks. After this, it is removed, and doctors install a new system.

Manufacturers of enteral nutrition

Now enteral nutrition for adults and children is produced by many companies, so you can choose a formula for almost any patient, taking into account his condition, diagnosis, allergies to any components, etc. Particularly worth noting is Brown's enteral nutrition: Nutricomp is used for exhaustion of the body after operations and serious illnesses - oncology, radiation and chemotherapy, for skull injuries, burns, gastrointestinal diseases, comatose states, etc.

B.Braun (Germany) produces enteral nutrition packages of 500 ml, 200 ml and 1000 ml.

Benefits of rehabilitation

Feeding through a tube is a complex procedure, during which you must strictly follow the rules, monitor sterility and hygiene. It is very difficult for an ordinary person to do everything correctly. Our rehabilitation center employs experienced professionals who are well acquainted with the features of tube feeding. Health workers will monitor the feeding schedule and follow all doctor’s recommendations regarding the menu and amount of food.

Caring for a bedridden patient is a task with which relatives of patients often turn to us. Our employees pay special attention to compliance with all medical recommendations. In addition to nutrition, our responsibilities include:

24-hour care;
prevention, treatment of bedsores;
physiotherapy;
massage.

The center has its own psychologists and speech therapists. These doctors help patients of all ages undergoing rehabilitation.

How will you feel?

Slight pain in the nasal cavity, pharynx and vomiting are possible, but not all patients experience this. It is important to listen to your doctor's commands and breathe properly through your mouth. Almost all patients tolerate both this manipulation and treatment with an installed probe satisfactorily. Don't worry, nasal breathing will continue. Sometimes it takes 2-3 days to get used to the probe. In extreme cases, the doctor may prescribe painkillers, antiemetics and antispasmodics. At first, you need to listen to yourself and understand what position you should be in in order to reduce discomfort in this area. The main thing is to remain calm and remember that this is a necessary and temporary measure. According to many patients, their fears about inserting a probe were greatly exaggerated.

Sample menu

The diet should consist of the following foods and dishes:

Porridge cooked in water or milk.
Vegetables. Preference should be given to steamed or stewed vegetables. It is better to limit the consumption of raw vegetables due to their ability to cause increased gas formation.
Boiled, stewed, steamed lean meat: rabbit, chicken, turkey, beef.
Steamed or oven-baked fish. Suitable for both sea and river.
It is recommended to bake fruits – pears and apples are ideal. Although if tolerated normally, you can give everything.
Low-fat fermented milk products: cottage cheese, kefir, fermented baked milk and others must be present in the diet.
Drinks: jelly, tea, rosehip infusion, compote.
Suitable baked goods include: bread, crackers, bagels, grain bread.
Eggs can be given in the form of an omelet, fried egg, or boiled.
For sweets, dried fruits, marshmallows and marshmallows, and honey are acceptable.

If in any doubt, it is better to consult the patient's doctor.