Q:
Why is monitoring enteral feedings important in LTC?
A:
Monitoring ensures the resident is receiving the correct nutrition safely and effectively. It helps identify complications early, such as:
- Tube blockage or displacement
- Aspiration risk
- Intolerance (vomiting, diarrhea, abdominal distension)
- Infection or contamination
- Skin breakdown at the insertion site
- Changes in hydration or nutritional status
What should be checked before starting each feeding?
- Hand hygiene and PPE (per Enhanced Barrier Precautions).
- Confirm resident identity using two identifiers.
- Verify correct formula, route, and rate per physician/dietitian order.
- Inspect the feeding tube site for redness, drainage, or leakage.
- Check tube placement (as per facility policy—mark at exit site and verify tube length).
- Ensure the formula is within expiration date, not contaminated, and at room temperature.
- Flush the tube with sterile or filtered water before the feeding.
What ongoing checks should be done during feeding?
- Ensure feeding pump settings match prescribed rate and volume.
- Observe the resident’s tolerance, including:
- Nausea, vomiting, coughing, or abdominal discomfort
- Distention or bloating
- Diarrhea or constipation
- Shortness of breath or signs of aspiration
- Monitor the insertion site for leakage, redness, or pain.
- Keep the head of the bed elevated 30–45° during feeding and for at least 30–60 minutes after.
How often should residual volumes be checked (if required)?
Follow facility policy and prescriber/dietitian direction:
- Typically checked before intermittent feeds or every 4–6 hours for continuous feeds.
- If residual volume is > recommended threshold (often >200–500 mL, depending on policy), hold feeding and notify the nurse or provider.
- Document the amount and any actions taken.
What should be documented during and after feeding?
Record:
- Formula type, rate, amount administered
- Flush volumes before, during, and after feeding
- Tolerance and resident response (e.g., nausea, distention, diarrhea)
- Condition of the tube site
- Any interventions (e.g., tube repositioning, holding feed, notifying provider)
- PPE used under Enhanced Barrier Precautions if applicable.
How should staff monitor hydration and nutrition status?
- Track daily intake and output (including flushes).
- Monitor for signs of dehydration (dry mucous membranes, poor skin turgor, low urine output).
- Observe for weight changes—usually weighed weekly or as ordered.
- Report significant weight loss, edema, or lab changes (e.g., electrolytes, albumin).
What signs indicate feeding intolerance or complications?
- Gastrointestinal: nausea, vomiting, cramping, diarrhea, bloating
- Respiratory: coughing, choking, gurgling, difficulty breathing (possible aspiration)
- Tube issues: clogging, leakage, or displacement
- Site problems: redness, pain, drainage, or granulation tissue
- Systemic: fever, lethargy, or sudden changes in condition
In the event of intolerance or complications, stop the feeding, keep the resident upright, and notify the nurse or provider immediately.
Written By:
Candace Lord
Clinical Consultant
Proactive LTC Consulting
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