Manual of Clinical Nutrition

Enteral Nutrition

Manual of Clinical Nutrition Management III- 39 Copyright © 2013 Compass Group, Inc.

Problem Approaches
Overhydration,
rapid/excessiv
e weight gain

Check fluid input and output.

A weight change of 0.2 kg/day or more reflects a change in extracellular fluid volume (1).

Consider fluid-restricted formula based on fluid/volume status and medical issues.

Abdominal
distention

Check gastric residual volume. If two consecutive measurements are > 500 mL, decrease or hold

feedings until possible causes are assessed (Grade III) (2), or follow organization-specific protocols

for gastric residual volume targets and intervention strategies (2-5).

Check for constipation, fecal impaction, or obstruction.

Place feeding tube in distal duodenum or proximal jejunum (Grade II) (1,2).

Aspiration risk
Maintain the head of the patient’s bed at a 30 to 45 angle during feedings (Grade III) (3-5).
Post-pyloric placement of the feeding tube tip at or below the Ligament of Treitz may be beneficial
for patients who are supine or heavily sedated (Grade II) (2-5). Consider the use of motility agents
such as prokinetic medications (metoclopramide and erythromycin) or narcotic agonists if
clinically feasible (5).
Implement continuous enteral feedings (4).

*The Academy of Nutrition and Dietetics has assigned grades, ranging from Grade I (good/strong) to Grade V (insufficient evidence), to

evidence and conclusion statements. The grading system is described in Section III: Clinical Nutrition Management A Reference Guide,

page III-1.

References

1. Malone AM, Seres DS, Lord L. Complications of enteral nutrition therapy. In: Mueller CM, ed. The A.S.P.E.N. Adult Nutrition
   Support Core Curriculum. 2nd ed. Silver Spring, Md: American Society of Enteral and Parenteral Nutrition; 2012:218-233.


2. Critical Illness Evidence-Based Nutrition Practice Guideline. Academy of Nutrition and Dietetics Evidence Analysis Library.
   Academy of Nutrition and Dietetics; 2012. Available at: http://www.andevidencelibrary.com. January 16, 2013.


3. Kattelmann K, Hise M, Russell M, Charney P, Stokes M, Compher C. Preliminary evidence for a medical nutrition therapy
   protocol: enteral feedings for critically ill patients. J Am Diet Assoc. 2006; 106:226-241.


4. McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G; ASPEN Board of
   Directors; American College of Critical Care Medicine. Guidelines for the provision and assessment of nutrition support
   therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and
   Enteral Nutrition (A.S.P.E.N.). J Parenter Enteral Nutr. 2009;33:277-316.


5. Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, Lyman B, Metheny NA, Mueller C, Robbins S, Wessel J;
   ASPEN Board of Directors. Enteral Nutrition Practice Recommendations. J Parenter Enteral Nutr. 2009;33:122-167. Also
   available at: http://www.eatright.org (“Evidence-Based Practice” link). Accessed September 20, 2010.


6. Malone AM, Brewer CK. Monitoring for efficacy, complications and toxicity. In: Rolandelli RH, ed. Clinical Nutrition: Enteral
   and Tube Feeding. 4th ed. Philadelphia, Pa: Saunders; 2005: 276-290.


7. Executive summary: standards of medical care in diabetes—2010. Diabetes Care. 2010;33 (suppl 1): S4-S10.