What to Feed a Patient with Feeding Tube: Tips for Recovery

How should one eat?

Hello, nutritionist.
My uncle had surgery near his oral cavity and esophagus and is unable to eat by mouth, so he has a feeding tube (I believe it's called a nasogastric tube).
He is now home and using a blender to puree food to administer through the tube, but recently he has been vomiting everything he eats.
What should I do? Previously, on a friend's suggestion, we tried Ensure, but he vomited that as well.
What can my uncle eat?

Zi Mi, 20~29 year old female. Ask Date: 2008/07/26

Dr. Huang Ruipei reply Nutrition

Hello! There are many reasons that can cause vomiting during nasogastric tube feeding, including: inappropriate composition and taste of the formula, lactose intolerance, too rapid infusion rate, low temperature of the formula, high osmolarity of the formula, effects of medications, or even the position of the tube.
From your description, it is unclear whether the vomiting issue started immediately after the tube was inserted for feeding.
Does he also vomit when just administering plain water? If he vomits even with plain water, or feels nauseous without eating, it is likely related to the underlying disease, other gastrointestinal disorders, or medications.
If he was tolerating the feedings well initially and has recently started vomiting, it would be important to investigate any recent changes in the formula composition, infusion rate or temperature, medications, or the condition of the nasogastric tube, as well as any changes in his medical condition or gastrointestinal issues to identify possible causes.

I recommend adjusting the feeding formula to include ingredients that he is accustomed to (if he has not eaten for a while, you might start with a simple mixture of warm diluted rice porridge with a little salt).
Begin with a small amount (about 50-100 cc) and feed frequently (6-12 times a day), using a syringe to slowly administer the feed.
If he no longer vomits, gradually increase the feeding volume and incorporate other ingredients.
Continuous vomiting can lead to esophageal injury and electrolyte imbalances, so if there is no improvement after a few days, it is advisable to seek medical attention promptly.
Wishing you safety and health.
RD Huang Rupei

Reply Date: 2008/07/26

More Info

Feeding a patient with a feeding tube can be challenging, especially when they experience complications such as vomiting. It’s essential to approach this situation with care and a focus on nutrition, comfort, and recovery. Here are some tips and considerations for feeding a patient with a feeding tube, particularly in the context of your uncle's situation.

Understanding the Feeding Tube
A feeding tube, such as a nasogastric (NG) tube, is often used when a patient cannot eat by mouth due to surgery or medical conditions. The tube allows for direct delivery of nutrition into the stomach. However, complications can arise, including nausea and vomiting, which can be distressing for both the patient and caregivers.

Common Causes of Vomiting with Tube Feeding
1. Feeding Formula Issues: The type of formula being used can significantly impact tolerance. If your uncle has tried a commercial formula like Ensure (安素) and experienced vomiting, it may be too rich or not suitable for his digestive system. Consider switching to a different formula, preferably one that is low in fat and high in protein, as these are often better tolerated.

2. Rate of Feeding: If the feeding is administered too quickly, it can overwhelm the stomach, leading to nausea and vomiting. It’s advisable to slow down the feeding rate. Instead of pushing a large volume at once, try smaller amounts over a longer period. For example, administering 50-100 ml over 30 minutes can help.

3. Temperature of the Formula: Cold formulas can cause discomfort. Ensure that the feeding formula is at room temperature before administration, as this can help with tolerance.

4. Feeding Position: The patient should be in an upright position during and after feeding to help prevent aspiration and reflux. Keeping the head elevated can aid digestion and reduce the risk of vomiting.

5. Digestive Health: If your uncle has underlying digestive issues, such as gastroparesis or other gastrointestinal problems, these need to be addressed. Consult with a healthcare provider to evaluate his digestive health and consider medications that may help with motility.

Recommended Feeding Practices
1. Start with Clear Liquids: If your uncle is experiencing frequent vomiting, it may be beneficial to start with clear liquids or a diluted formula. Gradually increase the thickness and caloric density as he tolerates it.

2. Homemade Blends: If using a blender to prepare food, ensure that the consistency is appropriate for tube feeding. The mixture should be smooth and free of any chunks that could clog the tube. You can blend foods like pureed fruits, vegetables, and proteins (like chicken or fish) with water or broth to achieve the right consistency.

3. Frequent, Small Feedings: Instead of three large meals, consider providing smaller, more frequent feedings throughout the day. This can help manage hunger and reduce the risk of vomiting.

4. Monitor for Reflux: If vomiting persists, monitor for signs of reflux or aspiration. If he is frequently bringing up undigested food or formula, it may indicate that the feeding regimen needs adjustment.

5. Consult a Dietitian: It’s crucial to work with a registered dietitian who specializes in tube feeding. They can provide tailored advice based on your uncle’s specific needs, preferences, and medical history.

When to Seek Medical Help
If vomiting continues despite making adjustments, it’s essential to consult a healthcare professional. Persistent vomiting can lead to dehydration, electrolyte imbalances, and other complications. A doctor may need to evaluate the feeding tube placement, check for any blockages, or assess for other underlying issues.

Conclusion
Feeding a patient with a feeding tube requires careful consideration of their individual needs and responses to nutrition. By adjusting the feeding regimen, monitoring for complications, and seeking professional guidance, you can help improve your uncle's nutritional intake and overall well-being. Remember, patience and gradual adjustments are key to finding the right approach for tube feeding.

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