Initial approach to access for enteral nutrition in hospitalized adults who are not critically ill

This figure summarizes an approach to selecting a route for enteral access in hospitalized patients who require enteral nutrition and are not critically ill. It is intended for use in conjunction with other UpToDate content. Refer to the topics on enteral nutrition for details on selecting an enteral formula, rate and volume of feeding, and optimizing tube feeds to improve patient tolerance.

GERD: gastroesophageal reflux disease.

* Gastrostomy tubes may be placed endoscopically, laparoscopically, or by interventional radiology. Selecting a placement method is informed by patient anatomy, local resources, and available expertise. Refer to UpToDate content on gastrostomy tube placement for additional details.

¶ As examples, we avoid gastric feeding in patients with postoperative ileus or trauma that involved esophageal injury.

Δ Symptoms of poorly tolerated gastric feeding include vomiting, uncontrolled heartburn/GERD, regurgitation, aspiration, epigastric fullness, abdominal pain, and/or abdominal distension.

◊ Rapid entry of formula into the jejunum may result in dumping syndrome characterized by palpitations, diaphoresis, tachycardia, hypoglycemia, and/or diarrhea. Management involves slowing the rate and/or changing the formula to promote slower absorption.

Graphic 59070 Version 3.0

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Initial approach to access for enteral nutrition in hospitalized adults who are not critically ill