Soins complexes à domicile pour enfants
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Enteral nutrition

How does it work?

Types of nasal tubes

Nasogastric tube
  • Tube inserted into a nostril and advanced down the throat to the esophagus and then the stomach.
  • Frequently used for home enteral nutrition.
  • Allows feeding and medication to be administered directly into the stomach.
  • Can be installed and replaced by the parent, depending on the child’s condition and if they have been taught by the healthcare team.
Nasoduodenal tube
  • Tube inserted into a nostril and advanced down the throat to the esophagus, the stomach and then to the first part of the small intestine (duodenum).
  • Allows feeding directly into the duodenum (bypassing the stomach).
  • Allows the administration of medication directly into the duodenum as needed.
Nasojejunal tube
  • Tube inserted through a nostril and advanced down the throat to the esophagus, the stomach and then to the second part of the small intestine (jejunum).
  • Allows feeding directly into the jejunum.
  • Allows medication to be administered directly into the jejunum as needed.
  • Can only be installed and replaced by the healthcare team.

NEVER INSTALL OR REPLACE THE BUTTON OR LONG TUBE IF YOUR CHILD HAS AN OSTOMY FOR LESS THAN 6 TO 8 WEEKS (or other length of time as recommended by your healthcare team) as the ostomy is not fully healed; all re-insertions in this time period are the responsibility of your healthcare team. 

Types of feeding buttons

Gastrostomy button
(eg, Mic-Key™, AMT MiniONE™, NutriPort™, Bard™, EntriStar™)
  • Device installed in a gastrostomy.
  • Allows feeding and medication administration directly into the stomach.
  • Can be installed and replaced by the parent only after 6 to 8 weeks after surgery (or other length of time as recommended by your healthcare team), if the model is balloon button and the parent has been taught this skill; non-balloon button models must be replaced by the healthcare team.
Gastrojejunal button
(eg, Mic-Key™J, AMT G-JET™)
  • Device installed in a gastrostomy that extends through a tube from the stomach to the jejunum.
  • Has two entry ports: one into the stomach (usually used for medications) and the second into the jejunum (usually used for continuous feeding).
  • Mostly used in children who cannot be fed directly into the stomach.
  • Can only be replaced by the healthcare team.
Jejunostomy button
  • Device installed in a jejunostomy.
  • Allows feeding directly into the jejunum.
  • Allows medication administration directly into the jejunum, as recommended by the healthcare team.
  • Mostly used in children who cannot be fed directly into the stomach.
  • Can only be replaced by the healthcare team. If the healthcare team allows the parent to change the button, they provide the necessary training.

Each type of button has its own extension set.

Types of long enterostomy feeding tubes

Gastrostomy tube 
  • Flexible tube inserted into the stomach through a gastrostomy.
  • Allows feeding and medication administration directly into the stomach.
  • Can be installed and replaced by the parent only after 6 to 8 weeks after surgery (or other length of time as recommended by your healthcare team), if the model has a balloon and the parent has been taught this skill; non-balloon tube models can only be replaced by the healthcare team.
Gastrojejunal tube
  • Flexible tube inserted into the stomach through a gastrostomy and which goes into the jejunum.
  • Has two entry ports: one into the stomach (usually used for medications) and the second into the jejunum (usually used for continuous feeding)
  • Mostly used in children who cannot be fed directly in the stomach.
  • Can only be replaced by the healthcare team.
Jejunostomy tube
  • Flexible tube inserted into the jejunum through a jejunostomy.
  • Allows feeding directly into the jejunum.
  • Allows medication to be administered directly into the jejunum, as recommended by the healthcare team.
  • Mostly used in children who cannot be fed directly into the stomach.
  • Can only be replaced by the healthcare team. If the healthcare team allows the parent to change the tube, they provide the necessary training.

Buttons are often installed in children. They have the advantage of being comfortable and safe.

The child can be fed through the urinary catheter, if recommended by the healthcare team, while waiting to have the urinary catheter replaced with a button or an enterostomy long tube.

Discuss this possibility with the healthcare team depending on your child’s condition.

A plug should be placed over the catheter opening between feeding sessions to prevent leakage.

The important thing is that the child receives the nutrients needed for energy and growth.

NOTE: For ease of reading the rest of the text, the word (nutritional) “formula” also includes “breast milk”, “fortified breast milk” or “infant formula”.

Methods of administration of the nutritional formula

By push
  • The formula is “pushed” slowly with a feeding syringe into the tube or into an extension set attached to the feeding button.
  • This method is used for bolus feeding and medication administration.
By gravity
  • The formula is poured into a bag connected to a tubing.
  • The bag must be suspended at a height above the child’s head (eg, on an IV pole).
  • The formula flows by gravity down the tubing through a drip chamber.
  • The tubing from the bag is connected to the feeding tube or to an extension set attached to the feeding button.
  • A roller clamp on the tubing adjusts the flow rate (or administration rate) of the formula.
  • This method is used for bolus feeding.
  • This method can be used as an alternative if the pump is not functioning.
By enteral feeding pump
(eg, Kangaroo™ ePump, Kangaroo™ Joey, Kangaroo™ Connect)
  • The formula is poured into a bag connected to tubing.
  • The tubing is inserted into an enteral feeding pump connected to an electrical outlet or powered by a rechargeable battery.
  • The bag and pump are suspended from an IV pole or placed in a special backpack.
  • The tubing from the bag is connected to the feeding tube or an extension set attached to the feeding button.
  • The pump controls the amount of formula dispensed and the flow rate.
  • Several models of electronic pumps are available for use in the home.
  • The pump method is used for bolus or continuous feeding.

Modalities of administration of the nutritional formula

Bolus (or intermittent)
  • Feeds are several times a day, over short periods of time, often during normal meal times.
  • Depending on the child’s specific needs, can be used as a meal replacement or as a supplement to a meal taken by mouth.
  • Each session lasts an average of 20 to 30 minutes (like the usual duration of a meal), depending on the amount to be given and the child’s tolerance. The child’s condition may require longer sessions (one hour or more).
  • Bolus feeding cannot be given in the jejunum.
  • Possible with the push, gravity or pump method of administration.
Continuous
  • Feeds run continuously at a regular pace for the prescribed number of hours/day.
  • Feeding may run throughout the day or night without interruption.
  • Mostly used with the pump delivery method.
  • Recommended for a child who:
    • has difficulty tolerating large amounts of formula at a time (does not tolerate bolus meals),
    • has slow stomach emptying,
    • needs a specific amount of formula in a given period of time,
    • is fed directly into the jejunum.
Bolus and continuous
  • Allows mixed administration of the formula (eg, bolus during the day and continuously during the night).
  • The material used for enteral nutrition (tube, button, adapter, connector, feeding bag with tubing, extension set, syringe, etc.) is reserved exclusively for this use.

Your healthcare team is available to supervise the care provided to your child, ensure the proper functioning of equipment and make recommendations to you as needed.

Refer to your healthcare team if the equipment used for your child at home is different from what is described in this section or in the methods of care.


https://complexcareathomeforchildren.com/enteral-nutrition/

Disclaimer: As medical and technical knowledge is constantly changing, this information is provided to you for educational purposes only. The information provided on this website is strictly provided on an “as is” basis without warranty of any kind, whether express or implied and should not at any time be considered as a substitute for professional advice from your physician or other qualified healthcare professional.

A collaboration of clinical experts across Quebec has taken every care to ensure that the information contained in this document is accurate, complete, and reflective of evidence-based practices. However, “Complex care at home for children” collaboration cannot and does not assume any responsibility for application of the content of this document or for any information that may be present in the websites cited as a reference. These web sites are provided for informational purposes only and do not represent the collaboration endorsement of any companies or products. Always consult your child’s physician and/or a qualified healthcare professional to learn more about recommendations specific to your child’s health needs.

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