Enteral nutrition, commonly known as tube feeding, provides necessary nutrients to individuals who cannot meet their needs through oral intake alone. Administering this specialized liquid diet often requires a feeding pump to ensure the formula is delivered safely and consistently. Setting up this device correctly involves preparing the formula, priming the tubing, programming the delivery rate, and securely connecting the system to the feeding tube.
Choosing the Right Formula
The selection of the specific enteral formula is an individualized decision made by a healthcare professional, typically a dietitian, based on the patient’s medical condition and digestive capacity. The most common choice is a standard, or polymeric, formula, which contains intact protein, complex carbohydrates, and fats. This type is recommended for individuals with normal digestive and absorptive functions, serves as the first-line treatment, and is generally the most cost-effective option.
For individuals experiencing difficulty with digestion or nutrient absorption, a semi-elemental or peptide-based formula may be necessary. These specialized formulas contain protein broken down into smaller peptides, along with fats that may include medium-chain triglycerides (MCTs), which are easier to absorb. They are often used for conditions like inflammatory bowel disease or short bowel syndrome where the digestive tract is compromised. Disease-specific formulas are also available, tailored for conditions such as diabetes, kidney failure, or respiratory disease, with modified nutrient profiles to manage specific metabolic demands.
The caloric density of the formula, which ranges from 1.0 to 2.0 kilocalories per milliliter, is another determining factor. While a standard density of 1.0 kcal/mL is common, a higher density is chosen for patients who require fluid restriction or need a greater concentration of nutrients in a smaller volume. A comprehensive nutritional assessment, considering the patient’s fluid status, body weight, and metabolic needs, guides the final formula prescription. Always check the formula for the correct name and expiration date before preparation.
Setting Up the Feed
Proper hygiene is the first step, involving thoroughly washing hands with soap and water for at least twenty seconds. Next, pour the prescribed amount of formula into the sterile feeding bag or container, often after shaking the pre-packaged container to ensure the contents are well-mixed. Opened formula must be refrigerated and discarded if not used within twenty-four hours to prevent bacterial growth.
The feeding set, which includes the tubing and an attached cassette, is loaded into the pump mechanism. The cassette snaps securely into the pump, and the flexible tubing is looped around the pump’s wheel or rotor. The feed bag should be hung on an IV pole or hook, ideally at least ten inches above the pump to assist with flow.
Once the bag is hung and the cassette is loaded, the process of priming the tubing begins. Priming removes air from the line before connecting it to the patient, preventing air from entering the gastrointestinal tract. This is often done automatically by pressing the “prime” button on the pump, which forces the formula through the tubing until it reaches the connector end. A manual prime can also be performed by gently squeezing the feeding bag or tubing until the liquid reaches the tip.
Programming the Pump
After priming the set, power on the pump to program the feeding parameters according to the healthcare provider’s instructions. The primary settings to input are the hourly flow rate and the total volume to be delivered (the dose). The flow rate is measured in milliliters per hour (mL/hr) and determines how quickly the formula is infused.
The initial flow rate is often started conservatively low, especially in patients who have been malnourished or had little nutrition for a period. This slow initiation is a preventative measure against refeeding syndrome, a potentially severe metabolic complication that occurs when nutrition is reintroduced too rapidly. For high-risk patients, the rate may start at a maximum of fifty percent of the target caloric goal and is then gradually increased, or titrated, over several days.
The total volume, or dose, is the entire amount of formula administered during a single feeding session. Once the rate and volume are programmed, the pump displays the settings and indicates it is ready to run. Many pumps feature an alarm system that sounds if the tubing becomes blocked, the bag runs empty, or an air bubble is detected, ensuring safe delivery.
Connecting the System
Connecting the primed tubing requires final safety checks to ensure patient comfort and prevent aspiration. The patient must be positioned correctly, sitting upright with the head of the bed elevated to at least a thirty to forty-five-degree angle. This elevated position must be maintained throughout the feeding and for a minimum of thirty to sixty minutes afterward to allow for adequate gastric emptying and reduce reflux risk.
Before connecting the pump tubing, the feeding tube should be flushed with a specific volume of water, typically using a syringe, to confirm the tube is patent and clear of residual material. The end of the pump tubing is then securely attached to the feeding tube connector, often with a twist-lock mechanism to prevent accidental detachment. Once the connection is secure and all clamps are opened, press the start button on the pump to begin the infusion.
The pump delivers the formula at the programmed rate, and the patient’s tolerance, including any signs of abdominal discomfort or diarrhea, should be monitored closely. After the total volume is delivered, the pump automatically stops and may sound an alarm indicating completion. A final flush of water is administered through the feeding tube to clear the line of remaining formula, which helps maintain the tube’s patency and provides hydration.