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TUBE FEEDING INTOLERANCE
TROUBLESHOOTING GUIDE
Diarrhea

Check for:

Tube position

POSSIBLE SOLUTIONS

Check for proper placement (e.g., naso-gastric tube has not migrated into small bowel)

Medication side effects

POSSIBLE SOLUTIONS

Evaluate medications (e.g., broad spectrum antibiotics, hyperosmolar or sorbitol containing meds, prokinetics, laxatives)3; consult pharmacist

Clostridium Difficile infection

POSSIBLE SOLUTIONS

Rule out infectious etiology and treat if necessary2,3

Rapid infusion rate

POSSIBLE SOLUTIONS

Review feeding regime, reduce rate/volume or adjust feeding schedule as needed, use room temperature formula3

Bacterial contamination of feeding solution

POSSIBLE SOLUTIONS

Review enteral feeding and equipment handling procedures – using aseptic technique to reduce the risk of touch contamination; follow hang time guidelines; consider closed feeding system3,6

Malabsorption, maldigestion, steatorrhea

POSSIBLE SOLUTIONS

Perform medical exams and testing if needed, review fat content of formula, consider peptide based, high MCT/LCT ratio formulas3

Underlying GI disorders, gastroenteritis or flu

POSSIBLE SOLUTIONS

Assess and treat underlying illnesses; focus on fluid needs; consider peptide based formulas with MCT in the lipid blend3

Fecal Impaction/ Constipation

POSSIBLE SOLUTIONS

Assess abdomen; disimpact as needed using enemas; monitor stool frequency and consistency3

Formula characteristics

POSSIBLE SOLUTIONS

Consider fibre unless contraindicated (may contribute to distension) and assess fluid needs3, consider peptide-based formula2,11 if feeding at high rates or into the small bowel consider lower osmolality formula3,12

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