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TUBE FEEDING INTOLERANCE
TROUBLESHOOTING GUIDE
Nausea / Vomiting / Reflux

Check for:

Anxiety

POSSIBLE SOLUTIONS

Reassure the patient, provide additional instructions and psychological help based on their needs

Medication side effects

POSSIBLE SOLUTIONS

Evaluate medications, consult pharmacist3

Gastro-intestinal obstruction

POSSIBLE SOLUTIONS

Discontinue tube feeding until medical evaluation3

Tube position

POSSIBLE SOLUTIONS

Check for proper placement (e.g., nasogastric tube has not migrated into small bowel)
Consider post-pyloric feeding below the Treitz ligament1,2
Note: attention to oral hygiene is important with enteral nutrition as microbial contaminations and alteration of microbiota in the oral cavity have been associated with aspiration pneumonia10

Formula odour

POSSIBLE SOLUTIONS

Consider closed system feedings; consider antiemetic agent if appropriate3

Positioning of patient

POSSIBLE SOLUTIONS

Elevate the headboard to 30-45 degrees during continuous feeding unless contraindicated; for intermittent feeding, elevate the headboard to the upright position during feeding and at least 30 minutes after2,3

Delayed Gastric Emptying

POSSIBLE SOLUTIONS

Assess abdomen, review medical history for any underlying motility disorders, consider prokinetic medications, monitor glucose control if relevant3; consider a whey-based formula7-9

Rapid infusion rate

POSSIBLE SOLUTIONS

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

Fecal Impaction / Constipation

POSSIBLE SOLUTIONS

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

Formula characteristics

POSSIBLE SOLUTIONS

Consider a whey-based formula to facilitate gastric emptying7-9; consider a lower fat, lower osmolarity and neutral pH formula

© Nestlé Health Science 2017 | All Rights Reserved The content on this website is for educational purposes only and should not be considered to be medical advice. It is not intended to replace the advice of your child’s healthcare team. Please consult your child’s healthcare team with any questions about your child’s symptoms or feeding concerns. Unless otherwise noted, all trademarks are owned by Societe des Produits Nestle, S.A., Vevey, Switzerland