Editing Artificial nutrition (section)

=== Risks: ===

* Resulting from intubation of GIT
** Malposition
** Blockage
*** Tube blockage is common, especially with fine-bore NGT
**** Prevention - flush twice daily
**** Treatment - flush with chymotrypsin or papain. Don't use guidewire as this may perforate the tube and/or patient.
** Displacement
*** Insert Foley if it comes out
*** If suspicious of displaced enterostomy, need contrast imaging
** Breakage/leakage
** Pressure necrosis of nasal mucosa
** Aspiration pneumonia
*** Keep head up while feeding
*** Use of PPI/H2 antagonist increases pH, which reduces risk of harm
*** Prokinetics if delayed emptying suspected
*** Consider more distal tube
* Resulting from nutrient delivery
** Diarrhoea
*** Occurs in >30%, especially critically ill
*** Usually multifactorial, including antibiotic treatment
*** Villous atrophy due to prior periods without enteral feeding
*** Infections
*** Reducing feed rates or using loperamide/codeine to slow transit time can help
** Bloating
** Vomiting
*** Elevate head of bed
*** Continuous feeding
*** Assess sedation + analgaesia requirements
*** Oropharyngeal decontamination
*** Distal feeding
*** Prokinetics
* Metabolic complications are uncommon
* Enteric infections are rare if feeds are stored properly