Addressing the unique needs and quality of life issues for adults receiving long-term home enteral nutrition.

Individuals who require home enteral nutrition (EN)-and, subsequently, their families-undergo major changes in family dynamics. They would benefit from an approach that provides ongoing nutrition, hydration, enteral access, and quality of life assessments from knowledgeable clinicians. Most individuals and families will be new to the enteral access device, handling and administration of the nutrition formula, medication delivery through feeding tubes, and troubleshooting associated complications. Educational sessions are typically given but may not be comprehensive enough to meet all needs, especially in the first weeks to months of home EN therapy. Quality of life assessments obtained in the early stages of EN support would help clinicians identify and focus on areas that need special attention for that individual and family. Ongoing clinical care is essential because over time, the nutrition prescription, delivery methods and schedules typically require alterations and feeding tubes need to be assessed and replaced. In addition to these important physical dimensions of care, attention should be placed on the psychological, cognitive, social, and ethical aspects of life for these individuals and their families.

Fluid Needs in the Older Adult Receiving Tube Feedings.

Fluid imbalance can occur quickly in older adults and in others who cannot express thirst or are in a setting where fluid status is not closely monitored. In tube-fed individuals receiving inadequate calories, severe malnutrition may occur in weeks to months, but improper water intake may lead to critical fluid imbalances in a matter of days. Simplistic equations frequently used to determine fluid needs in adults include milliliters per kilogram of body weight and milliliters per energy (kilocalories) consumed or per energy (kilocalories) need and variations of the Holliday-Segar formula. None of these fluid-requirement equations have been validated through evidenced-based science, and research investigations have revealed that they can grossly overestimate or underestimate fluid needs in the older adult. Clinicians need guidance to better estimate initial fluid needs for the older adult receiving tube feedings and to provide proper close monitoring afterward to avert preventable fluid imbalance-related hospital readmissions, morbidities, and mortalities in this patient population.

Enteral Access Devices: Types, Function, Care, and Challenges.

Enteral access feeding devices are placed in patients who have a functional and accessible gastrointestinal (GI) tract but are not able to consume or absorb enough nutrients to sustain adequate nutrition and hydration. For many individuals, enteral nutrition support is a lifesaving modality to prevent or treat a depleted nutrient state that can lead to tissue breakdown, compromised immune function, and poor wound healing. Psychological well-being is also affected with malnutrition and dehydration, triggering feelings of apathy, depression, fatigue, and loss of morale, negatively impacting a patient's ability for self-care. A variety of existing devices can be placed through the nares, mouth, stomach or small intestine to provide liquid nutrition, fluids, and medications directly to the GI tract. If indicated, some of the larger-bore devices may be used for gastric decompression and drainage. These enteral access devices need to be cared for properly to avert patient discomfort, mechanical device-related complications, and interruptions in the delivery of needed nutrients, hydration, and medications. Clinicians who seek knowledge about enteral access devices and actively participate in the selection and care of these devices will be an invaluable resource to any healthcare team. This article will review the types, care, proper positioning, and replacement schedules of the various enteral access devices, along with the prevention and troubleshooting of potential problems.