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Offsite Patient Education & Support

Enteral (NG/PEG) Nutrition

Weeks of vomiting and nausea can leave you very depleted. Nutrients can be replaced either through and IV (parenteral nutrition) or a gastric (stomach) feeding tube (enteral nutrition). A NG tube is passed through the nose, down the throat, to the stomach or jejunum, and the PEG requires an outpatient surgical procedure to implant it through the abdomen into the stomach. Sometimes, the tube will be advanced further, into the jejunum for added safety and tolerance. Both procedures are somewhat uncomfortable, but steps are taken to decrease any discomfort.

Safety of Enteral Feedings

Your doctor may suggest enteral feedings because it is often assumed this route is safer and better for the body than parenteral nutrition. A few medical research studies have shown benefits to enteral feeding for some women with HG, but it is not yet clear as to which women can tolerate it. There are some risks that women with HG are more prone to, and these should be discussed with your doctor. The most common risks include tube displacement, pulmonary (lung) aspiration and poor tolerance. Aspiration is one of the most concerning complications because it can cause pneumonia or other problems in the lungs. Many women with HG have slow emptying of their stomachs, reflux, extremely sensitive gag reflexes, and frequent vomiting which may make NG feedings less tolerable and somewhat risky. The smell of formula also may cause vomiting. Some women report repeated tube dislodgements due to vomiting, which may make them reluctant to continue this therapy.

If you try this route of nutritional support, make sure you are educated in the care of a gastric tube and able to identify signs of aspiration or other potential complications. Online resources are listed to the right for your reference. If despite this therapy, you continue to vomit or have severe nausea, you may benefit greatly from a period of rest for your stomach (i.e. no food intake for several days to a week). However, you will still require nutritional support due to weeks of vomiting and limited intake. Intravenous (IV) nutrition is another option to discuss with your health professional.

Additionally, if you do not improve, more aggressive antiemetics or higher doses should be considered. A second opinion may be necessary in this case if the care you are receiving does not seem to be helping you. See our Referral Network for more assistance. Remember, chronic dehydration and nutrient depletion make vomiting and nausea worse. So get the help you need so you improve and recover faster.

Risk Factors and Potential Complications

Risk Factors for Aspiration:

  • Decreased level of consciousness (sedative medication)
  • Diminished gag reflex
  • Gastric (stomach) reflux
  • Supine position (laying down)
  • Use of large diameter tubes
  • Delayed gastric emptying
  • Vomiting or retching
 

Risk Factors for Refeeding Syndrome:

  • Prolonged fasting
  • Repeated IV hydration
  • Significant stress
  • Nutrient depletion

 

Potential Complications of Enteral Nutrition:
Metabolic complications:
Electrolyte imbalances (K+, Na+) Due to fluid imbalance, renal impairment, diarrhea, Refeeding syndrome.
Hyperglycemia Too many calories or lack of adequate insulin.
Dehydration
 
Tube clogging
 
Tube malposition
 
Aspiration
 
Nausea and vomiting
 
Diarrhea
 
Constipation
 
Malabsorption/maldigestion  
Refeeding syndrome The metabolic cascade of events that takes place when a malnourished patient is refed.

Adapted from www.rxkinetics.com, www.medscape.com, and other sources.

Updated on: Apr. 18, 2013

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