Small Bowel Feeding Tube Insertions

( Please Refer to Placement of Small Bowel Feeding Tubes in Adults Policy SPT020 )

• Circumstances
• Indications
• Contraindications
• Placement of Small Bowel Feeding Tubes (SBFT) in Adults by TPNVAD Nurse Clinician

Circumstances:

The physician/NP shall:

1. Order the procedure to be done by the nurse using this standardized procedure
2. Be physically present or immediately available by telecommunication
3. Confirm and document the small bowel feeding tube position on post-procedure x-ray and communicate findings to the staff nurse.

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Indications (Subjective/Objective)

1. The patient demonstrates an inability to maintain adequate oral nutrition to meet caloric needs and has a functioning intestinal tract.
2. Small bowel enteral feedings are required for equal to or greater than one week, e.g., neurological injury or trauma.
3. There is a high risk for aspiration of oral nutrition as evidenced by:
4. Absent or impaired swallowing
5. Absent or impaired cough/gag reflex
6. Patient required to be in supine position
7. The patient has delayed gastric emptying or gastroparesis
8. The patient’s nutritional needs are being met through parenteral nutrition, and trophic feedings are required to maintain and enhance intestinal integrity
9. The patient is being transitioned from parenteral to enteral nutrition.

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Contraindications

1. Absolute:
   1. Absence of listed indications (reference paragraph II, B (Indications))
   2. Prior esophageal or gastric surgeries, e.g. Roux-en-Y gastric bypass, altered gastric/small bowel anatomic pathways and recent ENT surgery
   3. Gastrointestinal bleed
   4. Transsphenoidal surgical approaches
   5. Documented intestinal ischemia and/or hemodynamic instability
   6. High output small bowel or intestinal fistulas
   7. Gastric/small bowel/colonic obstruction and/or distal ileus/obstruction, e.g. tumors
   8. Esophageal varices, perforation, fistulas
2.  Relative (Requires communication with supervising physician prior to proceeding with procedure. See “NOTE” below.)
   1. Facial injuries/basilar skull fractures
   2. Malnutrition present, but patient expected to eat within five to seven days
   3. Hemorrhagic pancreatitis
   4. Repeated dislodgment (three (3) or more times) despite appropriate interventions, e.g. bridle
   5. Non-invasive CPAP ventilation
   6. Suspected or documented liver disease with coagulopathies, e.g. abnormal bleeding times, e.g. INR/PTT/Hgb/platelets
   7. Implanted medical devices, if using CORTRAK EAS
3. NOTE – Relative contraindications require, prior to procedure:
   1. Notification of the supervising physician regarding specific potential contraindications
   2. Subsequent confirmation from the ordering and/or supervising physician that the RN/NP is authorized to perform the procedure
   3. Documentation of the above information.

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