Nutrition entérale I: Alimentation orogastrique et nasogastrique

Enteral nutrition delivers nutritionally complete liquefied food or medications directly into the gastrointestinal tract via a tube, catheter, or stoma. It is crucial for patients unable to consume orally due to conditions like burns, oropharyngeal paralysis, swallowing difficulties, or those recovering from gastrointestinal surgery. Enteral nutrition is preferred over parenteral nutrition when the GI tract is functional because it maintains gut integrity and function.

Nasogastric tubes are inserted through the nostril into the stomach and are typically preferred for short-term feeding lasting less than four weeks. They are more comfortable and less obtrusive than orogastric tubes, allowing better speech and oral hygiene. Orogastric tubes are inserted through the mouth into the stomach and are used when nasal routes are obstructed or for infants and emergency situations. Both use radiopaque polyurethane or silicone tubes enabling X-ray confirmation of placement.

Nurses verify tube placement by measuring the tube's external length to detect any shifts, examining the aspirate's color and pH to confirm stomach placement (pH ≤ 5 indicates gastric placement), and assessing bowel sounds to ensure the GI tract is ready for feeding. These verification steps ensure the tube is correctly positioned in the stomach before administering nutrition.

Elevating the bed's head 30-45 degrees significantly reduces aspiration risk during tube feeding. Nurses should also use enteral-safe medications that are compatible and do not clog the tube, and monitor for aspiration signs such as coughing or wheezing. Regular monitoring for complications ensures patient safety throughout the feeding process.

Nurses should monitor for aspiration pneumonia, indicated by coughing or wheezing, and gastrointestinal complications including abdominal distention, discomfort, nausea, vomiting, or diarrhea. These signs may indicate intolerance to the feed. Nurses adjust the feeding regimen or conduct further evaluations as needed based on the patient's clinical response and nutritional tolerance.

Enteral nutrition is preferred when the gastrointestinal tract is functional because it maintains gut integrity and function better than parenteral nutrition, which delivers nutrients directly into the bloodstream. Enteral feeding preserves the digestive system's natural processes and is generally safer and more physiologically appropriate for patients with a working GI tract.

Both orogastric and nasogastric feeding tubes are made from radiopaque polyurethane or silicone materials. The radiopaque property enables X-ray confirmation of tube placement, ensuring accurate positioning in the stomach before feeding begins. These flexible materials allow safe insertion and patient comfort while maintaining visibility on imaging studies.