Enteral feeds should be colored distinctively to minimize the risk of confusion with fluids intended for intravenous use. The administration set must be sterile and have connectors incompatible with intravenous infusions.

Care is needed to prevent bacterial colonization of enteral feeds. High colonization counts have been found in up to 24 per cent of enteral feed reservoirs at 24 h. It is generally accepted that enteral feeds should not be left hanging at the bedside for more than 24 h, and many units limit this to 12 h at room temperature. Bacteria can migrate retrogradely from the patient to the feed reservoir. Other factors influencing the frequency of bacterial contamination are the number of manipulations during feed preparation, poor preparation technique, and feed composition.

Enteral feeds are usually given continuously by gravity feed or pump-assisted infusion. Preliminary studies suggest that intermittent bolus feeds given every 4 h have a more positive affect on nitrogen balance than the same quantity of continuous feeds. However, although bolus feeds are associated with periods when intragastric pH is significantly lower, the frequency of gastric colonization, ventilator-associated pneumonia, and death is unchanged from continuous feeding ( Bonten.i.ef a/ 1996).

Many units routinely use pump-assisted infusion of enteral nutrition solutions. Pump assistance may reduce the frequency of diarrhea.

Bowel sounds are a poor indicator of small bowel activity, particularly in patients subject to tracheal intubation and mechanical ventilation. Their absence should not delay a trial of enteral nutrition.

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