Management of enteral nutrition

Once a decision is made to start enteral nutrition, 30ml/h full strength standard feed may be started immediately. Starter regimens incorporating dilute feed are not necessary. After 4h at 30ml/h the feed should be stopped for 30min prior to aspiration of the stomach. Since gastric juice production is increased by the presence of a nasogastric tube, it is reasonable to accept an aspirate of <200ml as evidence of gastric emptying and therefore to increase the infusion rate to 60ml/h. This process is repeated until the target feed rate is achieved. Thereafter, aspiration of the stomach can be reduced to 8hrly. If the gastric aspirate volume is >200ml the infusion rate is not increased but the feed is continued. If aspirates remain at high volume despite measures to promote gastric emptying (e.g. metoclopramide or erythromycin) then either bowel rest, nasoduodenal/nasojejunal feeding or parenteral nutrition should be considered.

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