Enteral nutrition support with a nasoduodenal nutrition tube or jejunostomy tube is needed to ensure nutrient supply and promote wound healing when you are unable to eat normally by mouth after surgery.
The usual practice is to pass the nutrition tube through the nose, lower it into the duodenum, and then pump a formulated nutrition solution, through the tube, into the intestine. The nutrient solution will typically contain carbohydrates, proteins, electrolytes, vitamins, minerals, trace elements, and fluids in appropriate proportions.
Problems that may arise during this process include:
Bloating and diarrhea
Diarrhea is most commonly caused by the inability to adapt to hypertonic enteral nutrition preparations; other causes include lactose intolerance, poor intestinal motility, and dysbiosis of the intestinal flora.
Inability to adapt to hyperosmolar enteral nutrition preparations
This is the most common cause of diarrhea and causes osmotic diarrhea, which is characterized by diarrhea right at the start of enteral nutrition, with undigested enteral nutrition fluid or watery diarrhea in the stool. The best way to address this is to use enteral nutrition preparations early in the preoperative period to allow the intestine to adapt. During early postoperative enteral nutrition support, gradually increase the rate of enteral nutrition infusion at a uniform rate.
Lactose intolerance
Tell your doctor if you are lactose intolerant, which means that you usually have abdominal discomfort after drinking milk. Your doctor will then select a lactose-free nutritional preparation for you, along with a preoperative adaptive infusion and a postoperative slow titration in slowly increasing amounts to make you tolerate it slowly. If the diarrhea is caused by too high a concentration of nutrient solution, a low concentration of isotonic nutrient solution can be used.
Low bowel motility
If you have impaired bowel motility, medications that increase gastrointestinal motility can be given.
Gut flora imbalance
Diarrhea caused by dysbiosis of the intestinal flora can be treated with probiotic-added medications, such as Recticum and Pepcid, and antibiotics that tend to cause diarrhea can be stopped or replaced.
Glucose imbalance
We have a roughly fixed time frame for our three daily meals, and enteral nutrition is a continuous supply. After surgery, you may experience blood glucose dysregulation, such as hyperglycemia or hypoglycemia, so monitoring of blood glucose levels is required, more so for diabetics. If you have diabetes, you will often need to have insulin pumped continuously to keep your blood sugar stable. When the rate of nutrient infusion is constant, you can switch to long-acting insulin to control blood glucose; if you are not diabetic, it is easier to maintain blood glucose stability.
Hydroelectrolytic disturbances
After esophageal cancer surgery, all of your substance intake goes through enteral nutrition. However, the water, electrolytes, vitamins, and other substances contained in the enteral nutrition solution still do not fully meet your needs. You may experience symptoms of dehydration such as thirst and oliguria, or a deficiency of certain ions, etc., requiring additional water and sodium, potassium, and chloride ions, which may need to be supplemented by intravenous infusion if necessary.
Constipation
Possible causes include inadequate hydration, resulting in dry stools; use of nutritional solutions containing dietary fiber; and poor bowel motility. Solutions include application of laxatives, such as Dumec; or transanal use of opiates.
Reflux, aspiration by mistake
Possible causes include weakened or disturbed gastrointestinal motility, and too rapid a drip of nutrient solution. Because of the need for routine postoperative placement of a gastric tube, the incidence of misaspiration is low. If either of these occurs, the response includes elevating the head of the bed 30 or 45 degrees, slowing the drip rate of the nutrient solution, and discontinuing the nutrient solution at bedtime.
Blocking of the tube
Nutrient tubes need to be flushed with water regularly during use, otherwise they can become clogged due to nutrient solution adhering to the tube wall. The way to deal with it is to repeatedly pump the nutrient tube with syringe and water, or to pressurize the nutrient tube with aerated soda water to unclog it. If the above methods do not unblock the tube, you need to go to the hospital to see a doctor and have the tube replaced in time.
To avoid blockage, you and your family need to be aware of the following: flush the tube with water regularly and quickly during daily care; ensure a certain rate of nutrient infusion (>60 ml/h); use a continuous enteral nutrition pump to infuse at a constant rate; and avoid using nutrient solution with food residues.
Nausea and vomiting
In the early stage of enteral nutrition fluid use, especially in some patients receiving nutrition support via nasoduodenal nutrition tube, nausea is often felt, but it usually subsides after 1~2 days of gradual adaptation. If the nausea is severe, or if vomiting of the nutrient solution occurs, the physician needs to be informed promptly to determine if the end of the nutrient tube is too shallow and if there is intestinal obstruction.