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Tube Feeding: Positioning Guidelines & Considerations

Explore effective positioning strategies for patients with tube feeding to prevent aspiration and improve oxygen transport. Learn about common deformities, muscle tone issues, and behavioral considerations to enhance patient care.

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Tube Feeding: Positioning Guidelines & Considerations

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  1. Positioning and Tube Feeding Guidelines And Considerations Fran Dorman, PT, MHS Consultant Clinical Services Bureau

  2. Combination of gravitational back flow and impaired gastro-esophageal sphincter function Greatest with NG tube 30% of tracheostomies 12.5% of neurological patients Reflux with Tube Feeding

  3. Aspiration • Aspiration of secretions • Secretions colonized with bacteria

  4. Studies form ICU • Patient vent dependent and fed via tube • Decreased risk of aspiration when head of the bed was elevated at least 30° • Bowman et al. (2005)

  5. Nursing Research (Jan/Feb 2010) • Recommendation for Practice • Head of bed elevated 30° to 45° • During and for 30 to 60 minutes after feeding • Kenny and Goodman Care of the Patient with Enteral Tube Feeding: An Evidence-Based Practice Protocol

  6. Physical Therapy • Research regarding positioning • But not related to enteral feeding

  7. Positioning • Shared domain • PT can learn from nurses • Nurses can learn from PT

  8. Other Considerations • Fixed deformities • Skin problems • Abnormal muscle tone/control • Oxygen transport issues

  9. Fixed Deformities • Scoliosis • Kyphosis • Hip deformities • Combination of all of the above

  10. Scoliosis • Different curves • S • C • Rotational component • Positioning issues • Collapsed side • Oblique pelvis remember the hips

  11. Kyphosis • Head placement and managing oral secretions • 30° of elevation and rib cage

  12. Hip Deformities and Positioning • Fixed adduction • Fixed abduction • Lack of hip flexion • Fixed hip flexion

  13. Combination • Often deformities are combined

  14. Abnormal Muscle Tone • Extensor tone • Flexor tone

  15. Skin Integrity • Shear and skin breakdown

  16. Oxygen Transport • Best O2 transport • Value in change

  17. Behavioral Considerations • Ability to move out of prescribed position • Habitual poor posture

  18. Some Oral Intake • Impact of pelvis on head • How do we look at head position • 90-90-90 • Equipment

  19. Where to Begin? • The pelvis

  20. Most Common Problem • Posterior pelvic tilt • Causes • Lack of hip flexion • Tight hamstring • Chair of wheelchair seat depth

  21. Normal Spinal Curves

  22. Head Position • Recommendation form SLP literature • Sit upright • Tuck chin • Avoid chin evevation

  23. What we mean • In study 3 of 5 different positions were identified as chin tuck posture Okada 2007

  24. Looking at Head Posture

  25. When Sitting Upright May Not Be Best • Fixed kyphosis • Tilt-in-space

  26. Check the Chair/Wheelchair • Seat to floor

  27. Seat Depth Seat too long

  28. Hangers on Wheelchairs • Tight hamstrings and 70° hangers

  29. Trunk Rotation • Back to seat angle • Midline positioning and fixed hip abduction or adduction

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