Enteral Tube Feeding for Individuals with Cystic Fibrosis

Publication Date: September 3, 2016
Last Updated: March 14, 2022

Consensus Statements

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1. The CF Foundation recommends enteral tube feeding as a means to improve age-dependent anthropometrics in individuals with CF that are unable to consume adequate calories and protein to meet growth/weight maintenance goals, despite appropriate evaluation and intervention by a multidisciplinary team.
2. The CF Foundation does not recommend for or against enteral tube feeding to improve or stabilize pulmonary function in individuals with CF.
3. The CF Foundation recommends evaluation by a multidisciplinary CF team prior to enteral feeding tube placement in individuals with CF, to identify and treat conditions that might be contributing to nutritional decline.
4. The CF Foundation recommends that patient and family education about nutritional care including the role of enteral tube feeding be done throughout the lifetime of the individual with CF.
5. The CF Foundation recommends that the risks of certain conditions be considered and discussed with individuals with CF prior to the placement of an enteral feeding tube including but not limited to: coagulopathy, severe obstructive lung disease, ascites, portal hypertension, history of abdominal surgery, peritoneal dialysis, or alcohol and/or substance abuse.
6. The CF Foundation recommends against using FEV1 as an absolute contraindication to percutaneous or surgical enteral tube placement in individuals with CF.
7. The CF Foundation recommends nasoenteral tube feeding in individuals with CF who require short-term (less than 3 months) nutritional repletion.
8. The CF Foundation recommends discussion of third party/individual coverage of supplies and formula with individuals with CF prior to placement of an enteral feeding tube.
9. The CF Foundation recommends that a comprehensive history and physical exam, with specific attention to factors that represent potential complications be performed in advance of scheduling the placement of the percutaneous or surgical enteral feeding tube by the medical team performing the procedure in individuals with CF.
10. The CF Foundation recommends that clinical assessment of gastroesophageal reflux be performed prior to enteral feeding tube placement in individuals with CF.
11. The CF Foundation recommends against routine pH/impedance or radiographic procedures to assess gastroesophageal reflux in individuals with CF prior to percutaneous or surgical enteral feeding tube placement.
12 The CF Foundation recommends that, to mitigate perioperative risk, the CF provider managing the pulmonary care of individuals with CF determine timing, based on pulmonary status, for percutaneous or surgical enteral feeding tube placement.
13. The CF Foundation recommends that platelet count and international normalized ratio (INR) be measured in individuals with CF prior to percutaneous enteral feeding tube placement.
14. The CF Foundation recommends against the placement of a percutaneous or surgical enteral feeding tube during acute illness.
15. The CF Foundation recommends consultation with an anesthesiologist and the consideration of more intensive pulmonary therapy prior to placement of a percutaneous or surgical enteral feeding tube in individuals with CF and moderate to severe lung disease.
16. The CF Foundation recommends that enteral feeding tubes be placed by percutaneous endoscopic, laparoscopic, or radiologic technique when possible as opposed to open surgical techniques in individuals with CF.
17. The CF Foundation recommends that individuals with CF who are intolerant of gastric feeding receive jejunal feeding.
18. The CF Foundation recommends that airway clearance be re-initiated within 24 h of percutaneous or surgical enteral feeding tube placement in children and adults with CF.
19. The CF Foundation recommends optimal post-operative pain management to facilitate re-initiation of airway clearance in adults and children with CF who receive an enteral feeding tube.
20. The CF Foundation recommends initiation of a bowel regimen to prevent post-operative constipation or distal intestinal obstruction syndrome, in individuals with CF, especially those receiving narcotic pain management.
21. The CF Foundation recommends adherence to the 2010 Clinical Care Guidelines for Cystic Fibrosis-Related Diabetes in individuals with CF who are using enteral feeding tubes.
22. The CF Foundation recommends the use of supplemental enteral nutrition for pregnant or lactating women with CF who are unable to consume adequate calories and protein to meet nutritional goals despite appropriate evaluation and intervention by a multidisciplinary team.
23. The CF Foundation recommends the use of Cystic Fibrosis Foundation Evidence-based Guidelines for Management of Infants with Cystic Fibrosis to choose the best feeding type, breastmilk or formula, for enteral tube feeding in children with CF under 2 years of age.
24. The CF Foundation recommends continuous nocturnal infusion for individuals with CF who are receiving supplemental enteral tube feeding.
25. The CF Foundation does not recommend for or against the use of a specific type of formula (polymeric, semi-elemental, elemental) for enteral tube feeding in individuals with CF.
26. The CF Foundation does not recommend for or against a specific method of providing pancreatic enzyme therapy during enteral tube feeding in individuals with CF.
27. The CF Foundation does not recommend for or against the routine use of acid blockade during enteral tube feeding in individuals with CF.
28. The CF Foundation recommends a comprehensive planning approach with a multidisciplinary CF care team including the managing gastroenterologist, case manager and home care agency prior to discharge.
29. The CF Foundation recommends evaluation by a CF-trained Registered Dietitian Nutritionist (RDN) to calculate energy needs and assess optimal enteral tube feeding supplementation from enteral tube feeding in individuals with CF.
30. The CF Foundation recommends monitoring growth or BMI and tolerance of enteral tube feeding to allow changes if the individual with CF is not meeting goals or tolerating the current regimen.
31. The CF Foundation recommends monitoring for the development of an oral aversion, disordered eating, or other related behavioral concerns in individuals with CF receiving enteral tube feeding.
32. CF Foundation recommends that enteral feeding tube removal follow careful consideration of medical and psychosocial goals for individuals with CF.
33. The CF Foundation recommends that individuals with CF who have had enteral feeding tube placement be monitored at least annually by a gastroenterologist, preferably with enteral device experience, in addition to their quarterly CF care center visit.

Recommendation Grading

Overview

Title

Enteral Tube Feeding for Individuals with Cystic Fibrosis

Authoring Organization

Publication Month/Year

September 3, 2016

Last Updated Month/Year

August 1, 2023

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Provide the CF Team with information critical to the use of enteral feeding tubes, including criteria for recommending enteral tube feeding, assessment of confounding causes of poor nutrition, preparation for placement of the enteral feeding tube, and management of the tube after placement.

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Hospital, Outpatient

Intended Users

Dietician nutritionist, nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D003550 - Cystic Fibrosis

Keywords

cystic fibrosis, enteral nutrition, Nasojejunal tube, Feeding tube