Home Enteral Nutrition Therapy FAQs
Q: What is home enteral nutrition therapy?
Home enteral nutrition (HEN) therapy is one of the most common therapies administered in the home. Over 500,000 people in the United States have feeding tubes; most who are working, attending school, traveling, and able to carry on their normal daily activities. HEN is ideal for patients that are not able to meet their nutritional and caloric needs through the mouth but still have a functioning gastrointestinal (GI) tract.
Enteral nutrition is a liquid formula that is delivered directly into the digestive tract. The liquid food formula is administered through a small feeding tube that is either passed through the nostril down the esophagus and into the stomach, or one that may have been surgically placed into the stomach or gastrointestinal tract. Enteral nutrition can be a sole source of nutrients and calories or it can be a partial supplement. Many people continue to eat any food they tolerate orally when they have a feeding tube while the majority of their nutrition needs are provided through the tube. HEN can be long term or short term depending on nutritional needs and diagnosis. The tube is removed when the patient can maintain adequate weight and eat normally.
Q: When does someone require enteral nutrition?
When a patient has difficulty eating for whatever reason, and if the GI tract is functioning, then using the digestive tract would be preferable rather than feeding intravenously (through a vein). Use of the GI tract mimics the regular digestive process and can help boost the immune system.
Q: What medical conditions can be treated at home with HEN (home enteral nutrition therapy)?
There is a broad range of acute and chronic conditions in which HEN is applicable, they include, but are not limited to:
- Short Bowel Syndrome
- Gastrointestinal conditions
- Cerebrovascular Accident (CVA)
- Esophageal obstruction/paralysis/perforation
- Guillain-Barre’ Syndrome
- Amyotrophic Lateral Sclerosis
Q: Will my insurance cover HEN?
Home enteral nutrition services are covered by most insurance companies and we are able to accept many commercial and government payors. Insurance companies vary in what they will reimburse for HEN. Sometimes, payors will reimburse for the feeding supplies, pump and feeding tube but will not for the actual formula as they consider this “food” and something that the patient would routinely purchase. We can provide these formulas through self-pay if desired. Medicare beneficiaries must be enrolled in Part B and must meet specific criteria to be eligible for coverage. Our intake and reimbursement experts can assist you in determining eligibility and coverage for HEN. Medicaid reimbursement varies and is determined by the state patient resides in.
Q: How do I get started?
Specific protocols for feeding, administration, and monitoring will be written by the physician, surgeon or dietitian. The written orders will indicate the enteral formula, strength, rate, frequency, and delivery method. Formula can be administered by bolus (large intermittent syringe feeding) or gravity controlled and electronic pump (pole mounted or ambulatory). Choice of the delivery methods for a patient will depend on type of enteral access device and individual factors and needs.
When you first get your tube placed, ask for the packaging so you know the brand, type (G-tube, J-tube, G/J tube) and size (diameter is usually measured in French or Fr). If this is not available to you, we will contact the hospital and/or surgeon whom placed the device.
Preferred Homecare | Life Care Solutions have expert registered dietitians, registered diet technicians and enteral technicians that are here to assist you at admission and during your entire course of therapy. Our registered dietitians are available to assess your condition, make recommendations, collaborate and communicate with your physician and other healthcare team members at any time.
Q: What are the complications of HEN?
Complications of HEN are not common as long as feeding guidelines are followed. Feeding tubes can occasionally become clogged, displaced, and sometimes infections can occur. It is important that water flushes are given to prevent clogging and ensure proper hydration. Feeding tubes should be flushed with water before and after medication and formula delivery as well as every 4-6 hours during continuous feeds.
Feeding tubes inserted in the nose (nasogastric or nasojejunal) are temporary and short term but can cause irritation to the nose or throat as well as sinus infections and ulceration of the esophagus or larynx.
Complications in general include diarrhea, constipation, food entering the lungs (aspiration), dehydration, elevated blood sugar, vitamin and mineral deficiencies, electrolyte imbalance, and malabsorption of nutrients. These can usually be quickly resolved by adjusting the formula or method of delivery.
Routinely, a dietitian, nurse, or technician will teach the patient and caregiver how to prepare, administer and monitor the tube feeds and supplies as well as troubleshooting tips. Before going home from the hospital or skilled nursing facility, you and/or a caregiver may be instructed how to administer the formula, water, and possibly medications through the tube.
Q: When can I expect a delivery of my formula and supplies?
Most delivery cycles are every 30 days and a Preferred Homecare | LifeCare Solutions representative will contact you approximately 5-7 days before your next delivery is due. At this time, they will review your supply options, conduct a quick inventory and obtain some basic information regarding your health status. If there are clinical issues noted, the representative may involve a dietitian, nurse, pharmacist or your physician based on the concern.
Q: Can I work while on HEN?
There are many patients that continue to work, attend school, and have full and productive lives while on home enteral nutrition. The main determinant will be the disease process that caused the underlying GI problem as well as symptoms the patient may be having. Sometimes patients can receive night time feedings while at rest or if feedings are needed for an extended period of time the feedings can be placed on a small ambulatory pump with a backpack.
Q: How do I take care of my feeding tube?
Taking care of your feeding tube is easy. Simply wash the area around the tube with soap and water, pat dry, and then keep dry when not bathing or swimming.
Q: Can I shower or bathe with my tube?
It is usually okay to get your tube/insertion site wet in the shower 48 hours after the tube was inserted or upon your doctor’s orders. Cleanse the site with mild soap and warm water daily and pat dry. It is normal to have some crusty drainage around the tube; however, if there is a large amount of drainage or a foul smell, or the skin around the tube is red, warm and tender to touch, consult your physician, nurse, or dietitian.
Q: What are your business hours?
Regular business hours are Monday-Friday, 8:00am-5:00 pm for routine needs. However, our technicians, registered dietitians, nurses and pharmacists are available 24 hours/day, seven days/week, 365 days/year for new referrals, emergencies, changes in formula order, and questions. Please use the phone number that was provided to you at admission to contact us.
Information modified from the Oley Foundation Website at www.oley.org