2 types of nutrition support?
Enteral and Parenteral Nutrition
What is Enteral Nutrition?
Nutrients provided via GI tract
Candidates for Enteral nutrition?
- Protein-Energy malnutrition
- Unable to eat sufficient food/formula for AT LEAST 7 days.
- Just place below obstruction site*
i.e. Swallowing disorders, impaired motility, GI obstruction, Intestinal surgery, High nutrient requirements
Types of enteral formulas?
- Standard
- Elemental
- Specialized
When should standard be used?
When patient can digest and absorb nutrients. Its a polymeric formula.
When should Elemental be used?
When patients have compromised digestion and absorption.
-Protein and carbs are broken into small fragments so that digestion enzymes are not necessary for absorption.
When should specialized be used?
For disease specific patients. It contains specific formulations of carbs, pro, fat and vitamins depending on what the disease calls for.
Other considerations when choosing an enteral product??
- Macronutrient composition
- Energy density per fluid load
cal/mL: Standards are 1, 1.2, 1.5, 2.0 - Fiber content: Necessary for long term because you want your GI tract to continue functioning properly when you are done
- Osmolality: solute/solvent
Good formulas are isotonic. Bad are hypertonic which cause diarrhea
Delivery routes for formulas?
- PO (by mouth)
- TF (tube feeding)
- NG
- ND
- NJ
- Enterostomy:Entering organ- Gastrostomy: Entering stomach from outside
- G-Tube: “Mickey” “Button”
- PEG: Percutaneous endoscopic gastrostomy (non-surgical placement)
- Jejunostomy: Entering Jejunum from outside
- J-tube
- PEJ (Non surgical)
- Gastrostomy: Entering stomach from outside
Continuous Feeding?
A pump is used to pump formula in at a certain rate throughout the day.
- If doing over night, be sure to sit patient up to 45 degrees
- If using nano/oro, place tube below stomach is preferred so it doesnt come back up.
*Delivery max is no more than 150 mL/hour
Intermittent feeding?
- Gravity or Bolus(syringe)
- This is the preferred method cause it is easier on the body
*Delivery max is no more than 500mL/feeding
Possible complications from a feeding tube?
- Aspiration of formula
- Nausea, vomiting, cramping
- Diarrhea/constipation
- Fluid/electrolyte imbalances
- Nutrient deficiences: some formulas do not have all nutrients
- Clogged tube
- infection at tube insertion site
Monitoring schedule?
- Electrolytes, glucose and calcium
- Monitor biochemistries AT LEAST once per week until stable
- May be changed to once per month - Fluid balance
- Monitor daily I’s and O’s - Gastric residual volume
- If 200 mL is left after feeding, put back in and discontinue feedings.
What is Parenteral nutrition support?
- Used when GI not functioning properly
- Nutrients provided intravenously
Candidates for parenteral support?
- Malnourished OR likely to become so
- Unable to use the GI tract
- Intestinal obstruction
- Paralytic ileus: Lose motility in SI
- Short bowel syndrome: surgery took too much out
- Intractable vomiting: can’t stop
- Bone marrow transplant: destroys GI cells
- Sever malnutrition
- Intolerance to enteral nutrition
- unable to meet nutritional need via enteral nutrition
What makes parenteral solutions different?
- Customized to each patient
- 3-in-1 vs. 2-in-1: *3-in-1 includes fat so will need an emulsifier added in
- Amino acids
- Carbs
- Lipids
- Fluids & Electrolytes
- Vitamins & Minerals
How is parenteral nutrition administered?
- Called a CVC: Central venous catheter
- Can enter in the right subclavian artery and insert next to the heart in superior vena cava or peripherally can enter in the cephalic or basilic vein and be guided to the superior vena cava of heart.
pros to parenteral nutrition?
- Gives nutrition to critically ill
- Can be personalized
cons to parenteral nutrition?
- Expensive
- Invasive
- Sterile techniques
- High risk for infection
- Constant monitory and blood chemistries
- At risk for metabolic complications
Know the complications of parenteral nutrition both catheter related and metabolic
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Look at guidelines for nutrition support
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