Artificial feeding

Question 1

If someone is starving, what might shorten the time unitl their death?

Answer 1

Infection/trauma/surgery

Question 2

What are the cconsequences of starvation for a hospital patient?

Answer 2

Poor healing, immune system weakened, mobility weakened, fatigue, depression- longer stay

Question 3

How is malnutrition assesed on admission?

Answer 3

Malnutrition Universal Screening Tool (MUST) within 24hours. Trigger questions:

• Lost weight recently?
• Reduction in appetite?
• Will the admission impact on patient’s nutritional intake

If yes do a full MUST- BMI, % recent weight loss and acute illness with no nutritional intake for 5 days - each category is scored 0,1,2. Total out of 6 and if >2=high=malnourished.

Question 4

Can overweight people be malnourished?

Answer 4

Yes

Question 5

Other than MUST, what other ways are there to assess malnutrition?

Answer 5

Anthropometric (measure mid arm circumference)

Biochemical (albumin levels although this is a poor measure)

Question 6

Which 3 categories of people need artificial nutrition?

Answer 6

Can’t eat (due to stroke, head/neck trauma)
Can’t eat enough (burns, sepsis, pre-op)
Shouldn’t eat (bowel obstruction, leaks after surgery)

Question 7

What are the five routes of artificial feeding?

Answer 7

• Oral
• Supplements
• Enteral (naso-gastric/jejunal tube)
• Percutaneous endoscopic gastrostomy (PEG)/ radiologically inserted gastrostomy (RIG)
• Total parenteral nutrition (TPN)

Question 8

When would you start enteral feeding?

Answer 8

Poor oral intake >3 days
Dysphagia
Head injury
Prolonged recovery

Question 9

When would you use TPN?

Answer 9

Obstruction e.g. cancer
Short bowel syndrome (due to surgery)
Fistulae
Complicatoins post surgery

Question 10

What is a PICC?

Answer 10

Peripherally inserted central catheter

Question 11

What are possible complications of IV feeding?

Answer 11

Pneumothorax
Line infection
Pierce large vein- internal bleeding
Peropheral vein thrombophlebitis
High blood sugar
Electrolyte disturbance
Fatty liver
Refeeding syndrome

Question 12

What is refeeding syndrome?

Answer 12

Too much food given too soon so fluid balance problems, electrolyte shifts. Need to increase gradually to avoid this.

Question 13

What is it important to do with a patient who has TPN?

Answer 13

Monitor vital signs, blood glucose, U&E, electrolytes etc

Question 14

What is the route for IV feeding at

Answer 14

Peripheral

Question 15

What is the route for IV feeding at 2-4 weeks?

Answer 15

Central (chest)

Question 16

What is the route for IV feeding >4 weeks?

Answer 16

Tunnelled line (Hickman in midclavicular line, gap between skin and vein entry points to reduce infection risk.)