Chapter 13: Nutrition Support in the Oncology Setting Flashcards
What are the short term enteral devices?
Nasogastric/Orogastric
Nasoduodenal/Oroduodenal
Nasojejunal/Orojejunal
What are the long term enteral devices?
PEG Gastrostomy (G-Tube) PEG-J PEJ Jejunostomy (J-Tube)
What tubes have increased aspiration risk?
What tube have decreased aspiration risk?
Increased: NG/OG, ND/OD, NJ/OJ
Decreased: PEG-J, PEJ, J-Tube
PEG/G-tube is equivocal
What tubes require an infusion pump?
ND/OD, NJ/OJ, PEG-J, PEJ, J-tube
What are some contraindications for enteral feedings?
Bowel obstruction in lower GI hemodynamically unstable intractable diarrhea severe, active GI bleed ischemic or perforated gut high output fistula/ostomy (>500 ml/d) aggressive nutrition intervention not warranted extensive resection of small bowel need 100 cm jejunum and 150 cm ileum w/ ileoceal valve for adequate GI absorption
Describe the location, delivery timing, initiation rate, advancement schedule and equipment required for:
Bolus Feedings
Location: gastric
Delivery Time: ~15 minutes
Initiation rate: 60-120 ml first 1-2 feedings
Advanc Sch: increase by 60-120 ml every 8-12 hrs (or every 1-2 feedings)
Equipment: Catheter tip syringe
Describe the location, delivery timing, initiation rate, advancement schedule and equipment required for:
Intermittent/Gravity Drip
Location: gastric
Delivery Time: ~30-35 minutes
Initiation rate: 60-120 ml first 1-2 feedings
Advanc Sch: increase by 60-120 ml every 8-12 hrs (or every 1-2 feedings)
Equipment: gravity bags, pole
Describe the location, delivery timing, initiation rate, advancement schedule and equipment required for:
Cyclic
Location: gastric or small intestine
Delivery Time: 12-14 hrs per day
Initiation rate: 10-50 ml/hr
Advanc Sch: increase by 10-25 ml/hr every 8 hrs
Equipment: infusion pump with pole or backpack
Describe the location, delivery timing, initiation rate, advancement schedule and equipment required for:
Continuous
Location: gastric or small intestine
Delivery Time: 20-24 hrs per day
Initiation rate: 10-50 ml/hr
Advanc Sch: increase by 10-25 ml/hr every 8 hrs
Equipment: infusion pump with pole or backpack
What are the metabolic complications of EN Therapy?
Dehydration Overhydration Hyperglycemia Hypernatremia Hyponatremia Hypokalemia Hyperphosphatemia Hypophosphatemia
What are Gastrointestional complications from EN Therapy?
High gastric residual volume GERD/Aspiration N/V/abd distention/bloating Diarrhea Constipation
Information about Dextrose for TPN
Concentration: 2.5-7.0%
Energy Provision: 3.4
Min Daily Req: 100-150 gm
Optimal range: to meet daily needs
Max daily tol: 7 g/kg/day or 5 mg/kg/min
Information about Amino Acids for TPN
Concentration: 3-20%
Energy Provision: 4
Min Daily Req: 0.8 g/kg (or individualized based on patient tolerance)
Optimal range: 0.8-1 g/kg or 1.2-2 g/kg if catabolic
Max daily tol: 2.5 g/kg individualized, based on pt tolerance
Information about Lipids/IVFE for TPN
Concentration: 10%, 20%, 30%
Energy Provision: 10 (20 or 30%), 11 (in 10%)
Min Daily Req: 250 ml of 20% or 500 ml of 10% twice weekly or 500 ml of 20% once/week
Optimal range: 20-30% of calories from fat
Max daily tol: 2.5 g/kg/day or 60% of total calories (if stable)
Standard PN Electrolyte Requirements
Sodium - 1-2 mEq/kg
Potassium - 1-2 mEq/kg
Acetate - as needed to maintain acid-base balance
Chloride - as needed to maintain acid-base balance
Calcium - 10-15 mEq/day
Mg - 8-20 mEq/day
Phos - 20-40 mmol/day
