Enteral And Parenteral Nutrition

Question 1

Indications of nut. Support

Answer 1

OBMI <18.5 kg/m2
*Unintentional weight loss >10% in 3-6 months
*bmi<20 and unintentional weight loss >5% in 3-6 months
Little to no nutrition for 5+ days and unlikely to eat much in next 5 days
Poor absorptive capacity
High losses
Increased needs

Question 2

Enteral or tube feeding indications

Answer 2

, Malnourished/at risk and have:
Inadequate or unsafe oral intake
Functional and accessible git
Stopped when adequate oral intake is established

Question 3

Contraindications of enteral feeding

Answer 3

X severe disturbance of bowel - severe malabsorption issues eg short bowel syndrome / ongoing n+v
X GI obstruction, - inflammatory disease
X METABOLIC - diabetic ketoacidosis

Question 4

Nasal

Answer 4

Short term /temp feeding
nasogastric, Nasoduodenal, nasojejunal

Question 5

Gastric

Answer 5

Feeding req. For >1month
Gastrostomy-surgical, radiological gastrostomy, PEG, gastrojejunal
Gastrodudenal

Question 6

Jejunal

Answer 6

• Jejunostomy - surgical, pej
  Indications: increased aspiration risk, therefore post pyloric feeding indicated, upper GI obstruction
  Complications: perforation, displacement

Question 7

Bolus

Answer 7

Not freq used
Specific vol over 20-30mins
3-5 times per day, can match mealtimes
No more than 200-300 mls at a time

Question 8

Bolus top up feeding

Answer 8

Oral intake present but not sufficient
E.g breathlessness
Involves syringing feed down tube
No more than 2-300 mls at a time

Question 9

Pump

Answer 9

Continuous:
Well tolerated
Slow infusion good for gastric dysmotility
Indicated if feeding into the jejunum
Overnight:
Useful if supplementing oral intake
Considerate of routine and social

Question 10

What does PEG stand for

Answer 10

Percutaneous endoscopic gastrostomy (surgical insertion)

Question 11

What does RIG stand for

Answer 11

Radiologically inserted gastrostomy

Question 12

Peripheral parental nutrition

Answer 12

Short term ~2 was
Through peripheral vein in hand/forearm
Tolerance dependent on:
Osmolality (<850mOsmol/L)
PH
Infusion rate
Cannula diameter (thinner=better) and material (polyutherane/silicone preferred)

Question 13

Central venous catheters

Answer 13

Longer term use
Catheter tip Inserted into central vein
Hickman lines - centrally inserted
PICC - peripherally inserted and tunnelled
TID - totally implanted device

Should always be administered through dedicated lumen

Question 14

Pn/en fluid req?

Answer 14

30 - 35 ml/kg bw/day

Question 15

Complications of excess fluid in en/pn?

Answer 15

Delayed return to GI function a post-surgical complications

Question 16

Protein reqs en/pn?

Answer 16

AA = 0.8 - 1.0g /kg bw /day
N= 0.14-0.3g /kg bw/day
aim for ratio 150kcal : 1g N
all essential AA provided

Question 17

What provides energy in en/pn

Answer 17

Glucose (dextrose) provides carbs
fat should provide 20 - 30% kcal LCT fat needed to supply EFA - minimum 0.5 mg a day