Enteral Nutrition Flashcards
Why enteral vs. parental?
If the gut works use it
What feeds are included in enteral nutrition?
The term enteral refers to the GI tract. Tube feeding or oral feeds or both could be the route of feeding.
Under what conditions might tube feeding be neccessary?
EN is first modality for feeding people in critical care unit
* Swallowing problems
* Nerve disease
* Trauma
* Patient is unconscious
* Stroke
* Severeburns
What is the main indication for EN?
If patient is unable to meet fluid and nutritional needs by oral intake alone for a prolonged period or if its unsafe to eat orally due to a high risk of aspiration of food contents into the lung.
What are other indications for EN?
- Hypermetabolism when unable to meet total nutritional needs through oral intake
- Altered nutrient metabolism where requirements for specific macronutrients may be unique (such as MCT in liver disease, altered needs for amino acids in patients with inborn errors of metabolism) that cannot be met with diet alone.
- Oral supplementation (energy boosting) when decreased appetite due to illness, medical treatment
- When the patient experiences severe feeding inefficiency; a condition by which the investment of energy to consume a meal outweighs the potential nutritional value of intake.
How can EN be used as therapy?
- Usually supportive therapy (to promote improved nutritional status)
- Can be used as primary therapy used to treat disease (Crohn’s Disease)
Contraindications to EN
- Can meet at least BMR orally, try oral supplement strategies first
- Adults: Expected to need less than 5-10 days
- Children: expected to need less than 24-48 hours
- Severe acute pancreatitis; may feed carefully be below Ligament of Trietz
- High-output proximal fistulas; where IV replacement of losses difficult (> 2L)
- Intractable diarrhea or vomiting (especially when chemotherapy places patient at high risk for upper GI bleed)
- Complete bowel obstruction; with partial bowel obstructions can feed distal to obstruction very carefully
- Severe coagulopathy where risk for GI bleeding is high
- Severe Portal hypertension
- Abdominal wall infection
- Massive Ascites
Access devices for EN feeding
Short term feeding (< 8 weeks/ 8-12 weeks)
* Nasogastric (nose to stomach
* Naso-duodenal (nose to duodenum)
* Nasojejunal (nose to jejunum)
Longer term feeding (endoscopic or radiological placement)
* Gastrostomy (G-tubes) (directly into stomach)
* Gastro-duodenal (directly into stomach to duodenum)
* Gastro-jejunal (directly into stomach to duodenum)
* jejunostomy - directly into jejunum but not commonly used (very breakable)
What is dumping syndrome?
Gastrointestinal Disorder where large amounts of partially digested food reach the small intestine (hyperosmolar syndrome).
* Could be feeding undigested proteins for instance into small intestine which can bring in a lot of fluid rapidly and may take fluid supply from brain to GI causing disturbances. Need to consider if at risk for this.
* Need to avoid hyperosmolar formulas with dumping syndrome.
What are symptoms of dumping syndrome
- Nausea
- Weakness
- Sweating
- Palpitations
- Diarrhea
Syncope
What is the
* plaement
* aspiration risk
* dumping risk
* removal
* tolerance
for naso-gastric, naso-duodenal, and naso-jejunal?
What is an indication for jejunostomy?
Typically inserted if there is a blockage at the pylorus which precludes the ability to insert a G-J tube.
* Are placed surgically
* They are thinner; and can break more readily.
* Otherwise, the risk for aspiration and dumping syndrome are the same as GJ
What are the types of enteral feeding regimens
- Supplemental vs total support
- Bolus vs intermittent bolus vs continuous feeds
Differences between Bolus vs intermittent bolus vs continuous feeds
- Bolus feed: over 15 minutes – 30 minutes (feed is slowed down to prevent vommitting)
- Intermittent bolus: 1-2 hours
- Continuous feeds: >2 hours (pump regulates delivery at same rate)
What is a bolus feed?
The bolus method is a way to send formula through your feeding tube using a catheter syringe. A catheter syringe does not have a needle. It has a hole with a plunger in it. You pull up formula through the hole in the syringe. Then you push the formula into your feeding tube with the plunger.
Advantages and disadvantages of bolus feed
- Advantage: Short time, easy to administer, inexpensive (no pump required)
- Disadvantage: potential GI intolerance (if too much and too fast)
Advantages and disadvantages of continous feed
- Advantage: Potentially ↑ GI tolerance, ↓ risk of aspiration, gastric residual (reduced risk of vomitting)
- Disadvantage: costly; requires pump, less freedom
GI complications of tube feeding
- Nausea, vomitting
- large gastric residual
- diarrhea
- constipation
comp
Factors that result in nausea and vomiting
- large gastric residual
- Improper tube location or integrity
- rapid infusion rate, hyperosmolar formula
Factors that result in large gastric residules
- If the feed is stopped and the patient aspirates the same amount back then gave too much
- Hyperosmolar formula, high fat content of formula,
- gastroparesis (delayed gastric emptying)
Factors that lead to diarrhea
- medication (sorbital)
- lactose intolerance
- nutrient malabsorption
- bacterial overgrowth (from colon into SI)
- inadequate fibre
- rapid infusion rate
- hyperosmolar formula
- hypoalbuminemia (GI tract sloughing off protein)
- formula is too cold
Factors that may lead to constipation
- dehydration
- fecal impaction
- obstruction
- inadequate fiber
- decreased activity
- medications (analgesics)
- intestinal dysmotility
- aging patients
Osmolality of milk, orange juice and sherbert
