Enteral Nutrition

Question 1

What is Enteral Nutrition?

Question 2

Who is nutritional support like Enteral and prenteral feeding considdered for

Answer 2

• Malnourished (BMI under 18.5, 10% wightloss in 3-6m OR BMI 20 and the weightloss)
• People at risk of malnutrition, (poor absorbtion, not eaten in 5 days
• seriously ill.

Question 3

Why would artificial NT support be considered?

Answer 3

• person cannot eat
• ## gut doesn’t function.

Question 4

what is enteral Nutrition

Answer 4

Nutrition provided via the gastrointestinal trackt using a tube

Question 5

does enteral nutrition require the gut to work?

Answer 5

YES!

Question 6

Where is the tube placed? and Via what?

Answer 6

placed into:
Stomach
duodenum
jejunum

Via:
Nose
mouth
direct route (through skin)

Question 7

What are some indications for Enteral Feeding?

Answer 7

Neuromuscular swallowing disorder.
-Parkinson’s
-MS

GI dysfunction/Malabsorbtion.
- IBS

Mental health
- Anorexia nervosa
- Depression
- Dementia

Question 8

What are some contraindications of Enteral Tube feeding

Answer 8

Necrossis of GI
Intestinal obstruction
Severe malabsorbtion
when bowel rest is recommended (crohn’s)

Question 9

What are the SHORT TERM routes for enteral access? How long is short term access.

Answer 9

4-6 weeks ish
Gastric:
- Nasogastric
- Orogastric
post-pyloric (into the intestines, past the stomach
- nasoduodenal
- nasojejunal

Question 10

What are the LONG term routes for enteral feeding? How long

Answer 10

4-6 weeks +
Gastric
- Percutanous endoscopic gastrostomy (PEG)
- surgical gastrostomy
- radiologically inserted gastrostomy (RIG)

Post Pyloric
- PEG with jejunal ext
Percutaneous Endoscopic jejunotomy (PEJ)
- radiologically inserted jejunotomy

Question 11

Describe Nasogastric feeding tube

Answer 11

• short term
• through nose into stomach
• NG
  -bedside.

Question 12

describe orogastic feeding

Answer 12

orally to stomach

short term

OG

Question 13

How is positioning og the tube confirmed before feeding begins?

Answer 13

pH of aspirate using ph strips
xray.

Question 14

what methods are not recommended to test for tube positioning

Answer 14

whoos test
Ausculation of air unsufflated through tube.

Question 15

who are nasogastric tubes used for. Why?

Answer 15

Most common, everyone.
small and flexible, 1-2mm diameter, 12Fr.
guide wire.

Question 16

Describe Nasoduodenal feeding?

Answer 16

through nose, into duodenum.

Question 17

describe nasojejunal feeding?

Answer 17

nose to jejunum.

Question 18

Why/when use post-pyloric feeding?

Answer 18

patient has slow gastric emptying
risk of refluc or aspiration.

Question 19

what is a nasal retention device?

Answer 19

a little piece of plastic placed in the nose to prevent the feeding tube from displacing of NJ or NG (nose).

Question 20

Describe Gastrostomy feeding

Answer 20

Long term
most common long term. decreses nasal irritation and need for feeding pump.
PEG into stomach
can be used 4h after insertion.

Question 21

Describe Jejusnostomy

Answer 21

Long term
safe to use 24h after use
long term tube directly into jejunum

Question 22

what are some contradicitions to PEG (dirrectly into stomach)

Answer 22

no stomach (duh)
coagulation disorder
haemodynamic insatbility.

Question 23

describe a few considerations for Jejunal feeding? (there is a lot)

Answer 23

• increased risk of infection. Must be sterile, no touch. The tube doesnt go through stomach, hard to kill microbes
• can become blocked easily. need to be flushed frequently.
• feed type must be considered. dfat absorbrion is altered, less mix with bile and enz
• radiological guidance, need to expose to radiation.
• BUT. safer and less expensive than in vain.

Question 24

what are the delivery methods for feeding?

Answer 24

Bolus (with/without plunger)
Pump assisted

Question 25

Describe bolus feeding?

Answer 25

Gastorstomy only
deliver 240 to 480 ml of feed over 10-15 minutes.
this simulates meal time, give 1-2 bottles, 3-4 times a day.
can move around freely.
no pump

Question 26

describe pump assisted

Answer 26

used for patients acutely ill
delivers into small intestine

Question 27

how is feed selected?

Answer 27

dietician undertakes assesment