Feeding and Nutrition

Question 1

Nasogastric (NG) Tube Insertion

Answer 1

Passed into Stomach via Nose; Used for decompression for
the Stomach/GI Tract for obstruction (E.g. Gastric Outlet Obstruction, Ileus, Intestinal
Obstruction); For Gastric Lavage, as well as administration of Feed/Drugs especially in
critically-ill patients or patients with Dysphagia
o Lubricate NG tube well with aqueous gel; Estimate length between nostril to back of
throat; Pass along nostril with its natural curve promoting passage downward
o Rotate tube 180o when tip estimated to enter throat
o Allow patient to drink sip of water and advance, timing each push with swallow; If
failure, try other nostril; Then Oral insertion
o Stomach about 35-40cm in adults, 10-20cm beyond distance; Tape secreted to nose
o Confirm position by pH paper (pH<5.5 on sample >0.5ml), CXR otherwise

Question 2

Percutaneous Endoscopic Gastrostomy (PEG)

Answer 2

o Digital pressure applied to Abdominal wall and Endoscopist should identify indenting
on the Anterior Gastric wall; Transillumination from within the stomach can also be
seen through the abdominal wall
o Angiocath used to puncture abdominal wall through a small insertion; Guidewire
inserted and pull out through the mouth; Feeding tube pulled through and out of the
insertion in the opposite direction
o Alternatively, can be through a series of dilators to increase size of Gastrostomy and
tube is pushed in over the wire

Question 3

Radiological Inserted Gastrostomy (RIG)

Answer 3

X ray guided; Gastropexy stitches paced, held by

small plastic buttons; Use of dilators to enlarge Gastrostomy and insertion of RIG tube

Question 4

PARENTERAL FEEDING

Answer 4

• Nutritional Support should be considered for Malnourishment; Defined as either BMI<18.5,
Unintentional Weight Loss >10% over 3-6/12, BMI<20 + Weight Loss >5% over 3-6/12
o At Risk of Malnourishment – Little/no food intake 5/7 and likely for next 5/7; Poor
Absorptive Capacity, High Nutrition Losses, or Increased Nutritional Needs
• Nutritional Support should provide for 25-35 kcal/kg/day, Protein 0.8-1.5g, Fluid 30-35mg/kg,
Electrolytes, Minerals, Micronutrients and Fibre if appropriate
• Monitoring of FBC, U/Es, Glucose, Mg, Phos, LFTs including INR, Ca, Alb, CRP
o Zn, Cu, Se, Fe and Ferritin, Folate/B12, Mn, Vit D
• Complications include Mechanical trauma, Metabolic (Hyperglycaemia, U/E disturbances,
Hypercalcaemia, Nutritional Deficiencies), Oral/Tissue Dysfunction

Question 5

Routes of Administration for Parenteral Feeding

Answer 5

• Peripheral Parental Nutrition – Specially formulated mixtures from Peripheral use with Low
Osmolality and containing lipid emulsions
o Heparin, Steroids, and local GTN patches reduce occurrence of Thrombophlebitis
o Peripheral Cannula (5 days) or PICC line (1 month)
• Central Venous Catheter (Subclavian Vein or Internal Jugular Vein) – Complications include
Sepsis, Thrombosis, Pneumothorax and Embolism

Question 6

Refeeding Syndrome

Answer 6

• Patients who have eaten little/nothing for >5/7 should receive ≤50% energy requirements
• Shifts of Water and Electrolytes can occur after Parenteral and Enteral Nutrition
o Leads to Heart Failure, Circulatory Collapse and Death
• Carbohydrate Intake stimulates Insulin Release; Leads to Cellular Uptake of Phosphate,
Potassium and Magnesium; Hypophosphataemia, Hypokalaemia, Hypomagnesaemia and
Sodium Retention (Reduced Renal Excretion)