LECTURE 1 (Enteral feeding) Flashcards

1
Q

What is Parenteral feeding?

A

The direct infusion into a vein of solutions containing the essential nutrients in quantities to meet the daily needs of the patient

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2
Q

What are the basic components of Parenteral feeding?

A
  • Amino acids
  • Glucose
  • Fat emulsion
  • Electrolytes
  • Vitamins and minerals
  • Trace elements
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3
Q

What are the indications for Parenteral feeding?

A
  • Failure of gut function (e.g obstruction, surgical resection, severe malabsorption)
  • Intestinal failure has persisted/is likely to persist for several days

Explanation: Parenteral feeding should only be used when it is not possible to meet nutritional requirements via the GI tract

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4
Q

Why is Central venous access required?

A

Central venous access is required because Parenteral feeding solutions are hyperosmolar and there is a risk of thrombophlebitis associated with feeding into peripheral veins

ALTERNATIVES:
Peripheral veins can be used to provide short-term peripheral parenteral feeding via a midline or peripheral cannula

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5
Q

What is the best choice for long-term nutrition?

A

A skin-tunnelled catheter

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6
Q

Describe the termination of parenteral feeding

A
  • Should NOT be terminated until oral or enteral tube feeding is well established
  • Should we weaned off to half rate before stopping to prevent REBOUND HYPOGLYCEMIA and ensure adequate nutritional intake via alternative route
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7
Q

What are the complications of Parenteral feeding?

A
  • Fluid overload
  • Impaired liver function
  • Hyperglycemia/Hypoglycemia
  • Azotemia (high plasma urea levels)
  • Hypophosphatemia
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8
Q

What are Enteral feeding tubes?

A

The delivery of a nutritionally complete feed directly into the Gastrointestinal tract via a tube
[tube is usually placed into the stomach, duodenum or jejunum via either the nose/direct percutaneous route]

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9
Q

What is a Nasogastric/Nasojejunal tube?

A

A tube placed in the nose and passed down the oesophagus with the feeding tip ending in the stomach or small intestine respectively

[most commonly used enteral tube feed and is suitable for short-term feeding (2-4 weeks)]

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10
Q

What is a Gastrostomy tube?

A

A tube placed directly into the stomach allowing infusion of nutrients into the stomach/contain an extension into the jejunum

[used when enteral tube feeding is anticipated for more than 4 weeks]

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11
Q

What is the primary aim of enteral tube feeding?

A
  • Avoid further loss of bodyweight
  • Correct significant nutritional deficiencies
  • Rehydrate the patient
  • Stop the related deterioration of quality of life due to inadequate oral nutritional intake
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12
Q

What are the contraindications for NG tube placement?

A

ABSOLUTE CONTRAINDICATIONS:
- Mild face trauma
- Recent nasal surgery
RELATIVE CONTRAINDICATIONS:
- Coagulation abnormalities
- Recent alkaline ingestion (due to risk of esophageal rupture)
- Oesophageal varices
- Oesophageal strictures

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13
Q

What are the complications of NG tube insertion?

A
  • Gagging/vomiting
  • Tissue trauma along the nasal, oropharyngeal or upper GI tract
  • Nasal erosion
  • Oesophageal perforation (rare)
  • Incorrect placement into lungs (may cause aspiration)
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14
Q

How do you check to confirm that the tube is in the stomach?

A
  • pH paper
    [aspirate 0.5-1mL of stomach contents and test pH on indicator strips, if between 1-5.5 it’s in the stomach]
  • X-ray confirmation
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15
Q

How do you care for NG/NJ tubes?

A
  • Regular flushing before and after feed and medication
    [warm water to flush every 4-6 hours if feed is continuous/whenever feed is interrupted and with at least 10ml between each medication]
  • Liquid medication should be used + tablets should be crushed if no liquid is available]
  • Should be checked on a daily basis
  • Give regular attention to oral hygiene to reduce the risk of mouth infections
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