LECTURE 1 (Enteral feeding) Flashcards
What is Parenteral feeding?
The direct infusion into a vein of solutions containing the essential nutrients in quantities to meet the daily needs of the patient
What are the basic components of Parenteral feeding?
- Amino acids
- Glucose
- Fat emulsion
- Electrolytes
- Vitamins and minerals
- Trace elements
What are the indications for Parenteral feeding?
- 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
Why is Central venous access required?
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
What is the best choice for long-term nutrition?
A skin-tunnelled catheter
Describe the termination of parenteral feeding
- 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
What are the complications of Parenteral feeding?
- Fluid overload
- Impaired liver function
- Hyperglycemia/Hypoglycemia
- Azotemia (high plasma urea levels)
- Hypophosphatemia
What are Enteral feeding tubes?
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]
What is a Nasogastric/Nasojejunal tube?
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)]
What is a Gastrostomy tube?
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]
What is the primary aim of enteral tube feeding?
- 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
What are the contraindications for NG tube placement?
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
What are the complications of NG tube insertion?
- Gagging/vomiting
- Tissue trauma along the nasal, oropharyngeal or upper GI tract
- Nasal erosion
- Oesophageal perforation (rare)
- Incorrect placement into lungs (may cause aspiration)
How do you check to confirm that the tube is in the stomach?
- 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
How do you care for NG/NJ tubes?
- 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