LECTURE 1 (Enteral feeding)

Question 1

What is Parenteral feeding?

Answer 1

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

Question 2

What are the basic components of Parenteral feeding?

Answer 2

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

Question 3

What are the indications for Parenteral feeding?

Answer 3

• 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

Question 4

Why is Central venous access required?

Answer 4

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

Question 5

What is the best choice for long-term nutrition?

Answer 5

A skin-tunnelled catheter

Question 6

Describe the termination of parenteral feeding

Answer 6

• 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

Question 7

What are the complications of Parenteral feeding?

Answer 7

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

Question 8

What are Enteral feeding tubes?

Answer 8

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]

Question 9

What is a Nasogastric/Nasojejunal tube?

Answer 9

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)]

Question 10

What is a Gastrostomy tube?

Answer 10

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]

Question 11

What is the primary aim of enteral tube feeding?

Answer 11

• 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

Question 12

What are the contraindications for NG tube placement?

Answer 12

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

Question 13

What are the complications of NG tube insertion?

Answer 13

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

Question 14

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

Answer 14

• 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

Question 15

How do you care for NG/NJ tubes?

Answer 15

• 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