Lecture 11: Nutrition Support

Question 1

what to look for to ensure correct NG tube placement

Answer 1

in chest x ray:

• view is from upper oesophagus to lower diaphragm
• tube remains in midline down to diaphragm
• tube should bisect carina at T4
• tip of tube is clearly visible and below the diaphragm
• tip should be 10cm beyond the GOJ

Question 2

when is naso jejunal feeding used

Answer 2

• in patients prone to vomiting, gastroparesis and duodenal obstruction

Question 3

what are difficulties with naso jejunal feeding

Answer 3

• technically difficult

- generally needs endoscopy / interventional radiography to place

Question 4

when is PEG and RIG used

Answer 4

• for patients with functional gut but swallowing problems

- uses no tubes so is also more comfortable for patients

Question 5

risks and disadvantages of PEG and RIG

Answer 5

• patient has to be attached to a pump 20 hours a day
• risks of perforation
• sepsis
• bleeding
• reflux
• buried bumper

Question 6

when is PEJ used

Answer 6

• good long term option

- in case of gastroparesis / dueodenal obstruction

Question 7

what is monitored in parenteral nutrition

Answer 7

4 hourly
- temperature 
- blood glucose
daily
- urine inspection
- weight
- Mg, Ca, Po3-
- LFT and FBC
monthly
- micronutrients
- triglycerides

Question 8

what happens in refeeding syndrome

Answer 8

severe electrolyte and fluid balance shift

Question 9

what happens during and after starvation

Answer 9

during
- transmembrane pumps turned off
- Na drifts intracellularly
- K+ and PO3- drift extracellularly
after
- when pumps turn on
- sudden drop in plasma K+ and PO3- causes arrhythmias
- also get acute thiamine deficiency