Nutrition options in surgical patients

Question 1

NG feeding administration, complications, contraindications

Answer 1

Usually administered via fine bore naso gastric feeding tube
Complications relate to aspiration of feed or misplaced tube
May be safe to use in patients with impaired swallow
Often contra indicated following head injury due to risks associated with tube insertion

Question 2

Naso jejunal feeding why is it done- safe to use following oesophagogastric surgery?

Answer 2

Avoids problems of feed pooling in stomach (and risk of aspiration)
Insertion of feeding tube more technically complicated (easiest if done intra operatively)
Safe to use following oesophagogastric surgery

Question 3

Feeding jejunostomy

Answer 3

Surgically sited feeding tube
May be used for long term feeding
Low risk of aspiration and thus safe for long term feeding following upper GI surgery
Main risks are those of tube displacement and peritubal leakage immediately following insertion, which carries a risk of peritonitis

Question 4

PEG full form

Answer 4

Percutaneous endoscopic gastrostomy

- combined endoscopic and percutaneous tube insertion

Question 5

Total parenteral nutrition

indications for use

Answer 5

The definitive option in those patients in whom enteral feeding is contra indicated
Individualised prescribing and monitoring needed
Should be administered via a central vein as it is strongly phlebitic
Long term use is associated with fatty liver and deranged LFT’s

Question 6

Early causes of post-op pyrexia

Answer 6

Blood transfusion
Cellulitis
Urinary tract infection
Physiological systemic inflammatory reaction (usually within a day following the operation)
Pulmonary atelectasis - this if often listed but the evidence base to support this link is limited

Question 7

Late causes of post-operative pyrexia

Answer 7

Venous thromboembolism
Pneumonia
Wound infection
Anastomotic leak