Nutrition Support

Question 1

Mode of EN feeding for < 6 weeks

Answer 1

Nasogastric or nasoenteric (duodenum or jejunum)

Question 2

Mode of EN feeding for > 6 weeks

Answer 2

Gastrostomy or enterostomy
PEG may be used with PD if placed before PD cath.

Question 3

What are things to know about enteral formula selection?

Answer 3

No evidence to support usage of formulas specific for organ dsyfunction.
Immune-enhancing formulas have been shown to be beneficial in critically ill surgical pts that required higher protein needs like during CRRT

Question 4

What are mechanical complications of EN?

Answer 4

Tube dislodging or clogging

Question 5

What are ways to prevent GI complications in EN?

Answer 5

Aspiration: elevate head of bead >30 degrees, use lower goal volume, post-pyloric feeds
Constipation: add’l free water
Nausea: adjust goal rate and advance slowly

Question 6

What are the infusion rates for glucose and fat in PN?

Answer 6

Glucose: 4-5 mg/kg/min (stable); 4 mg/kg/min (critically ill or trauma)
Lipid: 2.5 g/kg/d

Question 7

What are SMOF ILE?

Answer 7

Soybean oil and fish oil-based lipids for PN
Provide medium chain TG
Higher proportion of omega-3 PUFA and omega-9 MUFA
More antiflammatory
Gold standard for PN

Question 8

When can PN be tapered and discontinued?

Answer 8

When pt is able to meet > 60% needs from EN or PO diet.

Question 9

What are contraindications for IDPN with lipids?

Answer 9

Known egg, soy, olive oil, fish, or peanut allergies
Severely elevated TG

Question 10

What are the KDOQI guidelines for IPN/IPAA?

Answer 10

Do not sub AA as general strategy to improve nutritional status in pts with PEW on PD.
AA dialysate is reasonable strategy to trial in attempts to improve nutrition status when requirements can’t be met with PO and EN intake.