Nutrition support Flashcards
Reasons for unsuccessful oral nutrition
Unsafe swallowing for patient.
Patient is unable to eat despite oral nutrition supplements.
Enteral feeding
- Mechanism
- Indications for use [4]
Nutrition fed through liquid into the gut
Only used if the gut is functioning:
- Unable to swallow
- Insufficient oral intake
- Unable to tolerate supplements
- Patient choice
Para-enteral feeding
Fluid with nutrients given IV
Used when gut is not functioning:
- Aperistaltic
- Obstructed gut
- Gut is too short or damaged
- High fistula
- Gut is inaccessible
Types of enteral access
Naso-gastric
Naso-jejunal
Percuntaneous endoscopic gastrostomy (PEG) / RIG (Radiologically insterted gastrostomy)
Percuntaneous jejunal (Jejunostomy/ PEJ/ RIJ)
Advantages of NG feeds [5]
Physiological- uses the gut
Fast and easy to pass tube
Minimally invasive
Generally well tolerated
Easy to remove
Indications of NG tube feeding
When the gut is still working
Stomach emptying
Short term feeding
Tube is accepted and tolerated by patient.
When it is safe to place tube and nose and oesophagus.
Risks of NG
Misplaced/ blocked tube
Reflux/ aspiration
Not tolerated
Naso-jejunal feeding advantages
Same as NG
Used for vomitting/ duodenal obstruction/ gastroparesis
Less likely to aspirate
Naso-jejunal feeding risk
Technically difficult
Needs endoscopy or interventional radiology
Risk of misplacement
May not be tolerated
PEG/ RIG
Percutaneous endoscopic gastrostomy / Radiologically inserted gastrostomy
PEG/ RIG advantages [4]
Physiological
Durable: can last years
Least likely to be displaced
More comfortable and cosmetic
Patients to use PEG/ RIG [5]
Has to have functioning gut
Has inability to swallowing food/ fluid
Condition must be irreversible or long-lasting.
Nutrition support is inappropiate
Can tolerate endoscopy
PEG/ RIG risks
Perforation
Sepsis
Bleeding
Misplacement
Reflux
Death
Percutaneous jejunal access advantages
Same as PEG
Tolerated in gastroparesis and dudodenal obstruction
Percutaneous jejunal access risks
Higher risk of complications that PEG
Contents of total parenteral nutrition
Fluid
Electrolytes
Amino acids
Lipids
Carbs
Vitamins and minerals
Problems with TPN
Line access complications
Hyperglycaemia
Fluid/ electrolyte disturbance
Over/ underfeeding
Liver disease
Atrophy and inflammation of gut as it is not used.
Expensive
Monitoring TPN
Checked every 4 hours
Checked daily for: line inspection, weight, LFT, FBC
Checked monthly for: micronutrients and TGs
Re-feeding syndrome
Severe electrolyte + fluid shifts due to metabolic abnormalities in malnourished patients that are re-fed.
During starvation, protein pumps are inactivated.
- Causes Na+ and water to shift intra-cellularly
- K+ and phosphate shift extracellular
K+ and phosphate excreted.
Increase in energy causes sudden drop in plasma K and phosphate but rise in Na+ and H2O.
Avoiding re-feeding
Replace electrolytes before feeding
Slow feeding- 5-10 calories per Kg of weight
Monitor electrolytes
Wernicke-korsakoff’s syndrome
Wernicke= encephalopaty Korsakoff= psychosis
Caused by thiamine deficiency
- Seen frequently in alcoholics
Treating/ avoiding Wernicke-Korsakoff
Replace thiamine before and during re-feeding
low risk= high dose oral thiamine
high risk= IV Pabrinex
PEG benefit in end stage dementia
Allows medication to be given
Allows maintenance of weight but:
- Doesn’t improve daily activities
- Does improve life expectancy
