Total Parenteral Nutrition Flashcards
How common is malnutrition
Malnutrition is a common clinical and public health problem, affecting all ages and all care settings
Age UK – 1 in 10 people > 65 are malnourished
Malnutrition affects 29% adults on admission to hospital
The cost of malnutrition in England was estimated to be £19.6 billion per year, or more than 15% of the total public expenditure on health and social care
Define malnutrition
Malnutrition - state in which a deficiency of nutrients such as energy, protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome (NICE CG32) .
Malnutrition is both a cause and a consequence of ill health. Increases a patient’s vulnerability to disease.
How do we treat malnutrition
Methods to improve or maintain nutritional intake are known as nutrition support
These methods can improve outcomes, but decisions on the most effective and safe methods are complex
What are the 6 types of nutritional support
Normal Diet
Softened diet
Intravenous fluids - hydration
Oral nutrition support – for example, fortified food, additional snacks and/or sip feeds
Enteral tube feeding – the delivery of a nutritionally complete feed directly into the gut via a tube
Total Parenteral Nutrition(TPN) - the delivery of nutrition intravenously
What are the consiquesnses of malnutrition
Weakness and loss of muscle mass Apathy and depression Reduced immune response Poor wound healing Increased morbidity and mortality
When is artificial nutritional support indicated
Patients who can’t meet their requirements by eating and drinking ‘normally’
Usual normal feeding aim:
Energy: 25-35 kcal/kg/day
Protein 0.8-1.5g kg/day
Fluid: 30-35 ml/kg/day
Adequate electrolytes, minerals, micronutrients and fibre
Note that this may vary depending on clinical circumstance e.g. refeeding syndrome
What are oral nutritional supports
Sip feeds Milk-based Ready to drink e.g. Fortisip Powdered supplements e.g. Complan Fruit juice based e.g. Fortijuice Semi-solid feeds High protein supplements Energy supplements
What are the rules around prescribing oral ntritional support
BNF borderline substances
Prescribed in certain circumstances
Most patients – not required long-term
Some can also be purchased but patient should be under healthcare professional supervision
When would we use an enteral tube feed
Most malnourished people have a functioning GI tract capable of absorbing nutrients
If inadequate or unsafe oral intake and functioning/accessible GI tract – enteral tube feeding
Enteral tubes cab be placed through nose or through abdominal wall
Nasogastric tube (NG) or nasojejunal (NJ) - fine bore tube
Access for up to 6 weeks
Percutaneous endoscopic gastrostomy (PEG) or Percutaneous endoscopic jejunostomy (PEJ)
Access for over 6 weeks
WHat are the benefits of enterak nutrition
More physiological – closely mimics normal feeding Less risk of infection Maintain GI tract Costs less Easier for home patients Patient ease Calorie control Safer and cheaper than TPN
When is enteral nutrition indicated
Eating & swallowing difficulties (dysphagia) - facial injury or surgery, neurological impairment, post-radiotherapy
Severe intestinal malabsorption e.g. Crohn’s disease, major GI surgery
Increased nutritional requirements e.g. severe burns
Eating disorders - anorexia nervosa
Self neglect – intentional/non-intentional
Chronic vomiting diarrhoea
What are some problems with enteral nutrition
Diarrhoea Regurgitation Taste and patient acceptability Abdominal distension Blocked feeding tubing Problems with the pump Placement of an external Dislocation of tubes esp. NG
How do we administer drugs via enteral feeding tubes
Use liquid preparation where available
Give each drug separately
Flush with >20ml water, before and after each drug
Not for m/r, e/c, cytotoxic
Crushed tablets may block tube – check resources
Which drugs can interact with enteral feeds
Directly with the feed: Ciprofloxacin Aluminium-containing antacids (Other metal salts such as calcium) Theophylline Phenytoin
When would total parenteral nutrition be used
Only when enteral route is not an option as GI tract is
Non-functional
Inaccessible
Perforated
Cannot take anything by mouth or via GI tract e.g. dysphagic post stroke, trauma, surgery
“Gut failure” - unable to digest and absorb food
The GI tract may be unavailable or unable to absorb nutrients
May be short or long-term
