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Enteral nutrition

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Enteral nutrition

  1. 1. EntEral nutrition in adults PRESENTER ; CLEMENT KIP
  2. 2. What's enteral nutrition? • Enteral nutrition is a way of providing nutrition to the patients who are unable to consume an adequate oral intake but have at least a partially functional GI tract
  3. 3. Indications of EN  Decreased oral intake <50% for 7-10 days  Malnourished unable to eat >5 days  Normal nourished patients unable to eat > 5 days  Adaptive phase of short bowel syndrome  Following severe trauma or burns  Inability to take oral feedings due to head or neck trauma.  Prolonged anorexia  Facial or oesophageal structural abnormalities  Coma
  4. 4. Contraindications for EN Severe acute pancreatitis High output proximal fistula Inability to gain access Intractable vomiting or diarrhea peritonitis Severe diarrhea Inability to gain access Ileus Intestinal obstruction Severe G.I. Bleed ASPEN. The science and practice of nutrition support. A case-based core curriculum. 2001; 143
  5. 5. Types of EN
  6. 6. Nasogastric Tubes Definition • A tube inserted through the nasal passage into the stomach Indications: • Short term feedings required • Intact gag reflex • Gastric function not compromised • Low risk for aspiration
  7. 7. Nasogastric Tubes Advantages: • Ease of tube placement • Surgery not required • Easy to check gastric residuals • Accommodates various administration techniques
  8. 8. Nasogastric Tubes Disadvantages: • Increases risk of aspiration • Not suitable for patients with compromised gastric function • May promote nasal necrosis and esophagitis • Impacts patient quality of life
  9. 9. Nasoduodenal/Jejunal Definition • A tube inserted through the nasal passage through the stomach into the duodenum or jejunum Indications: • High risk of aspiration • Gastric function compromised
  10. 10. Nasoduodenal/Jejunal Advantages: • Allows for initiation of early enteral feeding • May decrease risk of aspiration • Surgery not required
  11. 11. Nasoduodenal/Jejunal Disadvantages: • Transpyloric tube placement may be difficult • Limited to continuous infusion • May promote nasal necrosis and esophagitis • Impacts patient quality of life
  12. 12. Orogastric • Tube is placed through mouth and into stomach • Often used in premature and small infants as they are nasal breathers • Not tolerated by alert patients; tubes may be damaged by teeth
  13. 13. Enterostomy Placement • Gastrostomy • Jejunostomy
  14. 14. Gastrostomy Definition • A feeding tube that passes into the stomach through the abdominal wall. May be placed surgically or endoscopically Indications: • Long-term support planned • Gastric function not compromised • Intact gag reflex present
  15. 15. Gastrostomy Disadvantages: • May require surgery • Stoma care required • Potential problems for leakage or tube dislodgment
  16. 16. Jejunostomy Definition • A feeding tube that passes into the jejunum through the abdominal wall. May be placed endoscopically or surgically Indications: • Long-term feeding option for patients at high risk for aspiration or with compromised gastric function
  17. 17. Jejunostomy Advantages: • Post-op feedings may be initiated immediately • Decreased risk of aspiration • Suitable option for patients with compromised gastric function • Stable patients can tolerate intermittent feedings
  18. 18. Jejunostomy Disadvantages: • Requires stoma care • Potential problems related to leakage or tube dislodgement/clogging may arise • May restrict ambulation • Bolus feedings inappropriate (stable patients may tolerate intermittent feedings)
  19. 19. Bolus Feeding
  20. 20. Enteral Feeding Complications • Mechanical • Gastrointestinal • Metabolic • Infectious
  21. 21. Mechanical • Feeding tube obstruction • Feeding tube dislodged • Nasal irritation • Skin irritation/excoriation at ostomy site
  22. 22. Gastrointestinal Complications • Diarrhea • Constipation • Gastric distention/bloating • Gastric residuals/delayed gastric emptying • Nausea/vomiting
  23. 23. Metabolic • Fluid and Electrolyte abnormalities • Glucose intolerance • Ca++ , Mg++ , PO4 abnormalities • Other
  24. 24. Infectious Complications • Formula contamination • Unsanitary equipment • Failure to follow appropriate protocols re handling of enteral feedings/changing of bags and tubing
  25. 25. Monitoring of Patients on EN • Electrolytes • BUN/Cr • Albumin/prealbumin • Ca++ , PO4, Mg++ • Weight • Input/output • Vital signs • Stool frequency/consistency • Abdominal examination
  26. 26. PARENTERAL NUTRITION • This refers to nutrition directly into the systemic circulation, bypassing the gastro-intestinal tract (GIT)
  27. 27. ROUTES OF PARENTERAL NUTRITION • Peripheral Parenteral Nutrition (PPN) • Total/Central Parenteral Nutrition(TPN)
  28. 28. PERIPHERAL PARENTERAL NUTRITION • This refers to use of peripheral veins to provide a solution that meet nutrient needs for infusion. It has lower dextrose (5% to 10% final concentration) and amino acid (5% final concentration) • PPN may be used in patients with mild or moderate malnutrition to provide partial or total nutrition support when they are not able to ingest adequate calories orally or enterally or when central vein PN is not feasible
  29. 29. TOTAL PARENTERAL NUTRITION • CPN is often referred to as “Total Parenteral Nutrition” since the entire nutrient needs of the patient may be delivered by this route. It requires a central venous system for long term infusions
  30. 30. INDICATIONS FOR TPN • Gastrointestinal fistula • Bowel obstruction • GI non functioning • NPO >5 days • GI fistula • Acute pancreatitis • Short bowel syndrome • Nutritional needs not met; patient refuses food
  31. 31. Complications of PN
  32. 32. Summary of Parenteral Nutrition Guidelines in the Critical Care Unit 1. All patients receiving less than target in 3 days enterally to receive PN within 24 to 48 hours of admission once haemodynamically stable 2. PE requirements to be calculated at 25 kcal/kg/d and increased to target over 2 – 3 days 3. Carbohydrate to be given at a minimum of 2g/kg/d as glucose, monitor blood sugars (BS), BS >10mmol/l to be avoided 4. Lipids to be given at a dose of 0.7 – 1.5g/kg/d, EFA, EPA and DHA, live oil based, fish oil added 5. Protein to be given at 1.3 –1.5g ideal body weight (IBW) 6. Amino acid solution should contain glutamine at a dose of 0.2 -.04g /kg/Bodyweight/d (0.3 – 0.6g alanyl-glutamine dipeptide)
  33. 33. 7. Daily dose of multivitamin and trace element to be adhered to 8. PN admixtures to be administered as a complete All in One bag. If there is evidence of PEM on admission and enteral nutrition is not feasible, it is appropriate to initiate parenteral nutrition as soon as possible following admission and adequate resuscitation 9. If a patient is expected to undergo major upper GI surgery and EN is not feasible, PN should be provided under specific conditions: If the patient is malnourished PN to be given 5-7 days preoperatively and continued into the postoperative period 10. Wean PN gradually 11. Discontinue once the patient is able to adequately tolerate 60% of caloric requirements enterally
  34. 34. •Thank you