1. NUTRITIONAL SUPPORT

2. TYPES OF NUTRITIONAL SUPPORT Enteral Feeding Parenteral Feeding

3. Enteral feeding a method of provision of nutrients into the gastrointestinal (GI) tract through a tube.This method is used for nutritional support in patients who cannot ingest or digest sufficient amounts of food but have adequate intestinal functional capacity.

4. FEEDING TUBES Nasogastric/Nasoenteral Tubes Gastrostomy and Jejunostomy Tubes

5. NASOGASTRIC TUBE Made of silicone and polyvinyl Tubes used in adults vary in length between 30-43 inches with diameters from 8-14 french Usually used for short-term enteral feeding

6. ENTERAL FEEDING FORMULAS CLASSIFICATION: Polymeric formulas Monomeric formulas Blenderized foods Formulas for specific metabolic needs Immune-enhancing formulas Modular formulas Hydration solutions

7. GASTROSTOMY AND JEJUNOSTOMY TUBES Long-term enteral feeding (>4 weeks) They have a larger diameter (15-28 french) The risk of aspiration is considerably decreased. They are more convenient and aesthetically acceptable It can be placed surgically, endoscopically, or radiologically by fluoroscopy, sonography or tomography

8. INDICATIONS: Head and neck cancers Disorders of swallowing Multiple sclerosis Neurosurgical disease Parkinson’s disease Head injury

9. BENEFITS: Well tolerated (better than NGT) Improved nutritional status Low incidence of complications Reduction in aspiration pneumonia

11. COMPLICATIONS OF G-TUBE Leakage around g-tube Skin irritation Infection Pressure ulcers Fungal infection (candidiasis) Tube occlusion hyperplasia

12. 8. Gastric perforation 9. Gastrocolic fistula 10. Dehiscence 11. Subcutaneous abscess

13. PARENTERAL FEEDING When patients cannot use their gastrointestinal tracts for nutrition, parenteral nutrition may be used to maintain or improve the patient's nutritional status. This form of intravenous treatment provides all the nutrients that are delivered to the patient. This treatment may be temporary or long-term.

14. TYPES OF PARENTERAL FEEDING Partial parenteralnutrition Total parenteral nutrition (TPN)

15. Partial parenteral nutrition supplies only part of daily nutritional requirements, supplementing oral intake. Many hospitalized patients are given dextrose or amino acid solutions by this method.

16. Total parenteral nutrition (TPN) is given when a patient requires an extended period of intensive nutritional support. It is usually administered through a central venous catheter. TPN solutions contain high concentrations of proteins and dextrose. Various components like electrolytes, minerals, trace elements, and insulin are added based on the needs of the patient. Total parenteral nutrition provides the calories a patient requires and keeps the body from using protein for energy. TPN is given using an infusion pump.

17. INDICATIONS: Some stages of Crohn's disease or ulcerative colitis Bowel obstruction Certain pediatric GI disorders (eg, congenital GI anomalies, prolonged diarrhea regardless of its cause) Short bowel syndrome due to surgery