Enteral and parenteral nutrition pdf

Jeejeebhoy Published 1 August Medicine Proceedings of the Nutrition Society Nutrition support for patients in hospital has become an essential form of therapy. Total parenteral nutrition TPN was the preferred way of giving nutrition to hospital patients for many years but enteral nutrition EN is now the preferred route.

EN is believed to promote gut function and prevent translocation of intestinal bacteria, thus reducing the incidence of sepsis in critically ill patients. In consequence, the use of TPN has been discouraged as a dangerous form of therapy.

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Educational Resources. Attend a Webinar. Enteral and Parenteral Nutrition. The table below shows options for enteral access feeding Table 1. Short-term enteral nutrition is usually defined as use less than 4 weeks; long-term enteral nutrition is defined as use for more than 4 weeks.

For more specific information on percutaneous endoscopic gastrostomy, please see the ACG patient resource of the same name under GI Procedures. Nutrition delivered by enteral tubes can cause the following complications: food entering the lungs called aspiration , constipation, diarrhea, improper absorption of nutrients, nausea, vomiting, dehydration, electrolyte abnormalities, high blood sugar, vitamin and mineral deficiencies, and decreased liver proteins.

Feeding tubes inserted through the nose, such as nasogastric or nasoenteric tubes, can cause irritation of the nose or throat, acute sinus infections, and ulceration of the larynx or esophagus. Feeding tubes inserted through the skin of the abdominal wall, such as gastrostomy or jejunostomy tubes, can become clogged occluded or displaced, and wound infections can occur.

Enteral nutrition may be done at home. Orders that specify protocols for administration and monitoring will be written by a provider or dietitian. Most protocols require the prescriber to indicate the formula for feeding, strength, how quickly to feed, and delivery method.

Delivery methods include the following: gravity controlled and pump assisted. Gravity controlled feeding refers to any feeding method that uses manually controlled devices to deliver a feeding which is almost always a gastric feeding. Pump assisted feeding utilizes an electric pump device to more precisely control the rate of delivery in patients who are at a higher risk of inadvertently getting formula in their lungs, sensitive to volume, have delayed gastric emptying or are being fed into the small intestine.

Choice of the delivery methods for a particular person depends on the type of enteral access device as well as the person's individual needs. Water flushes should be administered to prevent clogging and ensure adequate hydration. Feeding tubes should be flushed with water before and after medication delivery and before and after every feeding or every 4 hours during continuous feeding. Often a dietitian, nurse or home care company will teach the patient how to prepare, administer, and monitor tube feeds.

In addition, a home care company may be available to explain the supply options available and help to arrange for home supplies and equipment. Again, the preferred route is by using someone's GI tract, but this is not always possible.

The intravenous route is more complicated and expensive to do and is almost always started in the hospital. Parenteral nutrition access options include central venous catheters which may include short term catheters which are tubes that are put in place in the hospital and generally removed prior to discharge and long term options such as tunneled Hickman catheters located in the upper chest, peripherally inserted central catheters PICC located in the upper arm, and ports implanted under the skin usually in the upper chest wall.

See figures 2 and 3 below. Central venous catheters are commonly used for patients requiring weeks, months or years of therapy. These are tunneled under the skin and put in place either in a Radiology Department or in an operating room. They require dressing care to be performed by the patient, a family member or a Home Care Service.

A PICC is commonly used in patients who require therapy for a short duration, usually for several weeks to a few months. A PICC may be placed while in the hospital at the patient's bedside, in the Radiology Department or rarely at home by a specially trained registered nurse.