ENTERAL AND PARENTERAL NUTRITION

Factors considered in selection of a feeding method.

Checklist for monitoring patients recently placed on tube feeding

Action Check
1. Before starting a new feeding  Complete a nutrition assessment
 Check tube placement
2. Before each intermittent  Check gastric residual
feeding:  Check gravity drip rate when applicable
3. Every half hour  Check pump drip rate, when applicable
4. Every hour  Check vital signs, including blood pressure, temperature, pulse,
5. Every 4 hours and respiration
6. Every 6 hours  Check blood glucose, monitoring blood glucose can be
discontinued after 48hrs if test results are consistently negative in
a non-diabetic client
7. Every 4 to 6 hours of  Check gastric residual
continuous feeding
8. Every 8 hours  Check intake and output
 Check specific gravity of urine
 Check tube placement
 Chart clients total intake of, acceptance of, and tolerance to tube
feeding
9. Every day  Weigh clients where applicable
 Check electrolytes and BUN when needed
 Clean feeding equipment
 Check all laboratory equipment
10. Every 7 to 10 days  Check all laboratory Findings
 Re-assess nutrition status
11. As needed  Observe client for any undesirable responses to tube feeding; for
example delayed gastric emptying, nausea, vomiting, and
diarrhea
 Check nitrogen balance
 Check laboratory data
 Chart significant details
Enteral formula classifications

Enteral formula Sub-category Characteristics Indications

Polymeric Standard Similar to average diet. Normal digestion
High nitrogen Protein > 15% of total Kcal. Catabolism Wound
healing

Calorie dense 2 Kcal/ml Fluid restriction

Volume intolerance
Electrolyte abnormalities
Fiber containing Fiber 5 – 15/l Regulation of bowel
function
Monomer Partially hydrolyzed One or more nutrients are Impaired digestive and
elemental peptide hydrolyzed, composition absorptive capacity
based varies.
Disease specific Renal Whole protein with Renal failure
modified electrolyte content
in a caloric dense formula.

Hepatic High BCAA, low AA, Hepatic encephalopathy

Pulmonary High % of calories from fat. ARDS

Diabetic Low carbohydrate Diabetes mellitus

Immune enhancing Critically ill Arginine*, glutamine, Critically ill.
Formulas omega-3 fatty acids, anti-
oxidants
Examples of enteral feed formulations

Feed Composition – 100g powder Indications

Infant feeding formulas  CHO-55.9% mainly lactose and For low birth weight,
maltodextrin. premature or light for date
 PRO-14.4% mainly whey protein babies when breast milk is not
and casein. available.
 FAT-24.0% MCT, milk, fat, corn
oil, soybean.
 CHO-56.2% For infants of normal birth
 PRO-12.5% weight (mature, normal for
 FAT-27.7% date) when breast milk is not
available.

 CHO-55.4% For infants and low birth

 PRO-11.4% weight, light for date babies
 FAT-27.7% corn oil, soy oil, when breast milk is not
coconut oil. adequate or not available

Lactose free infant  CHO-55.4% mainly maltodextrin For infants

formulas  PRO-14.0%
 Soy protein isolate.
 FAT-25% palm, soya and coconut
oil.

 CHO-52% For infants and adults when

 Corn syrup solids lactose or cow’s milk should
 PRO-14% be avoided.
 Soy protein isolate
 FAT-27%
 Blend of vegetable oils.

 CHO-50% corn syrup, sucrose. For infants and adults when

 PRO-15.6% soy protein isolate. lactose or cow’s milk should
 FAT-28.1% be avoided.
 CHO-40% For infants and adults when
 Glucose polymer and corn syrup lactose or cow’s milk should
solids. be avoided.
 PRO-12% Soy isolate.
 FAT-48% soy oil, coconut oil.
High protein powder  CHO-37.4% A protein caloric supplement
supplements  PRO-25% that can be incorporated in
 Full cream  FAT-28% liquid or solid diets
powdered milk  2. CHO-54% A protein caloric supplement
 Dried skimmed milk  PRO-36.4% useful where low fat diet is
powder (DSM)  FAT-1% required
  CHO-68%
 Corn syrup solids, glucose,
lactose.
 PRO-24%
 Non-fat milk,
 Whole milk, caseinate
 CHO-54% Glucose and tapioca
starch
 PRO-11% Hydrolyzed casein and
amino acids
 FAT-35% corn oil, MCT oil
 CHO-6.7%
 Lactose, sucrose
 PRO-17.1%
 Calcium caseinate
 FAT-0.6%
 CH0-30%
 PRO-55%
 FAT-1%
 Calories per 100g – 366g
Nutritionally complete  CHO-13.8g = 55% of total Cal.
liquid diets  PRO-3.8g = 15% total Kcal.
 FAT – 3.4g = 30% of total Kcal l.
 Energy = 100Kcal/100ml
 CHO-17g = 54.6% of total Kcal.
 PRO-7.5g = 15.1% of total Kcal.
 FAT-68g = 30.3% of total Kcal.
 ENERGY-1Kcal per ml.
 CHO-12g = 53% of total Kcal.
 PRO-3.4g = 15% of total Kcal
 FAT-3.2g = 32% of total Kcal
 FIBER-1.5g per 100ml (90 Kcal).
 CHO-58% of total Kcal.
 PRO-15% of total Kcal.
 FAT-30% of total Kcal.
 CHO-61.5g = 54% of total Kcal.
 PRO-15.8g = 14% of total Kcal.
 FAT-15.8g = 32% of total Kcal.
 ENERGY = 100 Kcal per 100ml.
Controlled fat diets
For oral or tube feedings. Useful
in Malabsorption and low fat
modified diets
Useful in high protein, low
calorie low fat, fat residue diets
A protein, vitamin and mineral
supplement ideal for high
protein diets, low fat diets and
cases of malabsorption useful
for patient allergic to
lactalbumins
Nutritionally complete liquid
diet for total or supplemental
feeding, tube feeding or oral
feeding
Low in lactose
High caloric formula suitable for
tube or oral feeding especially
where energy intake is
increased, where fluid is
restricted and or fat
Nutritionally
malabsorption complete feed for
oral or tube feeding in diabetics.
Nutritionally complete feed for
oral or tube feeding as a total
diet or supplemental diet.
Lactose free with fiber
Nutritionally complete feed for
oral or tube feeding as a total or
supplemental diet. Lactose free
feed, low in cholesterol and
sodium