Enteral Nutrition

Indicated to the following conditions:

– Severe swallowing difficulties
– Little or no appetite for extended periods, especially if malnourished
– GI obstructions, some types of fistulas, impaired motility of the upper GI tract
– After intestinal resection, beginning enteral feedings
– Mentally incapacitated due to confusion, dementia, neurological disorders
– Individuals in coma
– Individuals with extremely high nutrient requirements
– Individuals on mechanical ventilators
 Types of Enteral Formulas
• Standard formula: for patients who can digest
& absorb nutrients without difficulty; contains
protein & carbohydrate sources
• Hydrolyzed formulas: used for patients with
compromised digestive or absorptive functions
— macronutrients are partially or fully broken
down & require little, if any, digestion before
absorption
• Disease-specific formulas: designed to meet
nutrient needs of patients with particular
disorders: liver, kidney, lung diseases, glucose
intolerance, metabolic stress
• Modular formulas: contain only one or two
macronutrients; used to enhance other
formulas
 Enteral Nutrition in Medical Care
1. Open feeding system: requires formula to be
transferred from original packaging to feeding
• Administration of tube feedings container
– Safe handling 2. Closed feeding system: formula prepackaged
• Open feeding system in ready-to-use containers
• Closed feeding system

– Review of procedure with patient & family

– Verification of tube placement

– Formula delivery • Intermittent feeding: delivery of prescribed

• Intermittent feedings
• Continuous feedings
• Bolus feeding
volume over 20-40 minutes at scheduled
interval
• Continuous feeding: slow delivery at
constant rate over 8-24 hour period
• Bolus feeding: delivery of large amount of
liquid in less than 15-20 minutes few times a
day
 Enteral Nutrition in Medical Care

• Medication administration through feeding

tubes
– Potential for diet-drug interactions must
be considered before administration
– Continuous feeding halted for
approximately 15 minutes before & 15
minutes following medication delivery
(longer for some medications)
– Type of medication may make tube
administration impossible—require
change to alternate route
• Generally best to administer medications by
mouth whenever possible
 How to Administer Medications to Patients Receiving
Tube Feedings
Administration guides
• Consult with pharmacist to
• Dodetermine compatibility
not mix drugs together orofwith formula
medication
• Verify with feeding tube
tube placement & patency before administration
• administration
Position patient in semi-upright or higher position
– Diet-drug
• interactions
Flush
– Medicationwarm
tube with water before and after drug administration
• formulation
Use– liquid forms of drug whenever possible
• Availability of liquid form of
Crushdrug
tablets to fine powder & mix with water before administering (verify compatibility with
pharmacist first)
• Parenteral Nutrition Support
• Parenteral Nutrition
Support
1. Indicated for patients who do not have
functioning GI tract & who are
malnourished (or likely to become so)
2. Used when enteral formulas cannot be
use or intestinal function is inadequate
3. Life-saving option for critically-ill persons
Two main access sites: central or
peripheral vein
 Venous Access
• Peripheral parenteral nutrition (PPN)
– Can only provide limited amounts of energy &
protein
– Peripheral veins can be damaged by overly
concentrated solutions
– Limited to patients who do not have high nutrient
needs or fluid restrictions
– Used most often for short-term nutrition support
(7-10 days)
– Rotation of vein sites may be necessary
 Venous Access
• Total parenteral nutrition (TPN)
– Can reliably meet complete nutrient
requirements
– Provides nutrient-dense solutions for
patients with high nutrient needs or fluid
restrictions
– Preferred for long-term intravenous
feedings
– Inserted directly into a large central vein
or into central vein via peripheral vein
 Administering Parenteral Nutrition
• Multidisciplinary nutrition support team
of health care professionals
– Physicians
– Nurses
– Dieticians
– Pharmacist
• Specialized procedures involved
• Potential complications related to
venous line & metabolic problems
 Potential Complications of Parenteral
Nutrition
Catheter-related
• Air embolism
• Blood clotting at catheter tip
• Clogging of catheter
• Dislodgement of catheter
• Improper placement
• Infection, sepsis
• Phlebitis
• Tissue injury
Metabolic
• Abnormalities in liver function
• Electrolyte imbalance
• Gallbladder disease
• Hyper- or hypoglycemia
• Hypertriglyceridemia
• Metabolic bone disease
• Nutrient deficiencies
• Refeeding syndrome