Enteral nutrition - Modes, Indications, Complications

1. ENTERAL NUTRITION

2. 5-7 days of inadequate intake
Expected no intake for 7-9 days
Prolonged anorexia
Inability to take oral feedings
Impaired intestinal function
Critical illnesses
INDICATIONS:

3. Intestinal Obstruction
Intestinal Ischaemia/Perforation
Inability to access the gut.
Severe acute pancreatitis
High output proximal fistula
Shock
CONTRAINDICATIONS:

4. Preserves gut integrity
Possibly decreases bacterial
translocation
Preserves immunological function of
gut
Better tolerated by patient
Less costly than TPN
ADVANTAGES

5. Oral dietary supplements
Polymeric feeds
Monomeric
Specialized diets
Disease-specific feeds
TYPES

6. Gastric
Postpyloric
ADMINISTRATION SITES:

7. Advantages
More Physiological
Ease of placement
Formula osmolarity less problem
Disadvantages
Delayed gastric emptying
Gastroesophageal reflux and aspiration
GASTRIC FEEDS

8. Advantages
Minimize aspiration risk
Disadvantages
Difficulty with placement
Feeding intolerance
POST PYLORIC FEED

9. Nasogastric
Nasojejunal
Percutaneous endoscopic gastrostomy
Open gastrostomy
Transgastric jejunostomy
Jejunostomy
TYPES OF FEEDING TUBES

10. If tube feeding is needed for ≤ 4 to 6
weeks, nasogastric or nasoenteric is
usually used.
Tube feeding for > 4 to 6 weeks usually
requires a gastrostomy or jejunostomy
tube.

11. Cheap
Easy to insert
Residual volume can be assessed
Uncomfortable
Easily dislodged
Increase aspiration risk
NASOGASTRIC TUBE
Disadvantages

14. Decreased risk of aspiration
Decreased stimulus to pancreatic
secretion
Indicated--gastric reflux
--delayed gastric emptying
Disadvantages
Not easy to place
Damage to gastric mucosa
Impaired absorbtion
NASOJEJUNAL TUBE

16. Placement of tube through abdominal wall
directly into stomach.
GASTROSTOMY TUBE

17. Nowadays performed by percutaneous
insertion under endoscopic control
known as PEG.

18. o Contraindications
o Gastric ulcer
o Gastric carcinoma
o Ascites
o Coagulation disorders

19. Complications
Sepsis around PEG site
Nectrotizing fascitis and
intraabdominal wall abscess
Persistent gastric fistula

20. Creation of opening through skin at
front of abdomen and jejunal wall.
JEJUNOSTOMY

22. Percutaneous Endoscopic jejunostomy
Technically difficult
Allows concomittent jejunal feeding
and gastric decompression.

23. Bolus
Continuous
Intermittent
Cyclic
ADMINISTRATION

24. Bolus feeding
Large amount (300-400ml) is given in
short time period several times
daily

25. Continous feeding
Administration into the GIT via pump
or gravity, usually over 8 to 24 hours
per day

26. Intermittent feeding
300 to 400 ml, 20 to 30 minutes,
several times/day via gravity drip
or syringe.

27. Cyclic
via pump usually at night

28. Rate of administration
Gastric feeding
Standard formula : 50 cc/hr
Advanced by 25cc/hr every 4-8 hours
until goal rate is made
Elemental formula :25cc/hr for first
12 hour
Advanced by 25cc/hr every 6-12 hour
FEEDING PROTOCOL

29. Jejunal or duodenal feedings
Standard or elemental feeding at full
strength at 25 cc/hr for first 12 hour
then advanced by 25cc/hr every 6-12
hours.
Bolus feeding method not used.

30. Gastric feeds
Check residual volumes every 4 hours
Hold tube feeding residual greater than
200cc
Reinfuse residual recheck in 2 hours
Feeds should be held if increasing
abdominal distention
MONITORING TOLERANCE

31. Jejunal feeds
Monitor abdomen for distension
bowel sounds every 4 hours
Residual volumes are not helpful
Hold feeds if emesis abdominal pain or
distension

32. Weight -- 3 times/week
Edema -- daily
dehydration -- Daily
Fluid intake--Daily
Nitrogen balance – 2times /week
Electrolytes
BUN, Creatinine-- weekly
Glucose, Ca++, Mg++ -- weekly
Stool output-- Daily
MONITORING

33. Tube related
Malposition
Displacement
Blockage
Breakage/leakage
Local complication ( erosion of skin /
mucosa )
COMPLICATIONS

34. Gastrointestinal
Diarrhea (most common an dperticularly
common in critically ill
Bloating nausea vomiting
Abdominal cramps
Aspiration
Constipation

35. Metabolic
Refeeding syndrome
Electrolyte disorder
Vitamin mineral trace element
deficiencies

36. Infective
Exogenous (handling contamination)
Endogenous (patient)

37. Thank you…