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Enteral nutrition
- 1. Enteral Nutrition Dr. Noorulain FcpsII trainee
- 2. Delivery of nutrientsinto the existing Gastrointetinal tract.
- 3. 5-7 daysof inadequate intake Expected no intake for 7-9 days prolonged anorexia Inability to take oral feedings Impaired intestinal function Critical illnesses
- 4. Intestinal Obstruction Intestinal Ischaemia/Perforation Inability to access the gut. Severe acute pancreatitis High output proximal fistula Shock
- 5. Preserves gutintegrity Possibly decreases bacterial translocation Preserves immunological function of gut Better tolerated by patient Less costly than TPN
- 6. Oral dietarysupplements Polymeric feeds Monomeric Specialized diets Disease-specific feeds
- 7.
- 8. Advantages More Physiological Ease of placement Formula osmolarity less problem Disadvantages Delayed gastric emptying Gastroesophageal reflux and aspiration
- 9. Advantages Minimize aspirationrisk Disadvantages Difficulty with placement Feeding intolerance
- 10. Nasogastric Nasojejunal Percutaneous endoscopic gastrostomy Open gastrostomy Transgastric jejunostomy Jejunostomy
- 11. If tubefeeding is needed for ≤ 4 to 6 wk, nasogastric or nasoenteric is usually used. Tube feeding for > 4 to 6 wk usually requires a gastrostomy or jejunostomy tube.
- 12. Cheap Easyto insert Residual volume can be assesed Disadvantages Uncomfortable Easily dislodged Increase aspiration risk
- 13. Decreased riskof aspiration Decreased stimulus to pancreatic secretion Indicated--gastric reflux --delayed gastric emptying Disadvantages Not easy to place Damage to gastric mucosa Impaired absorbtion
- 15. Placement of tubethrough abdominal wall directly into stomach.
- 16. Now a daysperformed by percutaneous insertion under endoscopic control known as PEG.
- 17. o Contraindications o Gastriculcer o Gastric carcinoma o Ascites o Coagulation disorders
- 18. Complications Sepsisaround PEG site Nectrotizing fascitis and intraabdominal wall abscess persistent gastric fistula
- 19. creation of openingthrough skin at front of abdomen and jejunal wall.
- 20. Percutaneous Endoscopicjejunostomy Technically difficult Allows concomittent jejunal feeding and gastric decompression.
- 21. Bolus Continuous Intermittent Cyclic
- 22. Bolus feeding Large amount(300-400ml) is given in short time period several times daily
- 23. Continous feeding Administration intothe GIT via pump or gravity, usually over 8 to 24 hours per day
- 24. Intermittent feeding 300 to400 ml, 20 to 30 minutes, several times/day via gravity drip or syringe
- 25. Cyclic via pump usuallyat night
- 26. 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
- 27. Jejunal or duodenalfeedings 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.
- 28. Gastric feeds Checkresidual 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
- 29. Jejunal feeds Monitorabdomen for distension bowel sounds every 4 hours Residual volumes are not helpful Hold feeds if emesis abdominal pain or distension
- 30. Weight 3times/wk Edema Daily dehydration Daily Fluid intakeDaily output Nitrogen balance 2 times/wk Electrolytes BUN, Creatinine 2-3times/wk Glucose, Ca++, Mg++ weekly Stool output Daily consistency
- 31. Tube related Malposition Displacemant Blockage Breakage/leakage Local complication ( erosion of skin / mucosa )
- 32. Gastrointestinal Diarrhea(most common an dperticularly common in critically ill Bloating nausea vomiting Abdominal cramps Aspiration Constipation
- 33. Metabolic Refeedingsyndrome Electrolyte disorder Vitamin mineral trace element deficiencies
- 34. Infective Exogenous(handling contamination) Endogenous (patient)
- 35. If the gutworks Use it Thank you…