Gastroenterology feeding indications CC

Question 1

Nasogastric tube placement indications

Answer 1

• Decompression of GI tract when ileus or bowel obstruction present
• Suction & removal of gastric contents (i.e., overdose ingestion)
• Lavage & suction for evaluation of GI bleeding, or for active internal warming or cooling of a patient
• Administration of activated charcoal

Question 2

Duodenal feeding tube placement indications

Answer 2

• Safer administration of feeds & oral medications during OR procedures
• Potentially lowering the risk of aspiration since the tube can be placed distal to the pyloric sphincter in the proximal duodenum

Question 3

Small bowel feeding indications

Answer 3

• Delayed gastric emptying
• Postoperative gastric ileus
• Proven intolerance to gastric feeding
• Severe acute pancreatitis
• Requiring gastric decompression
• Intolerant to gastric feeds

Question 4

General contraindications for nasogastric and duodenal feeding tube placement

Answer 4

• Maxillofacial trauma
• Nosebleeds
• Esophageal abnormalities such as stricture
• Abnormal anatomy (esophagectomy, gastric bypass)
• Caustic ingestion

Question 5

NGT specific contraindications

Answer 5

• Inability to protect the airway (if the patient has high residuals from gastric feeds, these feeds may be aspirated)

Question 6

Absolute contraindications for enteral nutrition

Answer 6

• Anastomotic leak
• Ischemia
• Necrosis
• Bowel obstruction
• High-output fistula (unless reliable feeding access distal to the fistula is achievable)
• Generalized peritonitis
• Uncontrolled severe shock states

Question 7

Relative contraindications for enteral nutrition

Answer 7

• Expected fasting period of ≤5 days
• Gastric aspirate volume >500 ml over 6 hours
• Localized peritonitis or intra-abdominal abscess
• Active upper GI tract hemorrhage
• High risk of pulmonary aspiration due to improper airway protection
• Abdominal compartment syndrome
• Dementia, agitation, confusion
• Ileus

Question 8

Parenteral nutrition indications

Answer 8

Per ASPEN guidelines:

• Previously healthy patients with no evidence of protein calorie malnutrition if enteral nutrition is not feasible after 5–7 days of hospitalization
• Protein calorie malnutrition upon admission with no enteral feeding options
• Severely malnourished patients, prior to major upper GI surgery with no enteral feeding options
• Other indications include: Nonfunctioning gastrointestinal tract, Short gut, Prolonged need for bowel rest (typically >14 days)

Question 9

Contraindications to parenteral nutrition

Answer 9

• Hypertriglyceridemia (>250 mg/kg)
• Lipid nephrosis
• Egg allergy
• Acute pancreatitis