Chapter 10: Overview of EN Flashcards
(39 cards)
Name 6 benefits in EN feeding.
Nutrients provided via the enteral route undergo first-pass metabolism, 1. promoting efficient nutrient utilization. The presence of nutrients in the SI maintains normal gallbladder function by stimulating the release of cholecystokinin, 2. reducing the risk of cholecystitis that may occur if patients are kept NPO.
- Luminal nutrients provide GI structural support and
- help maintain the gut-associated and mucosa-associated lymphoid tissues vital to immune function
((this is via: IgA, which is secreted within the GI tract when there are nutrients, can prevent bacterial adherence and translocation)) - EN reduces infectious complications
- less expensive than PN
Name 8 contraindications for EN.
- Severe Short Bowel Syndrome (<100-150 cm remaining small bowel in the absence of the colon, OR 50-70 cm remaining small bowel in the presence of the colon).
- Other severe malabsorptive conditions
- Severe GI bleed
- Distal high-output GI fistula
- Paralytic ileus
- Intractable vomiting and/or diarrhea that does not improve with medical mgmt
- Inoperative mechanical obstruction
- When the GI tract cannot be accessed – ie: when upper GI obstruction prevent feeding tube placement
Placement of long-term feeding tubes is indicated if EN is expected to last longer than..?
4-6 weeks
Define standard EN formulas
meet normal requirements for most patients; energy density of 1-2 kcal/ML; may or may not contain fiber
Define disease-specific EN formulas
Designed for patients with renal/hepatic disease, diabetes, pulmonary (COPD, ARDS) disease, and immunocompromised patients; elemental and semi-elemental options available
Define modular components.
Can be co-administered via feeding tube to provide additional:
- Energy (maltodextrin, hydrolyzed corn starch)
- Fat (fish oils, MCTs, etc)
- Protein (powdered calcium caseinates, whey protein concentrates)
- Individual AA (glutamine, arginine)
Note these are not mixed directly with EN formulas because they may clog the feeding tube.
What is the typical dose for thiamin supplementation?
100 mg thiamin daily for 5-7 days
(True or False) Aspiration of gastric contents is less likely to result in bacterial colonization of the respiratory tract than oral secretions.
TRUE
What type of EN route of delivery reduces risk of aspiration?
Post-pyloric; which reduces the volume of stomach contents; shown to have a 30% lower rate of aspiration than gastric feeding
(True or False) Gastric feeding is considered safe for most patients.
TRUE
(T/F) Gastric feeding is preferable if waiting for migration of a feeding tube tip past the pylorus will delay the early initiation of EN.
TRUE
**What is the ASPEN recommendation for when EN needs to be initiated in a well-nourished patient?
**NPO/Inadequate oral intake x 7-14 days
**What is the ASPEN recommendation for when EN needs to be initiated in a high-risk critically ill patient?
***Within 24 - 48 hours of initial insult (mechanical ventilation, surgery, neurologic injury) (“Early EN initiation”
Pump-assisted continuous drip infusions
Preferred method for critically ill patients, who are vented (using oro-tracheal method), at risk for refeeding, have poor glycemic control, have jejunostomy tube, or have an intolerance to intermittent gravity or bolus feeding
Gravity drip method
(Without use of a pump), may be used to provide continuous drip feedings to the non-critically ill patient living at home or outside the hospital setting
Cyclic feedings
Uses pump or gravity drip, over a time period that is less than 24 hours. Minimum infusion time per day is 8 hours, depending on volume tolerance
Intermittent feedings
Uses infusion pump or gravity drip; selected for patients with feeding tubes that terminate in the stomach to accommodate the larger volumes administered in a shorter time period
Volumes range from 240 - 720 mls (1 - 3 cups)
Administered time period ranges from 20 - 60 mins
Can be provided from 4 - 6 times / day, depending on volume required
Bolus feedings
Provide a set volume of formula at specified time intervals over a VERY SHORT period of time, usually with a feeding syringe.
Typical feeding: 240 mL of formula over a 4 - 10 min. period, with infusions 3 - 6 times/day, with at least 3 hours between feedings
These can also be administered with the gravity drip method, which the rate of formula is regulated by adjusting a roller clamp.
What is the recommended EN initiation for critically-ill patients?
Start at 10 - 40 mL/hr, increasing by 10 - 20 mL/hr Q 8 - 12 hours to goal rate.
Many critically-ill patients can tolerate rapid advancement of EN to goal rate within 24 - 48 hours, minimizing energy and protein deficits.
Volume-Based feeding
prescribed in terms of the goal volume per day, rather than goal volume per hour; more recent feeding method used in the critically-ill patient population
EN formulas are typically started at goal rate, or rapidly advancing to the goal
Define hemodynamically unstable.
Defined as those with a mean arterial BP of less than 150 mmHg, or those who are starting vasopressor meds, or require increasing doses to maintain BP
Ischemia bowel may occur as a result of reduced blood flow to the gut, a potential consequence of low BP
Hypocaloric feeding
Defined as 65 - 70% of energy needs as estimated by IC (or calculations); provided as high-protein hypocaloric EN, designed for critically-ill obese patients to minimize the metabolic complications of feeding, preserve LBM and mobilize fat stores
What are the energy recommendations for critically-ill patients w/ sepsis, starting EN?
Provide 60 - 70% of energy needs (with 100% estimated protein needs), during the first week of EN. Then advance to more than 80% of estimated energy needs after the first week.
Define trophic feeding. When is it indicated, and for which patients?
10 - 20 mL/hr or up to 500 kcal/day; indicated for patients with ARDS or acute lung injury who are expected to be vented for more than 72 hours AND not high nutrition risk or malnourished.
