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Flashcards in Enteral & Parenteral Nutrition Deck (25):

Consequences of malnutrition

Weakness, loss of muscle mass, apathy, depression, reduced immune response, poor wound healing, increased morbidity + mortality


Who needs artificial nutrition?

Patients who can't meet their requirements by eating and drinking normally


What different ways are there to feed a patient?

- Normal diet
- Softened diet
- Enteral nutrition
- IV fluids
- Parenteral


Benefits of enteral nutrition compared to i.v.

- Less risk of infection
- Maintain GIT
- Gut bacterial translocation
- Cheaper
- Easier for home patients
- Can control calorie intake


Problems of enteral nutrition

- Diarrhoea
- Regurgitation
- Abdominal distension
- Blocked feeding tubing
- Problems with pump
- No taste
- Patient acceptability


Who needs enteral nutrition?

- Eating and swallowing difficulties
- Severe intestinal malabsorption
- Increased nutrition requirements
- Eating disorders
- Self neglet


Routes of enteral nutrition administration

- Orally
- Naso-gastric tube
- Percutaneous endoscopic gastrostomy
- Percutaneous endoscopic jejunostomy


Examples of sip feeds

- Milk based
- Fruit juice based
- Semi solid
- High protein supplements
- Energy supplements


Drug administration via enteral nutrition

- Use liquid preparation where available.
- Flush w/ 20mL water before and after each drug.
- Crushed tablets may block tube.
- Not for m/r, e/c, cytotoxic


Drug interactions with enteral nutrition

Drug interactions directly with the feed (Ciprofloxacin, aluminium based antacids, theophylline, phenytoin, penicillamine) or Physiological interactions (Warfarin/anticoagulation, decrease Vit K)


Oral syringes and enteral nutrition

- Only use syringes not compatible w/ IV lines to give oral medicines.
- Syringes should be a different colour and marked oral/enteral.
- DO not use 3 way taps to give oral medicines


Total Parenteral Nutrition

Only when EN is not an option as patient cannot take anything my mouth or via GIT or may have gut failure so unable to digest and absorb food. May be short or long-term


Short term TPN (Who is it for?)

- Awaiting feeding tubes
- Bowel obstruction
- Following major excisional surgery
- ICU patients with multi-organ system failure
- Minority of patients w/ IBD
- Severe pancreatitis
- Pre-term neonates
- ACUTE intestinal failure


Long term TPN (Who is it for?)

- Radiation enteritis
- Crohn's disease following multiple resections
- Motility disorders e.g. scleroderma
- Bowel infarction
- Cancer surgery
- CHRONIC intestinal failure


How is short-term TPN administered?

Peripherally via venflon


How is long-term TPN administered?

Peripherally via a catheter/PICC (Hickman line) or Central line (intrajugular, subclavian, femoral)



Enters body through brachial vein in arm and leads to vena cava in heart


Central line

Enters body through the right part of the chest , past the collar bone and into the vena cava of heart


Regimen (osmolarity)

<900mosmol/L (Peripheral)
<1200mosmol/L (PICC)
<1700 mosmol/L (Central)


How do you make a parental nutrition bag?

Aseptic suites in sterile environment. Careful stability check. All units monitored by government


What are the contents of a TPN bag

- Macronutrients = Nitrogen (protein), Glucose (carbohydrate), Fat (lipid), Fluid
- Micronutrients = Electrolytes, vitamins, trace elements (metals)


What do you monitor in patients with parenteral nutrition?

- Clinical history
- U&Es (Na, K, Ur, Cr)
- Glucose, LFTs (inc. albumin baseline twice weekly)
- FBC (inc. folate and B12)
- Trace elements (Mg, PO4, Ca)
- Vitamins (Selenium, zinc)
- Fluid balance


What complications are associated with TPN?

- Air embolism
- Insertion problems, catheter blockage
- Line infections
- Metabolic problems (hypo/hyperglycemia, impaired liver function)
- Bone disease
- Re-feeding syndrome


Refeeding syndrome

Severe electrolyte and fluid shifts when patients go from starved to fed. Therefore, introduce feeding at <50% of normal requirements. Max 10kcal/kg/day, increasing slowly to meet full needs by 4-7 days. Restore circulatory volume and monitor fluid balance


Refeeding treatment

- Feeding no more than 50% of the normal requirements
- Max 10kcal/kg/day increasing slowly to meet full needs by 4-7 day
- Restore circulatory volume
- Provide: Oral thiamine, oral vitamin B, multivitamins, use iv if not for oral management (Pabrinex)
- Make sure the following are maintained : K+, Phosphate, Mg2+
- Treatment for approx 10 days or until stable.