EnteralNutritionforAdultPatients.pptVIP

Enteral Nutrition forAdults: Administration Issuesincluding material from Dietitians in Nutrition Support A DIETETIC PRACTICE GROUP OF AMERICAN DIETETIC ASSOCIATION “Your link to nutrition and health.” Contraindications for EN Severe acute pancreatitis High output proximal fistula Inability to gain access Intractable vomiting or diarrhea Aggressive therapy not warranted Expected need less than 5-7 days if malnourished or 7-9 days if normally nourished Contraindications for EN Inadequate resuscitation or hypotension; hemodynamic instability Ileus Intestinal obstruction Severe G.I. Bleed Indicators of Adequate Fluid Resuscitation in Critically Ill Pts Urine output should be 30 ml/hour Heart rate 120 beats/minute; preferably 100 beats/minute Systolic BP should be ~100 Ask staff/medical team If patient is receiving fluid boluses in addition to continuous IVF, likely they are not adequately resuscitated Nasogastric Tubes Nasogastric Tubes Definition A tube inserted through the nasal passage into the stomach Indications: Short term feedings required Intact gag reflex Gastric function not compromised Low risk for aspiration French Units—Tube Size Diameter of feeding tube is measured in French units 1F = 33 mm diameter Feeding tube sizes differ for formula types and administration techniques Generally smaller tubes are more comfortable and better suited to NG or NJ feedings May be more likely to clog with viscous formula or formula mixtures Nasogastric Tubes Advantages: Ease of tube placement Surgery not required Easy to check gastric residuals Accommodates various administration techniques Nasogastric Tubes Disadvantages: Increases risk of aspiration (maybe) Not suitable for patients with compromised gastric function May promote nasal necrosis and esophagitis Impacts patient quality of life Nasoduodenal/Jejunal Definition A tube inserted through the nasal passage through the stomach into the duodenum or jejunum Indications: High risk of aspiration Gastric