enteral & parenteral feeding

8/8/2019 Enteral & Parenteral Feeding

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Enteral & ParenteralFeeding

Oleh:Imelda T. Pardede

Bagian Gizi Medik FK UNRI


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If the gut works, use it

Or loose it


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I. Enteral feeding


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Enteral FeedingMethod of provision of nutrients into the GITthrough a tube

Nutritional support for patients whose oralintake does not meet requirement >5 daysHave adequate intestinal functional capacity


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1 . Feeding tubes

C ategories:1. Through nasal cavity: NGT, NET2. Through abdominal wall: gastrostomies,

jejunostomies


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Feeding tubesType of access:

S tate of upper GIT Anticipated length of feedingExpertise of the professional


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a. NGTU sually for short term (


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b. NETU sually for longer term (>4weeks) enteral feedingU sed if risk of aspiration existsor when gastric motility isimpaired

Advancement of tube fromgaster into the small bowelmay require administration of

prokinetic drugsPlacement of tube intoduodenum or jejunum may befacilitated by endoscopic or radiographic techniques.


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2 . Feeding formulas

Medical foods ( US FDA 1989):distinguished from other foods for special

dietary purposes of foods which make healthclaims by the requirement that they be usedunder medical supervisionC riteria:

- food for oral or tube feeding- labeled for dietary management of a

medical disorder, disease or condition


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Feeding formulasPolymeric formulasMonomeric formulasBlenderized foodsFormulas for specific metabolic needsModular formulas

Hydration solutions


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Feeding formula: polymeric

C ontains macronutrients in the form of intactprotein, TAG & C HO polymersC ontains micronutrients: vitamins, minerals,trace elements & (fiber)Lactose & gluten freeC aloric density: 1 2 kcal/mL

Osmolality: 300 650 mOsm/kgMost commonly used formulaEntrasol TM, Nutren1.0 TM, Nutren Fiber TM,Ensure TM


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Feeding formula: monomericC ontains macronutrients in form of:- protein as peptide/amino acids

- fat as L C T & or M C T- C HO as partially hydrolized maltodextrin or

oligosaccharidesRequire less digestion: for patients with impaireddigestion/absorption pancreatic insuff., S BS C ontains micronutrients: vitamins, minerals &trace elements


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Lactose & fiber freeC aloric density: 1 1.5 kcal/mLHigher osmolality: 270 650 mOsm/kgOsmolality >300 mOsm/kg water shiftdiarrhea

Exmp: PeptamenTM


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Feeding formula: natural foodBlenderized natural foodPrepared from: milk, beef, fruits,vegetables & fiber Nutrient content & nutritionalcompleteness unsure

Risk of solution contamination: increased


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Feeding formula: specific metabolic needs

Nutritional product in which specificnutrient added/removed to meet

special metabolic requirementC ategories:- formula for patients with inherited

metabolic disorder - formula for patients with specificmedical condition


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High B C AA formulaHigh EAA formulaHigh fat/low C HO formula

Immune-modulating formulaFormulas for Diabetes

Assignment


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Feeding formula: modular

Provide each of macronutrients or micronutrients singlyU sed to prepare specialized formula or tomodify regular formulaC ontains: C HO polymers, TG of L C T or M C Tand protein modular products


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Feeding formula: hydration solutions

Provides fluid & electrolyte to preventdehydration in diarrheaC ontains sodium & glucoseOsmolarity varies between 224 311 mmol/LExp: oralit


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3 . Nutrient absorption & utilization

C arbohydratesProtein & amino acids

FatsVitamins & trace elementsFiber


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4 . Indication & contraindication

General: inadequate amount of food ingested withadequate GI functionS pecific:

- severe dysphagia e.c. obstruction or dysfunction of oropharynx or esophagus

- coma, delirious state- persistent anorexia- nausea or vomiting due to gastric disorder - fistula of distal intestine or colon- severe malabsorption- recurrent aspiration: jejunostomy- certain diseases or disorders- increased nutritional requirement- growth induction in children with specific diseases: C rohn disease


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Complication

Arising from tube insertion- trauma & bleeding from nose & upper GIT

- perforation- misplacement into respiratory tract- aspiration pneumonia- vomiting

Arising from the feeding- clogging, kinking, bursting- obstruction of feeding tubes


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ComplicationC linical problems associated with tube feeding- diarrhea

- aspiration- contamination of feeding solutions- underfeeding- overfeeding

- refeeding syndrome- constipation


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II. Parenteral feeding


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Parenteral Feeding

A provision of nutrient solution into systemiccirculation , bypassing alimentary tract & the

1st

circulatory pass through the liver.

Objective: maintaining or improving nutritional& metabolic status of patients who in criticalperiod of time cannot be adequatelynourished by oral and enteral feeding


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S ystem of delivery: venous access

C entral parenteral nutrition ( C PN)Peripheral parenteral nutrition

(PPN)


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S ystem of delivery: method of administration

C ontinuousIntermittent

Admixture method:1) Y-site2) TNA


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Parenteral formulas

C omplex solution provides nutrients adequate tosupport vital metabolic activities, promote weight gain,wound healing, anabolism & growthFluid: 30 40 mL/kg/dayC arbohydrate dextrose: 40 50% total cal.initial dose: 125250 g/dayProtein synthetic crystalline AA: 10 20 % of totalcal. 0.8 2 g/dayFat EFA linoleic acid from soybean and or safflowerEmulsifier: egg yolk phosphatides & glycerol 15 30% total cal.Packaging: 10%, 20% and 30%


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Parenteral formulas

Electrolytes: Na, K, C a, Mg, C l, P, andacetateNo bicarbonateVitamins: A, D, E, B 1, B 2, B 3, B 5, B 6, B 12 , C ,biotin, folic acid and KTrace minerals: Zn, C u, C r, MnNo ironBiliary disease: C u, MnRenal dysfunction: S e, C r, Mo


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Indication: timing for nutritional intervention

Patient not expected to resume oral or enteral intake for at least 10 to 14 days

Baseline nutritional status: malnourished vswell-nourishedIllness severity: critical vs stable


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enteral & parenteral feeding

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