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Enteral Nutrition

Enteral Nutrition
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Enteral Nutrition Definition

Nutrition is an important necessity to make one highly functional and sustain a healthy living. It is also important in managing a diseased individual to hasten recovery apart from preventing further complication as a result of nutritional deficiency.

Enteral nutrition is advisable to patient who cannot meet their nutritional needs due to their debilitating state resulting to inability to proper and normal way of feeding. It is especially indicated when there is no other way to sustain and prevent complications from nutritional deficiency except through tube feeding.

Enteral nutrition is a method of nutritional solution for meeting the nutritional needs of a patient with a functional gut but is unable or unwilling to achieve nourishment through oral means.

Enteral Feeding

Enteral feeding is a method of nourishing an individual with inability or unwillingness to nourishment via oral achievement. Enteral feeding is indicated to sustain and provide optimal health to ailing or debilitating patients when there is no means of introducing nutrients orally.

Food contained in enteral feeding are commercially prepared although they contain the same nutrients found in regularly prepared food. The feed is given according to the needs of patient including their tolerance. It is administered according to specific needs of the patient, functionality and capacity of gastrointestinal tract and the underlying condition of the patient.

This method of feeding is especially beneficial to patients who are critically ill and must achieved optimal nourishment to aid in recovery. It is also beneficial to patient with limited oral intake after a specific surgical procedure.

There are different routes in which to administer enteral feed and it is best for clinician to assess and evaluate the patient to identify which method of feeding best suits their patient. It is also best to identify the purpose, advantages and disadvantages of enteral feeding to patient.

The following enteral feeding method may be utilized in introducing enteral nutrition:

Nasogastric. Indicated to patient with intact gag reflex and normal gastric emptying. The patient should also have no esophageal reflux and stomach disease. This is the most common delivery routes utilized depending on adequate gastric emptying. Insertion of tube is easily achieved although displacement of tube is highly possible. This route allows for hypertonic feed, high feeding rates and bolus feeding into the stomach. The disadvantage of this route is the high risk for pulmonary aspiration including self-conscious state of patient in terms of physical appearance due to a noticeable tube.

Nasoduodenal. Indicated for patient with impaired gastric emptying and esophageal reflux. This route is better than nasogastric tube in terms of aspiration as nasoduodenal reduces its risk. The disadvantage of which is potential gastrointestinal tract intolerance and the necessity for endoscopic placement of nasoenteric tube.

Nasojejunal. Indicated for patient with impaired gastric emptying, esophageal reflux and gastric dysfunction resulting from trauma or surgery. Tube feeding may be introduced immediately after injury and reduced the risk for aspiration.

Gastrostomy. This is a long term feeding indicated for patient with normal gastric emptying but the ability to oral diet is impaired. Introduction of percutaneous endoscopic gastronomy costs less and does not require surgery and the large bore tube provides larger reservoir for stomach capacity and it decreases the risk for occlusion.

Jejunostomy. Indicated for long term feeding and patient with high risk for aspiration. It is utilized for patient with inaccessible upper GI tract. Introduction of percutaneous endoscopic jejunostomy costs less and requires no surgery and reduces the risk for aspiration. The setback for this route is leakages from digestive secretion and potential for fistula after tube removal.

Enteral Nutrition

Picture : Enteral and Parenteral feeding routes

Image source : medscape and bmj

Enteral Nutrition Formulas

Provision of enteral formulas requires assessment of patient for the absorption and digestive capacity of the patient. Selection of formula must be specific and must consider the tolerance and underlying condition of the patient. Nutrient composition includes:

  1. Carbohydrates – must have low osmolality and must be soluble and easily digested. Commonly used are starch, glucose polymers, disaccharides and monosaccharide.
  2. Protein – protein components for enteral nutrition consists of intact protein, partially hydrolyzed protein, dipeptides and tripeptides.
  3. Fat – components are polyunsaturated fatty acids, medium chain triglycerides and saturated fatty acids.
  4. Fiber – consists of soluble or insoluble fiber.
  5. Water – generally contains about 690 to 860 ml/1000ml of enteral formula

Enteral Nutrition Guidelines

Health care practitioners owe it to their patient undergoing enteral nutrition to have safe order, delivery and monitoring of enteral nutrition administration to achieve goal of optimal wellness of the patient.

  1. Ordering enteral nutrition should be in black and white with specification clearly written and in understandable manner. Patient demographics should be carefully recognized such as patient’s name, birth date, weight, room number and medical record number. Formulas should be written properly including generic name and trading name. Enteral route must be clearly and legibly ordered and written including the administration method and rate of administration.
  2. All equipments to be used such as bottles, bags, syringes and must be properly labeled with patient demographics, formula type, route of administration, time and date of formula preparation and initials of the ones who prepared and hanged it.
  3. Water safety should be considered in reconstituting formula.
  4. Basic and proper hygiene measures must be observed in preparing, administering and storing enteral formulas.
  5. Hang time must be observed wherein hang time is described as EN formula safe for delivery from the time formula was reconstituted and warmed.
  6. Patient positioning must be considered prior to administration of enteral nutrition.
  7. Frequent assessment of patient prior and after enteral nutrition is administered.

Parenteral vs. Enteral Nutrition

Enteral nutrition is feeding a patient through a tube where the gastrointestinal tract is functioning while parenteral nutrition is given intravenously indicated to patient with impaired gastrointestinal tract.

Enteral Nutrition Supplements

Nutritional supplements are given to compliment an individual’s dietary needs. These supplements can be given orally or via enteral feeding. These enteral nutrition supplements are commercially available prepared and formulated to meet nutritional needs of EN patients.

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