Enteral Nutrition for Adults: Administration Issues incorporating material from Dietitians in Nutrition Support A DIETETIC PRACTICE GROUP OF AMERICAN DIETETIC ASSOCIATION "Your connection to sustenance and wellbeing."Slide 2
Contraindications for EN Severe intense pancreatitis High yield proximal fistula Inability to obtain entrance Intractable spewing or looseness of the bowels Aggressive treatment not justified Expected need under 5-7 days if malnourished or 7-9 days if typically sustained ASPEN. The science and routine of nourishment support. A case-based main subjects. 2001; 143Slide 3
Contraindications for EN Inadequate revival or hypotension; hemodynamic precariousness Ileus Intestinal block Severe G.I. DrainSlide 4
Indicators of Adequate Fluid Resuscitation in Critically Ill Pts Urine yield ought to be >30 ml/hour Heart rate <120 thumps/minute; ideally <100 pulsates/minute Systolic BP ought to be ~100 Ask staff/restorative group If patient is getting liquid boluses notwithstanding consistent IVF, likely they are not satisfactorily revivedSlide 6
Nasogastric TubesSlide 7
Nasogastric Tubes Definition A tube embedded through the nasal section into the stomach Indications: Short term feedings required Intact muffle reflex Gastric capacity not traded off Low hazard for goalSlide 8
French Units—Tube Size Diameter of bolstering tube is measured in French units 1F = 33 mm distance across Feeding tube sizes vary for recipe sorts and organization strategies Generally littler tubes are more agreeable and more qualified to NG or NJ feedings May will probably stop up with gooey equation or recipe blendsSlide 9
Nasogastric Tubes Advantages: Ease of tube position Surgery not required Easy to check gastric residuals Accommodates different organization methodsSlide 10
Nasogastric Tubes Disadvantages: Increases danger of goal (perhaps) Not reasonable for patients with bargained gastric capacity May advance nasal corruption and esophagitis Impacts persistent personal satisfactionSlide 11
Nasoduodenal/Jejunal Definition A tube embedded through the nasal entry through the stomach into the duodenum or jejunum Indications: High danger of goal Gastric capacity traded offSlide 12
Nasoduodenal/Jejunal Advantages: Allows for start of early enteral sustaining May diminish danger of desire Surgery not requiredSlide 13
EAL EN Tube Placement Guidelines Critical Care Enteral Nutrition (EN) controlled into the stomach is satisfactory for most fundamentally sick patients. In the event that your organization\'s strategy is to gauge GRV, then consider little inside tube bolstering situation in patients who have more than 250ml GRV or recipe reflux in two sequential measures. Little entrail tube arrangement is connected with decreased GRV. ADA EAL Critical Care Guidelines got to 8-07Slide 14
EAL EN Guidelines (Critical Care) Adequately-fueled reviews have not been led to assess the effect of GRV on desire pneumonia. There might be particular malady states or conditions that may warrant little inside tube situation (e.g., fistulas, pancreatitis, gastroporesis), be that as it may they were not assessed at this period of the examination. Reasonable; c onditional ADA EAL Guidelines Critical Care got to 8-07Slide 15
Nasoduodenal/Jejunal Disadvantages: Transpyloric tube situation might be troublesome Limited to persistent imbuement May advance nasal rot and esophagitis Impacts understanding personal satisfactionSlide 16
Orogastric Tube is put through mouth and into stomach Often utilized as a part of untimely and little newborn children as they are nasal breathers Not endured by ready patients; tubes might be harmed by teethSlide 17
Enterostomy Placement Gastrostomy JejunostomySlide 19
Gastrostomy Definition A bolstering tube that goes into the stomach through the stomach divider. May be put surgically or endoscopically Indications: Long-term bolster arranged Gastric capacity not traded off Intact muffle reflex presentSlide 20
Gastrostomy Disadvantages: May require surgery Stoma mind required Potential issues for spillage or tube dislodgmentSlide 21
Jejunostomy Definition A sustaining tube that goes into the jejunum through the stomach divider. May be put endoscopically or surgically Indications: Long-term nourishing choice for patients at high hazard for goal or with traded off gastric capacitySlide 23
Jejunostomy Advantages: Post-operation feedings might be started promptly Decreased danger of yearning Suitable alternative for patients with bargained gastric capacity Stable patients can endure irregular feedingsSlide 24
Jejunostomy Disadvantages: Requires stoma mind Potential issues identified with spillage or tube dislodgement/obstructing may emerge May confine ambulation Bolus feedings unseemly (stable patients may endure discontinuous feedings)Slide 25
Determining Method of Administration Feeding site Clinical status of patient Type of recipe utilized Availability of pump Mobility of patientSlide 26
Initiation of Enteral Feedings Dilution of enteral equations not for the most part suggested Initiate at full quality at moderate rate and consistently progress Allows accomplishment of objective rates all the more rapidly; less control of recipeSlide 27
Administration Bolus Intermittent Continuous CyclicSlide 28
Bolus Feedings Definition Infusion of up to 500 ml of enteral equation into the stomach more than 5 to 20 minutes, ordinarily by gravity or with a huge bore syringe Indications: Recommended for gastric feedings Requires in place choke reflex Normal gastric capacitySlide 29
Bolus Feedings Advantages: More physiologic Enteral pump not required Inexpensive and simple organization Limits bolstering time so patient is allowed to ambulate, take an interest in recovery, or carry on with a more ordinary life in the home Makes it more probable patient will get full measure of equationSlide 30
Bolus FeedingSlide 31
Bolus Feeding Disadvantages: Increases chance for goal Hypertonic, high fat, or high fiber equations may postpone gastric purging or result in osmotic looseness of the bowelsSlide 32
Initiation of Bolus Feedings Adults: Initiate with full quality equation 3-8 times each day with increments of 60-120 ml q 8-12 hours as endured up to objective volume; does not require weakening unless important to meet liquid prerequisites Children: Initiate with 25% of objective volume separated into the coveted number of day by day feedings; increment by 25% every day partitioned among all feedings until objective volume is achieved ASPEN Nutrition Support Practice Manual, 2005, 2 nd ed, p. 78Slide 33
Continuous Feedings Indications: Initiation of feedings in intensely sick patients Promote resilience Compromised gastric capacity Feeding into little gut Intolerance to other encouraging systemsSlide 34
Continuous Feedings Definition Enteral recipe organization into the gastrointestinal tract by means of pump or gravity, more often than not more than 8 to 24 hours for each day Advantages: May enhance resistance May diminish danger of goal Increased time for supplement assimilationSlide 35
Continuous Feedings Disadvantages: May lessen 24-hour implantation May confine ambulation More costly for home bolster Pumps are more exact; valuable for little bore tubes and gooey feedings, yet numerous payers have strict criteria for endorsement of pumps for home or LTC utilizeSlide 36
Initiation of Continuous Feedings Adults: Initiate at full quality at 10-40 ml/hour and progress to objective rate in additions of 10 to 20 mL/hour q 8-12 hours as endured Can be utilized with isotonic or hyperosmolar equations Children: Isotonic equation full quality at 1-2 mL/kg/hour and progressed by .5-1 mL/kg/hour q 6-24 hours until objective rate is accomplished ASPEN Nutrition Support Practice Manual, 2005, second ed, p. 78Slide 37
Intermittent Feedings Definition Enteral recipe controlled at determined circumstances for the duration of the day; for the most part in littler volume and at slower rate than a bolus encouraging yet in bigger volume and speedier rate than constant dribble sustaining Typically 200-300 ml is given more than 30-a hour q 4-6 hours Precede and take after with 30-ml flush of faucet water Indications: Intolerance to bolus organization Initiation of support without pump Preparation of patient for recovery administrations or release to home or LTC office The A.S.P.E.N. Nourishment Support Practice Manual, 2 nd Edition, 2005Slide 38
Intermittent Feedings Advantages: May improve personal satisfaction Allows more prominent versatility between feedings More physiologic May be preferable endured over bolusSlide 39
Intermittent Feedings Disadvantages: Increased hazard for desire Gastric extension Delayed gastric purgingSlide 40
Cyclic Feedings Definition Administration of enteral equation by means of consistent dribble over a characterized time of 8 to 12 hours, for the most part nocturnally Indications: Ensure ideal supplement consumption when: Transitioning from enteral support to oral sustenance (upgrade craving amid the day) Supplement insufficient oral admission Free patient from enteral feedings amid the daySlide 41
Cyclic Feedings Advantages: Achieve supplement objectives with supplementation Facilitates move of support to oral eating routine Allows daytime ambulation Encourages patient to eat typical dinners and snacksSlide 42
Cyclic Feedings Disadvantages: May require high mixture rates—may advance prejudiceSlide 43
Enteral Feeding Tubes Types: pediatric versus grown-up; gastric versus little gut Sizes: littler sizes (5-8 Fr) for business items conveyed by means of pump; bigger sizes for thick, blenderized, fiber-containing recipes, gravity and bolus feedings Weighted versus unweighted: it was once imagined that weighted tubes encouraged transpyloric section; now directed by individual inclination Stylet versus no stylet: stylet encourages tube arrangement past the pylorus for little, adaptable tubes Composition: silicone and polyuretha
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