Nutritional support refers to providing essential nutrients through enteral or parenteral feedings to those unable to take in enough nourishment from food alone.
Studies show that patients managed by nutrition support teams experience shorter hospital stays. These teams, which consist of physicians, dietitians and pharmacists working together as one, provide education, assessment and implementation of nutritional therapy therapy.
What is Nutrition Support?
Nutrition support involves giving liquid supplements with nutritious liquids directly into a patient’s stomach or small intestine via an IV line or via another similar route, providing essential proteins, sugars, fats, vitamins, minerals and other elements essential to maintaining a healthy diet.
Nutritional support should be sought when food intake or assimilation will be limited for an extended period, leading to starvation. For instance, patients recovering from severe head injury often require nutritional assistance due to protracted semi-starvation states.
Nutritional support services may be delivered in an independent department headed by a physician, dietitian, or pharmacist, or integrated within other departments where clinicians maintain appointments as part of their primary duties and offer nutrition consultation as part of their duties.
Enteral Nutrition (EN)
Enteral nutrition (EN), also known as intravenous nutrition or IV nutrition, is the provision of liquid nutritional formulas that supplement or replace caloric intake for patients requiring total care nutrition support. Products like Boost and Ensure may provide this service.
EN can provide significant relief for patients unable to consume enough food, or those whose gastrointestinal tracts have become compromised, who cannot consume adequate nutrition on their own. It has proven itself superior over PN in various patient populations.
Clinicians should take several factors into consideration when setting an EN goal rate or volume, including medication effects on gastrointestinal function (e.g., high osmolality drugs causing diarrhea; sorbitol-containing medications altering gut bacteria levels; antibiotics leading to altered gut flora); expected duration of EN therapy as well as patient expectations regarding how often to administer it.
Parenteral Nutrition (PN)
Parenteral nutrition (PN) may be the only means of providing energy-rich nourishment to those who no longer can digest or absorb their own food, providing essential energy sources and sustenance to patients who lack access to traditional forms.
Hospitalized patients at risk of malnutrition who cannot be fed by enteral route should be evaluated for parenteral nutrition (PN). However, it should not be introduced suddenly; rather it should be started gradually over time according to each patient’s history and tailored individually in order to prevent deficiencies and excesses in nutrition.
PN can be administered either through a central or peripheral vein. For optimal results, the solution should be mixed before and during infusion to ensure no precipitates form. Fluid needs should be assessed daily on hospitalized patients to assess any inputs/outputs.
Nutrition Support Professionals (NSPs)
Nutrition support professionals include dietitians, nurses, pharmacists, physicians and advanced practice providers who have received specialty training to provide enteral and parenteral nutrition to individuals in hospitals, home care agencies, long term care facilities or research institutes. Nutrition support specialists learn through on-the-job training as well as networking with other nutrition support specialists – they may join organizations such as ASPEN for continued professional growth in this area of nutritional support as well as taking certification exams to further their careers.
An NSP in a multidisciplinary team is responsible for overseeing nutrition (and fluid) management for patients, teaching aseptic technique for setting up PEG tubes, managing complications associated with therapy and tracking patient response to therapy. They should be able to demonstrate improvement of quality of life, reduced resource usage and increase survival rates as evidence of their work.
Continuing Education
Many professions, including teaching and healthcare, require continuing education requirements in order to remain licensed. The aim is to promote professional growth by expanding foundational knowledge while staying abreast of recent advancements within their respective field.
Nutritional support is an integral component of patient care, yet is often neglected during clinical training. A recent study concluded that most medical and nursing schools do not meet the minimum 25 hour recommendation for nutrition education among students.
Healthcare professionals seeking to advance their nutrition expertise now have access to an ever-increasing number of continuing education opportunities, including accredited seminars, courses, and certificate programs. These programs equip healthcare providers with tools necessary for improving nutrition-related outcomes for their patients.
