Nutritional support involves administering an array of nutrients via oral ingestion or intravenous infusion. These nutrient mixtures, typically composed of commercial products, include calories, protein, fats, vitamins minerals and fluids.
Nutrition support must be tailored specifically to each patient. Family physicians should closely supervise nutrition support patients to assess tolerance, complications (e.g. catheter-related sepsis) and appropriateness.
Multidisciplinary team approach
To provide safe, cost effective nutritional support to patients, a multidisciplinary team approach is often necessary. This is particularly true when managing Total Parenteral Nutrition (TPN). An TPN team may include dietitians, nutrition support nurses, geriatricians and clinical pharmacists working collaboratively in order to identify and address an individual’s nutritional requirements.
Research has demonstrated that patients managed by TPN teams have fewer complications and consistently reach their caloric and protein intake goals more often than those managed solely by physicians.
One key to creating a multidisciplinary nutritional support team is making a business case for its presence. To do this, create a Nutrition Steering Group which reports directly to the Trust board. Once established, an NSC can hire a nutrition nurse specialist and a weekly clinic can be organized in a clinical room equipped for aseptic procedures. Once in operation, NST should quickly prove its worth through producing data such as rates of CRS cases, avoided PEG insertions and wasted PN bags.
Cost-effectiveness
The cost-effectiveness of nutrition support remains controversial. Clinical trials comparing it with standard care have been inconclusive due to inadequate sample sizes, use of non-typical patient populations, concurrent treatments and unclear outcome measures. Yet evidence indicates positive effects for nutrition support on various clinical outcomes; such as in the EFFORT trial which is the largest randomized clinical trial outside critical care today and showed significantly lower 180-day mortality rates among participants who received nutrition support versus those without. Nutritional support also reduces healthcare costs associated with longer hospital stays and readmissions costs as well as healthcare costs related to longer hospital stays and readmissions.
Nutrition support involves either oral intake through a tube directly into the gastrointestinal tract, or intravenous administration of nutrients directly into bloodstream by peripheral or central routes, known as total parenteral nutrition (TPN). Thanks to advances in enteral and TPN equipment, formulations, nutrient delivery devices, as well as gastrointestinal and vascular access devices, more patients now receive adequate nutrition support from dedicated multidisciplinary nutrition support teams.
Efficacy
Nutrition support is crucial for people unable to eat normally due to illness. Nutrition support entails artificial feeding that directly delivers nutrients directly into the body via tube feeding or intravenous administration, and has proven particularly useful in the treatment of various conditions like cancer and bone marrow transplantation, while improving immunity among GI disorders patients.
However, it has been difficult to demonstrate the efficacy of nutritional support through clinical trials. Studies have been plagued by disparate study populations, differing treatments, and non-standardized outcomes; and most have excluded older persons – those most at risk from malnutrition.
Composition of a multiprofessional nutrition support team (NST) in hospitals varies based on available resources and patient care needs, often including physicians, dietitians, nurses or pharmacists. NSTs usually serve a consultative and monitoring function within hospitals while offering education and training on nutritional management practices.
Safety
Nutritional support involves administering enteral and parenteral nutrition via tube feeding. Enteral nutritional support (EN) is delivered via a tube that passes down your throat or stomach to provide liquid nutrition directly into the small intestine, while parenteral nutrition support (PN) delivers fluids, vitamins, and minerals through an IV catheter into vein. Formulas used may contain protein, sugars, fats, vitamins, and minerals among other essential micronutrients.
Numerous prospective, randomized clinical trials and expert groups have reported that nutrition support improves outcomes in certain patients. It can reduce hospital-acquired infections and wound breakdown as well as increase hospital discharge rates while improving quality of life.
Family physicians should assess patients receiving EN and PN support for tolerance of their feeding regimen, any complications related to using tubes (such as vomiting and intestinal obstruction) as well as weight loss. Furthermore, family physicians must closely monitor laboratory values like glucose, triglycerides, magnesium and phosphorus levels as well as adverse events and product complaints that arise during this process.
