Nutritional support improves quality of life and increases survival for many diseases, yet its effects on mortality are difficult to demonstrate in clinical trials and meta-analyses due to various variables including disease severity and blunt outcome measures.
All acute hospital trusts should establish multidisciplinary nutrition support teams consisting of gastroenterologists, intensivists, dietitians and specialist nutrition nurses. These teams should assess the need for nutritional assistance, implement it as necessary and track response over time.
Enteral Nutrition
Enteral nutrition (EN) provides vital macro and micro nutrients to those unable to meet their nutrition requirements through oral intake alone, for reasons including swallowing difficulties, critical illness or treatments that interfere with eating such as radiotherapy to the head and neck area. EN is considered more physiological form of artificial feeding than parenteral nutrition (PN); however it still may result in hyperglycemia and electrolyte abnormalities as possible side effects.
People receiving enteral nutrition (EN) typically utilize one of three feeding tubes – nasogastric, gastrostomy or jejunostomy – that directly deliver formula into their stomach or small intestine. The type of tube chosen depends on which area of their GI tract will be involved with feeding (pre-pyloric vs post-pyloric), length of need for EN treatment as well as timeframe of its necessity; dietetic consultants are available to offer guidance as to which formula may best suits each case – dietetic consultants can advise as well as formula suitable options when choosing which type of tube used.
There are a range of EN formulas designed to meet adult dietary reference intakes and caloric needs, from standard, semi-elemental, to peptide based formulas. For the safest, most effective administration, the tube should be placed at an appropriate position in your GI tract as determined by a gastroenterologist, then administered from either a reservoir or pump via tubing connected directly to either your tube (nasogastric, gastronomy or jejunostomy) via gravity or mechanical peristaltic pumps ensuring a steady and selected delivery rate over time.
An individual on EN should follow the nutritional plan provided by their healthcare provider and attend regular appointments with the nutrition support team to monitor weight and nutritional status. Sometimes these meetings take place at the nutrition support facility (NF), while sometimes with health care practitioners or nurses in their home setting.
Nutrition through EN is an intricate task and necessitates multi-disciplinary collaboration. Nutrition support team offers comprehensive assessments on an individual’s current state and nutritional requirements, creating an individualized care plan, as well as training staff members on its administration. An Accredited Practising Dietitian (APD) should also oversee patients receiving enteral nutrition therapy to help ensure good eating and chewing skills are being practiced and their tube feeding schedule adhered to as effectively as possible. An APD will also help reduce risks of complications like reflux and nasopharyngeal ulcers, providing education on how to best manage them for patients and their families. The nutrition care pathway below details the process of overseeing EN from initial needs assessment through discharge, with a nutrition care plan, sample EN formulas and information on administering nasogastric and gastronomy tubes. In addition, this pathway includes a checklist and resource to verify where nasogastric tubes have been placed.
