Nutrition support refers to enteral or parenteral nutrition therapy for patients unable to absorb nutrition through food alone. It can help ensure they remain nourished as part of treatment plans.
Clinical trials and expert groups have confirmed the efficacy of nutrition support in various surgical populations such as elderly hip fracture patients.
Nutrition support benefits remain to be proven for other populations. There are various team models, and an ideal team should include physicians, dietitians and pharmacists.
What is it?
Nutrition support refers to the nonvolitional administration of nutrients through liquid feed into either the gastrointestinal tract (enteral nutrition) or directly into bloodstream bypassing gut (parenteral nutrition). Both accessibility and quality have improved considerably over the years.
Nutrition support offers many advantages to certain subgroups of patients. For instance, head-injured patients are at particular risk of protracted semistarvation without proper nutrition support. Nutrition assistance has also proven useful in supporting malnourished cancer patients going through chemotherapy/radiation or bone marrow transplantation treatments.
Hospitals should establish multidisciplinary teams to oversee nutrition support services, consisting of dietitians and physicians. The optimal team model may vary depending on resources and policy considerations; ideally, however, a physician should head the NST. Moreover, this should take place in a clinical room equipped with aseptic facilities for inserting parenteral lines and dispensing drugs.
How does it work?
Many patients suffering from inflammatory bowel disease find it challenging to obtain enough calories and nutrients through food alone due to complications like weight loss, obstruction, surgery or severe inflammation. Nutritional support may provide invaluable help.
Nutritional support may take the form of either enterral nutrition (given directly into your stomach or small intestine) or parenteral nutrition, an intravenous line injected directly into the bloodstream to bypass your gut (parenteral nutrition). People who suffer from weak or damaged guts are more likely to require parenteral nutrition.
An effective and cost-efficient system for meeting nutritional support needs lies within a multidisciplinary team overseen by a Nutrition Steering Group that reports to the Hospital Trust Board. Such teams should include dietitians, nurses and pharmacists – each team should demonstrate its value by way of quality improvement and cost savings – this first step includes creating such an group with diverse skillsets.
Why is it used?
Nutritional support is generally recognized as one of the best means of maintaining or restoring nutritional status for hospitalized patients, however there have been few clinical trials with appropriate designs to demonstrate its benefits in this context. Furthermore, nutritional support may lead to various complications which must be recognized and managed promptly.
However, enteral tube feeding and parenteral nutrition provide significant patient, functional, financial and lifesaving benefits in specific circumstances – for example head injury. Studies demonstrate the positive influence of nutritional support on elderly persons’ outcomes, especially due to its ability to lower risks associated with malnutrition – something nutritional support can do by decreasing its risks and thus protecting from its associated consequences. Nutritional support can be administered either orally (enteral) or intravenously (parenteral), usually via formulas containing three-in-one total nutrient admixtures with fat emulsions infused separately. Furthermore, these solutions must be given at an accurate rate and in conjunction with medications compatible with their components.
What are the risks?
Nutrition support can have significant clinical, functional and financial benefits; however in certain instances it may represent an extended period of semistarvation with associated risks. If this is the case for you then providing nutritional assistance may help mitigate these consequences as well as positively alter disease progression or response to therapy.
Retrospective study results revealed that nutrition support team management was associated with reduced metabolic abnormalities compared to non-team managed patients (Hickey et al., 1979). Catheter removal was the leading cause for nutritional support suspension; other complications like hyperglycemia, hypophosphatemia and hypocalcemia rates were significantly reduced among these group of team-managed patients.
Family physicians should closely supervise those receiving EN or PN for their tolerance to tube feedings as well as complications of parenteral nutrition such as infections or thrombophlebitis. Laboratory assessments should include serum glucose, potassium, magnesium, phosphorus and iron levels.
