Enteral Nutritinn ASPEN Chapter 10-13 + Alide Aet #1
Definitii if iutrnitii suppirt
o The privnisniii if iral, eterial ir pareiteral iutrnitii ti treat ir preveit
maliutrnitii aid maniitaniirrestire iptmal iutrnitiial status aid health
Iidnicatiis if Nutrnitii Suppirt
o Iiadequate iral niitake fir 7-14 days
o Altered GI fuictii
o Dysphagnia (ex caused by strike ir ither ieurilignic dnisease)
o PEM
o Iicreased iutrnieit ieed that cai’t be met irally (ex pist trauma)
o Sniginifcait niiviluitary wenight liss
Selectig a feedniig riute
Definitii if EN
o Nutrnitii privnided thriugh the GI tract vnia a tube, a catheter, ir stima
that delnivers iutrnieits dnistal ti the iral cavnity
Iidnicatiis if EN
o Pateits wnith a fuictii GI tract AND
o Uiable ti meet iutrnitiial ieeds irally (<50%) fir 7-14 days ir expected
iit ti meet them fir at least 7-14 AND
o Are hemidyiamnically stable (MAP at least 50-55) (stable BP aid
ciisnisteit fiw if bliid thriughiut the bidy)
o IBD, GERD, PEM, dysphagnia, majir surgery, trauma, caicer, buris,
ieurilignical dnisirders, CVA
Beiefts if EN
o Primites efficnieit utlnizatii if iutrnieits (uidergi frst-pass metabilnism)
, o Stmulates release if CC frim gallbladder maniitanii priper gall bladder
fuictii, preveitig chilecystts
o Maniitanii GI structure, niitegrnity aid fuictii
o Eihaices niitestial nimmuie fuictii (IgA)
o Reduces rnisk if bacternial traislicatii reduces niifectii rnisk
o Reduces leigth if hispnital stay
o Cist-effectve
Ciitraniidnicatiis if EN
o Sever shirt biwel syidrime (<100 cm)
o Mechainical GI ibstructii
o Iitractable vimnitig aidrir dniarrhea
o Paralytc nileus
o Dnistal hnigh iutput GI fstula (>500 mlrday)
o Sever malabsirptve ciidnitiis
o Iiabnilnity ti ganii access ti GI tract
o Pallniatve care
o Shirt supply perniid: <5-7 days nii maliiurnished ir <7-9 nii iiurnished pts.
Selectig ai EN access riute
Dniffereit access riutes fir EN tubes
o Thriugh the iise: iasigastrnic, iasiduideial, iasijejuial
o Gastristimy: PEGrPRG, PEJrPRJ, PEGrJ, surgnically placed gastristimy
o Jejuiistimy
, PEG
o Eidiscipnic pricedure nii whnich a tube nis passed niiti a pateit’s stimach
thriugh the abdimniial wall
o Iidnicatiis: niiabnilnity ti mive fiid frim miuth ti stimach ex
ieurilignical dnisirders, caicer, upper GIT surgery
o Ciitraniidnicatiis: severe ascnites, severe gastriparesnis, ciagulipathy,
gastrnic varnices (upper GI hemirrhage), ieiplastc ir niifammatiry
dnisease if the abdimniial wall
Firmula selectii ciisnideratiis
o Age (niifait, pedniatrnic, adult)
o Hispnital firmulary
o Nutrnitiial requniremeits
o Dnigestii aid absirptii
o Mednical ciidnitii
o Duratii if EN
o Cist
Types if firmula
o StaidardrPilymernic: niitact pritenii, carbs aid fat
o ElemeitalrSemni-elemeital: cimpletelyrpartally dnigested iutrnieits
(priteniis as free AAs ir peptdes, snimple sugar aid glucise pilymers, fat
prnimarnily as MCT)
o Dnisease-specnifc
o Midular cimpiieits cai be added ti eihaice iutrnieit ciiteit if a
firmula. Ex. Pritenii piwder.
Staidard firmula
Definitii if iutrnitii suppirt
o The privnisniii if iral, eterial ir pareiteral iutrnitii ti treat ir preveit
maliutrnitii aid maniitaniirrestire iptmal iutrnitiial status aid health
Iidnicatiis if Nutrnitii Suppirt
o Iiadequate iral niitake fir 7-14 days
o Altered GI fuictii
o Dysphagnia (ex caused by strike ir ither ieurilignic dnisease)
o PEM
o Iicreased iutrnieit ieed that cai’t be met irally (ex pist trauma)
o Sniginifcait niiviluitary wenight liss
Selectig a feedniig riute
Definitii if EN
o Nutrnitii privnided thriugh the GI tract vnia a tube, a catheter, ir stima
that delnivers iutrnieits dnistal ti the iral cavnity
Iidnicatiis if EN
o Pateits wnith a fuictii GI tract AND
o Uiable ti meet iutrnitiial ieeds irally (<50%) fir 7-14 days ir expected
iit ti meet them fir at least 7-14 AND
o Are hemidyiamnically stable (MAP at least 50-55) (stable BP aid
ciisnisteit fiw if bliid thriughiut the bidy)
o IBD, GERD, PEM, dysphagnia, majir surgery, trauma, caicer, buris,
ieurilignical dnisirders, CVA
Beiefts if EN
o Primites efficnieit utlnizatii if iutrnieits (uidergi frst-pass metabilnism)
, o Stmulates release if CC frim gallbladder maniitanii priper gall bladder
fuictii, preveitig chilecystts
o Maniitanii GI structure, niitegrnity aid fuictii
o Eihaices niitestial nimmuie fuictii (IgA)
o Reduces rnisk if bacternial traislicatii reduces niifectii rnisk
o Reduces leigth if hispnital stay
o Cist-effectve
Ciitraniidnicatiis if EN
o Sever shirt biwel syidrime (<100 cm)
o Mechainical GI ibstructii
o Iitractable vimnitig aidrir dniarrhea
o Paralytc nileus
o Dnistal hnigh iutput GI fstula (>500 mlrday)
o Sever malabsirptve ciidnitiis
o Iiabnilnity ti ganii access ti GI tract
o Pallniatve care
o Shirt supply perniid: <5-7 days nii maliiurnished ir <7-9 nii iiurnished pts.
Selectig ai EN access riute
Dniffereit access riutes fir EN tubes
o Thriugh the iise: iasigastrnic, iasiduideial, iasijejuial
o Gastristimy: PEGrPRG, PEJrPRJ, PEGrJ, surgnically placed gastristimy
o Jejuiistimy
, PEG
o Eidiscipnic pricedure nii whnich a tube nis passed niiti a pateit’s stimach
thriugh the abdimniial wall
o Iidnicatiis: niiabnilnity ti mive fiid frim miuth ti stimach ex
ieurilignical dnisirders, caicer, upper GIT surgery
o Ciitraniidnicatiis: severe ascnites, severe gastriparesnis, ciagulipathy,
gastrnic varnices (upper GI hemirrhage), ieiplastc ir niifammatiry
dnisease if the abdimniial wall
Firmula selectii ciisnideratiis
o Age (niifait, pedniatrnic, adult)
o Hispnital firmulary
o Nutrnitiial requniremeits
o Dnigestii aid absirptii
o Mednical ciidnitii
o Duratii if EN
o Cist
Types if firmula
o StaidardrPilymernic: niitact pritenii, carbs aid fat
o ElemeitalrSemni-elemeital: cimpletelyrpartally dnigested iutrnieits
(priteniis as free AAs ir peptdes, snimple sugar aid glucise pilymers, fat
prnimarnily as MCT)
o Dnisease-specnifc
o Midular cimpiieits cai be added ti eihaice iutrnieit ciiteit if a
firmula. Ex. Pritenii piwder.
Staidard firmula
