Enteral Nutrition: What, Why, When, and How?

1. -- Aim for a healthy weight. -- Become physically active each day. -- Let the (Food Guide) Pyramid guide your food choices. -- Eat a variety of grains daily, especially whole grains. -- Eat a variety of fruits and vegetables daily. -- Keep food safe to eat. -- Choose a diet that is low in saturated fat and cholesterol and moderate in total fat. -- Choose beverages and foods that limit your intake of sugars. -- Choose and prepare foods with less salt. -- If you drink alcoholic beverages, do so in moderation. DG 2000- Public Comment Period

2. Enteral Nutrition What, Why, When, and How? Definition: liquid formulated foods designed to be used to supplement oral intakes or provide complete nutrition. Typically used in hospitalized pts, often in tube feedings. ENTERAL FEEDINGS SHOULD BE USED WHENEVER A CLIENT CAN DIGEST OR ABSORB NUTRIENTS VIA THE GI TRACT!! “IF THE GUT WORKS, USE IT!”

3. Formula Types Standard, Intact, Blenderized For Pt able to digest/ Absorb nutrients May contain pureed foods!!!!! $ Hydrolyzed-- $$ Protein delivered as small peptides/ AA for those with compromised digestive function. Modular Contain a single nutrient (pro, CHO, lipid) Combined to meet unique needs of each pt Used least often, $$$$$ Often low in fat

4. Nutrient Content of Enteral Formulas Caloric Density (kcal per ml or cc) 0.5 1.0 1.5 2.0 Normal formula Energy Needs Met in Smaller Volume: • Kcal needs high • Low appetite • Volume Restricted For pts with damaged or atrophied GI tract. Dilute formulas allow for recovery of GI function.

5. Important Considerations: Physical Properties Formula Osmolality (# of osmotic particles per Kg of solvent) Hypotonic Isotonic Hypertonic 280-320 mmol/kg May cause Osmolality of human gastric plasma retention; Example: 0.85 % sodium chloride in duodenum, or “normal saline” may cause fluid shift, 5% glucose solution diarrhea, ( 5 g per 100 ml) dehydration

6. Other Important Physical Properties Renal Solute Load (RSL) Remember: Hyperosmolar solutions require increased water intake in order for renal excretion, particularly in the pediatric patient. Dehydration is a great risk-- hypernatremia azotemia (high serum N) oliguria fever weight loss

7. Tube Feeding protocols Frequency/ amount Bolus*= large volume delivered intermittently ex: 400 ml q 4 h (2,400 ml per 24 hours) Continuous= given over 16 to 24 hours ex: 75 ml per h for 24 hrs (1,800 ml per 24 hrs.) (final rate) Intermittent*= gravity drip using smaller volumes than bolus; more often *Often poorly tolerated; n/v/d, aspiration

8. Volume and Rate of Delivery Standard Procedure: use full-strength formula but control flow rate! Nasogastric Feedings: start slow: 25-50 ml/ hour increase 10-25 ml per 8-24 hrs. Measuring Residuals: withdrawing formula left in stomach using a syringe if 100-150 ml remain, no add’t feeding.

9. Methods of Delivery Due to risk of aspiration-- Elevate upper body >30˚; remain at least 30 min. after feeding. Supplemental Water can be provided in the feeding tube. Functions to: • flush tube to prevent clogging • meet daily fluid requirements