Enteral Nutrition Diet - Essay Example

Enteral Feeding Patients admitted to critical care units are more often than not malnourished either because of their disease process or due to decreased intake of nutritious diet, or both. Malnourishment in these patients is dangerous and contributes to several complications which increase the mortality and morbidity rate (Binnekade et al, 2005). Hence, it is recommended that every effort be made to improve nutrition of the critically ill patient. There are several methods to enhance the nutrition status of intensive care patients, one of which is enteral feeding.

There are different methods of enteral feeding and nasogastric tube feeding is the most commonly used method among them. In this essay, indications, scientific rationale, restrictions for the feeding and teaching plan for the feeding will be discussed through review of current research pertaining to enteral feeding. Severely ill patients admitted to critical care unit are in a hypercatabolic state and protein energy malnutrition is a major problem in them. Research has shown that early initiation of feeds enterally, is beneficial and has many advantages like decrease in complications due to sepsis and improved outcomes (DeB et al, 2001).

This is because; enteral nutrition preserves the mass of the gut, prevents permeability of the gut to bacteria and their toxins, and preserves the lymphoid tissue of the gut (Binnekade, 2005). Enteral feeding has gained immense popularity because of lower rate of complications with the procedure and also lower cost involved (Binnekade, 2005). Early initiation of enteral feeding has been made a standard protocol in several intensive care units. Because of these protocols, the incidence of enteral feeding has increased dramatically.

Malnutrition is not only a cause, but also a consequence of poor health. It makes the individual vulnerable to infection, causes delay in wound healing, impairs the function of lungs and heart, causes depression and decreases the strength of the muscles. In general patients with malnutrition have higher mortality and morbidity rates. In surgical patients, those with malnutrition have 3 times increased risk of complication. They also have increased mortality rates, with risk being 4 times those without malnutrition.

Persistence of poor eating and inability to properly feed for several weeks can cause death by itself (NICE, 2006). Enteral feeding must be initiated in patients who are either malnourished or at risk of malnourishment and are either unable to take sufficient nutrition or oral intake is unsafe. At the same time, the gastrointestinal tract must be accessible and functional. It should not be initiated in those who are not malnourished. According to NICE guidelines (2006), "surgical patients who are: malnourished and have; inadequate or unsafe oral intake and a functional, accessible gastrointestinal tract and are due to undergo major abdominal procedures, should be considered for pre-operative enteral tube feeding.

" NICE (2006) recommends that in general surgical patients, enteral feeds must not be initiated within 48 hours after surgery unless they suffer from malnourishment or are at definite risk of malnourishment. Several types of tubes have come up for establishing enteral tubes. The choice of tubes depends on the expected duration of feeding, condition of the patient and the anatomy of the gastrointestinal tract of the patient. The most frequently used tubes are nasogastric tubes. Other tubes include nasojejunal tubes and nasoduodenal tubes.

In some patients, tubes may need to be inserted through gastrostomy or jejunostomy, either through radiological, endoscopic or surgical means and tubes for such purposes are different (Bourglat et al, 2007). Nasogastric tubes are mainly employed for feeding patients for a short duration of time and those who do not have problems like gastroesophageal reflux, vomiting, poor gastric emptying, intestinal obstruction and ileus. Use of these tubes for feeding is dangerous in patients who have unsafe swallow and in those who need to be nursed in the prone position.

It is always advisable to use fine bore tubes of sizes between 5 – 8 FrG. Larger bore tubes must be used only when there is a need for gastric decompression due to large volumes of gastric aspiration (NICE, 2006, (Stroud, 2003)). Nasogastric tubes can get misplaced or moved out of position easily and hence it is important to verify their position before administration of each feed. When nasoduodenal or nasojejunal tubes are introduced, their position must be checked using an abdominal X-ray, unless the tube has been placed under fluoroscopic guidance (Stroud, 2003).

Gastrostomy tubes are placed directly through the abdominal wall. They are used in those who need long term feeding and the nasogastric access in them is difficult. The tubes are placed with the help of endoscope. They can also be placed surgically or radiologically. Jejunostomy tubes are placed through surgical approach. They pass into the jejunum through the abdominal wall. Complications of enteral tube feeding include complications of insertion like intracranial insertion, nasal damage, perforation of the esophageal and pharyngeal pouches and intestinal perforation, post insertion trauma like stricture formation, fistulae, erosions and discomfort, displacement of tube and subsequent bronchial administration of feeds, reflux related problems like aspiration and oesophagitis, gastrointestinal intolerance and metabolic problems (NICE, 2006).

Enteral feeds can be given either as bolus feeds or continuous feeds. Nasogastric tube feeding permits higher rates of feeding, hypertonic feeds and bolus feeding. The rates of feeding can be altered using enteral feeding pumps. High aspirates are an indication to reduce the rate of feeding, or prokinetics can be administered to facilitate gastric emptying (Metheny et al, 2008). Introduction and positioning of nasogastric tube is inconvenient to the patient and care must be taken to introduce the tube properly and put it in the right position.

The tube should not be introduced into the trachea or leave it just in the esophagus. After insertion of the tube, proper placement of the tube must be verified either pushing 60 ml of air through the tube and by auscultating air gush over stomach or by aspirating gastric contents. The tube should be secured only after confirming proper positioning. Appropriate training and experience is essential for safe, secure and comfortable insertion of nasogastric tube. The type, frequency and duration of feeds introduced through the nasogastric tube depends on the age and clinical condition of the patient.

The feeding may be continuous or intermittent. Thus, it is very important for nurses administering nasogastric tube feeding to possess adequate knowledge and expertise while inserting the tube and delivering feeds (Bourglat et al, 2007). Enteral feeding is a common requisite in critically ill patients because of frequent malnourishment in them either due to increased catabolism or due to previous prevalence of undernourishment. Malnourishment contributes to several complications, which can be reverted by appropriate initiation of supplemental and complementary feeds, the most common of which is enteral feeds.

The most common method for administration of enteral feeds is the nasogastric tube feeding, which is associated with a few complications like delayed gastric emptying. Delayed gastric emptying contributes to esophagitis, aspiration and feed intolerance and most institutions which administer nasogastric tube feeding administer prokinetics to facilitate gastric emptying. References Bourglat, A.N., Ipe, L., Weaver, J., Swartz, S., and Dea, P. (2007). Knowledge of Enteral Feeding Development of Evidence-Based Guidelines and Critical Care Nurses.

Critical care Nurse, 27(17- 29). Binnekade, J.M., Tepaske, R., Bruynzeel, P., Mathus-Vliegen, E.M.H., and de Haan, R.J. (2005). Daily enteral feeding practice on the ICU: attainment of goals and interfering factors. Critical Care, 9, R218-R225. De B., Chapman, M., Fraser, R., Finnis, M., De Keulenaer, B., Liberalli, D., Satanek, M. (2001). Enteral nutrition in the critically ill: a prospective survey in an Australian intensive care unit. Anaesth Intensive Care, 29, 619-622. Metheny, N.A., Schallom, L.

, Oliver, D.A., and Clouse, R.E. (2008). Gastric Residual Volume and Aspiration in Critically Ill Patients Receiving Gastric Feedings. American Journal of Critical care, 17, 512- 519. NICE. (2006). Nutrition support for adults oral nutrition support, enteral feeding and parenteral nutrition. London: National Collaborating Centre for Acute Care at The Royal College of Surgeons of England. Stroud, M., Duncan, H., and Nightingale, J. (2003). Guidelines for enteral feeding in adult hospital patients.

Gut, 52(Suppl 7), vii1-vii12.