NUTRITIONAL SUPPORT
Nutrients are given to a patient via an enteral or parenteral route. Using the
enteral route, food is administered by mouth or by a feeding tube that is directly
inserted into the GI tract—usually into the stomach or small intestine. A feeding
tube is used whenever the patient cannot swallow.
The parenteral route is the use of high caloric nutrients administered
through large veins such as the subclavian vein in a process called total par-
enteral nutrition (TPN) or hyperalimentation. The parenteral route is the least
preferred because the process is three times more expensive than enteral with-
out a significantly improved benefit. Furthermore, the parenteral route has a
high rate of infection and does not promote GI function, liver function, or
weight gain.
Enteral nutrition
Enteral feeding is the preferred method of providing nutritional support to a
patient. However, the patient must have adequate GI tract function to enable
food to be digested, absorbed, and waste eliminated.
It is important to determine if the patient has GI motility and small bowel
function. Otherwise, the patient may experience uncontrolled vomiting and
become at high risk for aspiration should the intestine be obstructed. Decreased
bowel sounds are common in critically ill patients. They may also have a
decrease or absence of gastric emptying.
There are several methods used for enteral feeding. These are:
- Oral.This is ingesting food naturally.
- Nasogastric tube.This is the most common method. It consists of a tube
passedthrough the nose and down the esophagus ending shortly below the
xiphoid process. This is used for short-term therapy. - Gastrostomy.A feeding tube placed in a hole in the abdomen leading to
the stomach. This is used for long-term therapy. - Nasoduodenal.A tube is passed through the nose and down the esophagus
ending in the duodenum. - Nasojejunal.A tube is passed through the nose and down the esophagus
ending in the small intestine. - Jejunostomy.A feeding tube is placed in a hole in the abdomen leading to
the small intestine.
CHAPTER 11 Nutritional Support Therapies^185