Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Enteral and Parenteral Nutrition 527

➣gastrostomy

>6 weeks duration

normal gastric function

surgical, radiological, or percutaneous placement

large bore tube, medication administration or gastric decom-

pression possible

➣jejunostomy

>6 week duration

impaired gastric motility or access

GERD/aspiration risk decreased

bolus poorly tolerated

laparoscopic, fluoroscopic or endoscopic placement

➣combined gastrostomy/jejunostomy

gastric decompression with otherwise intact GI tract

➣medications via gastric port decrease risk of clogging jejunal port

➣continuous feedings (16–24 hours)

➣cyclic feedings (6–8 hours)

➣bolus (<15 minutes duration, 4–6 times daily)

➣formula options:

polymeric (1–2 kcal/ml, lactose/gluten free,+/−residue)

elemental (minimal residue, low viscosity, lactose-free, often

hypertonic)

disease specific

modular components

■parenteral access

➣peripheral

standard venipuncture method

<600–900 mOsm/L to avoid phlebitis

➣central

centrally placed multilumen catheter placed surgically

➣composition options:

dextrose concentrations 5–70%

amino acid concentrations 3–15%

lipid concentrations 10–30%

electrolytes, vitamins, minerals

Side Effects & Complications

■enteral

➣high gastric residuals

➣nasopharyngeal, nasolabial, ostomy site irritation

esophageal/laryngeal ulceration/stenosis