Please enable JavaScript.
Coggle requires JavaScript to display documents.
9|Nutritional support (Types (Parenteral (Peripheral: Smaller calibre…
9|Nutritional support
Types
Enteral vs Parenteral: nutrition by GI tract vs other than GI (eg. vein) :check:
- More physiologic
- Less complications
- Mucosa preserved
- Cheaper
- Allows lesser caloric intake
Enteral
Feeding tubes
Non-invasive :check:
- NG tube
- OG tube
- ND tube
- NJ tube
Invasive :check:
- Gastro: Percutaneous endoscopic gastrostomy (PEG)
- Gastro: Open gastrostomy
- Jejunostomy tubes
-
Feeds :check:
- Commerically prep (Polymeric, Monomeric, physiological)
- Blenderised feeds (clog up tube, uncommon)
Enteral Contraindications/Parenteral indications :check:
- ileus: lack of movement in gut
- anastomosis: dehescience
- fistula: stuff comes out
- insufficient amounts of nutrients (PN can give more)
Enteral Complications 12% rate :check:
- Gastrointestinal: Distention, nausea, vomiting, diarrhoea, ischaemia
- Mechanical: Malposition, sinusitis, ulceration, erosion, blockage
- Metabolic
- Infectious: Aspiration, bacterial, regurgitation (NG, OG)
Parenteral
Peripheral: Smaller calibre veins :check:
- ST (1-2wks)
- Mild stress
- Low caloric / High fluid
Central/Total: Bigger calibre veins : :check:
- To avoid thrombophlebitis
- Lead to Superior Vena Cava (Long peripheral line, Subclavian, Internal jugular, External jugular)
Steps to ordering TPN :check:
- Determine total fluid volume
- Determine needs (Fat/Carbo/Protein/Electrolyte/Vitamins)
TEE: Total energy expenditure: REE (Harris-Benedict/Schofield) + Stress factor + Activity factor (Refer to slide 42)
First principle: Fats 1/4, CHO 3/4
Protein: N balance, stress, BW, C:N ratio 150 cal: 1g Nitrogen
Vitamins: x2/3 recommended for oral intake
Insulin: Sliding scale, give separate infusion
1g N = 6.25 protein
Revision: holliday segar formula
- 10% for every deg rise in temp
If temperature rises with catheter: :check:
- What is happening: Sepsis change
- Management: Remove catether, let bacteremia subside before resetting
Complications of TPN :check:
- Mechanical: Pneumothorax, embolism, vascular injury, thoraic injury
- Metabolic: Excessive / Inadequate administration (Consequence, cholestatic jaundice excess fat/calorie)
- Infectious:Contamination
When to stop TPN :check:
- When enteral feeding can restart
- Wean slowly to avoid hypoglycemia
Risk of malnutrition
- Surgery/trauma/sepsis
- Starvation
- Critical illness
- Need prolong bowel rest
Detection of malnutrition :check:
- [Subjective] Hx (significant wt loss 15% bw)
- [Subjective] Physical examination (Edema, ascites, vitamin deficiency, easy bruising)
- [Objective] Anthropometric measurements (BMI, tricep-skinfold, bioelectric impedance, hand grip dynamometry, mid arm muscle circumference)
- [Objective] Investigation (Albumin, transferrin, total lymphocyte count, prothrombin time) Slide 60
-