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7/30/2019 Prescribing Regimens of Feeding Jejunostomy
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PRESCRIBING REGIMENS OF FEEDING
JEJUNOSTOMY
RUPESH KUMAR
PGT,DEPT OF SURGERYMEDICAL COLLEGE, KOLKATA
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Definition
Enteral nutrition: the provision of nutrients
into the gastrointestinal tract through a tube
or catheter when oral intake is inadequate.Also it may include the use of formula as oral
supplements or meal replacement.
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Principles of Enteral
Feeding
Stomach Principal defense against an
enteralosmotic
load.
SI - Principal area for nutrient absorption.
Hyperosmolar solutions invites morecomplications.
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Routes for administration of
enteral feeding
Nasoenteric and postpyloric feeding.
Gastrostomy
Jejunostomy
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An approach to feeding
advancement Position of the patient
For gastric feeding- first osmolality then
volume is increased. Feeding started at the @ 10-20mL/hr
Gastric volumes checked every 4-6 hrs
If less
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For SI feeding- volume is increased first thenthe osmolality (
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Rationale for enteral nutrition
Low cost
intestinal mucosal atrophy.
infection complications & acute phaseprotein production
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Which patient is eligible for
nutrition support ?Enteral nutrition
Should be used in Pt. who have at least 2-3 ft
of functional gastrointestinal tract. Who are or will become malnourished.
In whom oral intake is inadequate to restore
or maintain optimal nutritional status.
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General Indications:
The pts premorbid state Poor nutritional status
Significant weight loss
Duration of starvation > 7 days Anticipated duration of artificial nutrition >7days
The degree of anticipated insult, surgical/ otherwise
Serum albumin< 3gm%,transferrin
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ENTERAL FORMULA COMPOSITION
Formulas classified in a variety of ways, usuallybased on protein or overall macronutrientscomposition.
General purpose formulas are tolerated by mostpatients and most of these formulas provide
1kcal / ml.
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General formulas that provide 1.5 to 2 kcal / ml
are used to restrict fluid for patients withcardiopulmonary, renal & hepatic failure.
High nitrogen formulas used for patients withburns, fistulas, sepsis or trauma.
Disease specific formulas for patients with
renal, hepatic or cardiopulmonary disease,metabolic stress,immunosuppression, or glucoseintolerance.
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ENTERAL FORMULA CATEGORIES
Generalpurpose / intact
(polymeric)
* Use in patients with normal digestion and absorption.
* Contain intact protein.
* Instituted at full strength ; low viscosity; 300-500 mOsm / kg.* Provide 1-2 kcal / ml.
* Lactose free.
* 30-40 gm protein / L.
Defined /
hydrolyzed(monomeric)
Use in patients with GI compromise.
(hydrolyzed nutrients to improve digestion). Osmolality depends on hydrolysis.
Provide 1-2 kcal / ml.
Lactose free.
30-45 gm protein / L.
Also known as chemically defined, peptide based and elemental formula.
Semielemental use in patients with limited GI function. contains free amino acids, minimal fat and minimal residue.
hyperosmolar and low viscosity.
provide 1 kcal / ml.
40 gm protein / L.
Also known as free amino acid formula.
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ENTERAL FORMULA CATEGORIES
(CONT.)
Disease specific Designed for specific organ dysfunction or metabolic disorder. May not nutritionally complete.
Most are hyperosmolar.
Redehydration For patient requiring an optimal ratio of simple carbohydrate toelectrolytes for the purpose of maximizing fluid and electrolyteabsorption and rehydration.
Modular Formula providing protein, fat or carbohydrate as single nutrientsto alter the nutrient composition of commercial formulas or food.
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ADMINISTRATION
The three common methods of tube feeding
administration are :
1. Bolus feeding: infusion of up to 5oo ml of enteralformula over 5 to 20 mins by large-bore syringe .
2. Intermittent drip feeding: administered of enteral
feeding at specified times throughout the day;generally in smaller volume and at a slower rate
than a bolus feeding but in large volume and
faster rate than continuous feeding.
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3. Continuous drip feeding: administered ofenteral formula into the gastrointestinal tract
via pump, usually over 8 to 24 hours of day.
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Products
Complete Formulas
Modular (Supplements)
Elemental Disease Specific
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Complete formulas
Also called meal replacements Intact nutrients
One or two sources of protein, carbohydrate and fat Carbohydrate: Maltodextan, hydrolyzed corn starch,
corn syrup Protein: Soy protein, casein Fat: Soybean oil, canola oil, corn oil Vitamins: RDA in 1250 2000 ml Minerals: Na, K, MG, Phos, Ca & usually trace
With and without fiber
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Modular products
Also called supplements
Provides only one type of nutrient
Given with a complete formula Protein: ProMod, Propac
Fat: MCT oil, Safflower oil
Carbohydrate: Polycose, corn syrup
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Elemental formulas
Nutrients broken down
Low fat
MCT oil Examples: Peptamin; Criticare HN
Use: Malabsoption states: Short bowel,
fistula, pancreatitis
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Disease specific formulas
Hepatic disease
Renal disease
Trauma & stress Pulmonary disease
Diabetes
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Hepatic disease
Low in aromatic amino acids and methionine
High in branched chained amino acids
Low in amino acid concentration (High calorie to nitrogen ratio)
Products: Hepatic-Aid II
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Renal disease
Amin-Aid; Suplena
Low protein, high in essential AA
Modified electrolytes Caloric dense
Nepro higher in protein for dialysis patients
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Trauma & stress
TraumaCal; Stresstein; AlitraQ
High nitrogen
May be high in BCAA Caloric dense
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Pulmonary disease
Pulmocare
55% of calories from fat
Primarily corn oil Intended to decrease CO2 production
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Diabetes
Glucerna
Less carbohydrate
More fat
Intended to improve glucose tolerance
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Monitoring pts receiving
nutritional support
Fluid balance record, daily weighing
Document daily calorie and N intake RFT, LFT biweekly
Regular check ups for Phos,Ca,Mg,alb,Protein,
Haematological indices Regular examination of route of access
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Complications of enteral
nutrition
Gastrointestinal Diarrhea, nausea,vomiting, abd discomfort, bloating,regurgitation and aspiration of fluids.
Mechanical-
Metabolic-
Infective-
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Thank You