Nutrition and Feeding Tubes

When patients lack access to nutrition, the body:

• The body begins using its own reserves for energy

• Body burns muscle, then fat

In acute care, the goal is to not surpass more than ____ hours NPO

48

NPO=

nil per os, nothing by mouth

nutritional support mind map

Formal evaluations

• PMV

• FEES

• VFSS

• Clinical

what do SLP evals determine?

full, partial, or no oral intake (NPO)

Considerations of duration of NPO

• Must give MD/RD team an idea of how long until next eval

• Anticipated length of NPO status to determine additional interventions moving forward

RD eval

• medical history

• dietary intake

• clinical assessment

• Recommendations for nutritional intervention

RD medical history

Meds, allergies

RD dietary intake

Food preferences, special diets

RD clinical assessment

• BMI, weight

• Signs of malnutrition

• Labs

• GI function

RD recommendations for nutritional intervention

Caloric/protein goals, supplementation need, weight maintenance

What is artificial nutrition?

Nutrition and hydration delivered via means other than oral intake

types of artificial nutrition

1. intravenous

2. enteral

intravenous

• IV hydration

• Total parenteral nutrition (TPN)

bypasses the stomach

enteral

• Nasogastric (NG-tube)

• Gastrostomy (G-tube)

• Jejunostomy (J-tube)

Tube Feeding: Pt Population Considerations

• nuerologically impaired

• require long term intervention

• chronic issues

• HNC

Recommendation for oral intake may be described with 3 main categories, what are they?

1. oral

2. partial

3. NPO

What are the 2 main types of artificial nutrition?

1. intravenous

2. enteral

Why is it imperative to communicate with a pt’s team about an NPO status?

anticipaticated duration of we would estimate what the NPO status would be. important to determine if artificial nutrition is needed and what type

IV hydration

• No protein or calorie nutrition- hydration only

• Must make decisions about nutrition quickly

• Allows for evaluation by SLP and RD for further treatment planning.

Very short term 1-3 days average (to by time on what the plan is)

IV hydration

Parenteral Nutrition

• Intravenous administration of nutrients, fluids, or medications

• Referred to as Total Parenteral Nutrition (TPN)

• Bypasses normal digestion via liquid chemical formula delivered to the bloodstream through IV catheter

• Delivered via central line

• Very expensive

Not a long-term or home-based solution (usually)

Parenteral Nutrition

How are IV hydration and parenteral nutrition similar?

intraenous- the way its delivered

How are IV hydration and parenteral nutrition different?

one is hydration

Nasogastric (NG) Tubes

• Nasogastric tubes deliver nutrition via tube passed through the nose into the gut

• Multiple sizes for multiple purposes

Should be removed/replaced by 14-21 days to reduce mucosal injury

NG tubes

Enteral feeding delivers nutrition directly to…

the stomach, duodenum, jejunum

what type of delivery for NG tubes?

nutrition & medication

diameter of NG tube

larger diameter (16 Fr)

suction of NG tube

• Stomach pumping

• Ingestion of poisons

• Small bowel obstructions

Dobhoff Tubes (Type of NG tube) DHT

• Small bore (8fr)

• More comfortable

• Medications clog frequently

NG Tube Complications

• Tissue damage

• Bleeding

• Infection

• Aspiration

• Need for physical restraints

  • Patients frequently pull

  • NG may have bridle

Describe the difference between a general NG tube and a dobhoff tube

the size, diameter, NG is larger

NG: suctioning as needed

DHT: nutritional delivery

List 2 possible complications of an NG tube

mucosal damage, infection, bleeding, pain

2 types of G-tube

1. Surgical

2. Percutaneous

Used when tube feeding is anticipated for 30 days or more

G-tube

Gastrostomy Tube (G-tube): what are some complications?

• Requires sedation to place

• Do not eliminate aspiration

  • Shown to increase discomfort

  • Do not improve functional status

• Must flush with water to keep clear

Surgical (open) G-tube

• Surgical procedure with placement at the stomach

• Usually reserved for patients already going to OR

• May be needed if unable to place endoscopically or radiologically

  • Potentially due to anatomic obstruction

Percutaneous endoscopic gastrostomy (PEG tube)

• Placed via endoscope and guidewire pull through

• Cheaper and quicker to perform

Jejunostomy Tube

• Tube directly placed in the jejunum (small intestine)

• Performed in the OR

• Can be advanced from a G-tube to a J-tube if feeds not tolerated

• Used frequently in those who reflux tube feeds

Feeding Tube Complications

1. feeding-related

2. tube-related

3. stoma site

feeing-related complication

• Nausea, vomiting, diarrhea (NVD)

  • Due to rapid feeding, formula intolerance, gut bacteria imbalance

• Aspiration

  • Body position (HOB >30 degrees)

tube-related complication

• Dislodgement

• Blockage

stoma site complication

Infection risk, bleeding, and skin breakdown around stoma

Formula chosen by who and for what needs?

RD/MD to meet patient’s nutritional needs

feeding delivery methods

1. bolus feeds

2. intermittent feeds

3. continuous feeds

4. cyclical feeds

bolus feeds

Larger volume over shorter time period (15-30 mins); syringe or gravity bag

intermittent feeds

Smaller volume over longer time period (20-60 mins); pump or gravity bag

continuous feeds

Small volume delivered slow and continuously; pump

cyclical feeds

Small volume delivered continuously over set time period; pump

Keys of Nutritional Intervention

Multidisciplinary approach to nutrition intervention is ideal

SLP is a key member of the team when it comes to the patient + medical team making informed decisions about nutritional intervention(s)

Neither the patient or the medical team are REQUIRED to follow our recommendations because they are just that... recommendations!