Patients needing nutritional support
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- Undernourished preoperatively – weight loss > 10%, underweight (BMI < 18)
- Anticipated/actual intake minimal/limited > 7 days
- Complications, infection
- ↑operative risk – inflammatory bowel disease, heart disease, diabetes, cirrhosis, alcoholism, renal disease, morbid obesity, cancer, AIDS, elderly, neurosurgical
- major injury, sepsis
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Oral
- Can/will eat and swallow
- Functional gut
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Enteral
- Functional gut
- Can supplement poor oral intake
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Parenteral
- Non-functional/inaccessible gut
- Obstruction, ↓ absorptive surface, extended feed intolerance,
- intractable diarrhoea
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DELIVERY
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Food fortification
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Oral supplements
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Nasogastric
- low risk aspiration
- short term feeding, < 14 days
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Nasoenteral
- high risk aspiration
- short term feeding, < 14 days
- ↓ gastric motility
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Gastrostomy/(jejunostomy)
- high risk aspiration
- long term feeding anticipated
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Peripheral
| Total parenteral nutrition - 100% nutrient requirements
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LIMITATIONS
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- appetite often poor
- hospital food unacceptable
- food system inflexible
- actual intake very difficult to monitor
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- limited palatability
- high volumes may be needed
- compliance notoriously poor
- actual intake very difficult to monitor
- costly
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- fine-bore tube
- tube blockage
- tube dislodgement
- local irritation
- feeding may be interrupted
- nausea, gastric discomfort
- gastric residues
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- tube placement more difficult
- local irritation
- feeding may be interrupted
- nausea, gastric discomfort
- continuous feeding required
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- care of gastrostomy site
- local irritation
- feeding may be interrupted
- nausea, gastric discomfort
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- dilute nutrients
- large fluid volumes
- fat main source energy
- protein intake limited
- cannot supply total
- nutrient needs
- risk of infection
- costly
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- central venous
- catheter required
- hypertonic solutions
- care of catheter
- ↓ gut function
- risk of infection
- costly
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MONITOR
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- compliance
- tolerance
- actual intake versus estimated requirements
- weight status/triceps & mid-arm circumference (MAC)
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- residues
- gastric discomfort – distension
- constipation
- diarrhoea (check antibiotics)
- nausea, vomiting
- actual intake versus estimated requirements
- weight status, MAC
- electrolytes
- fluid balance
- dumping
- stoma site
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- standard clinical observations
- biochemistry
- hyperglycaemia
- electrolytes, acid base status
- fluid balance
- cannula/catheter site for infection or thrombophlebitis
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