Level 2

Semester 3
Module 6A
Nutrition amd Metabolism
Level 2- Semester 3- Module 6A

Enteral and parental

nutrition

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 Contact data
Level 2- Semester 3- Module 6A

• Contact: Reem Elsharkawy .

• email: reemraouf64@gmail.com

• Mobile: 01006151100

• Academic hours:
➢Monday: 10:00-12:00 AM

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 Contents of the Lecture
Level 2- Semester 3- Module 6A

• Nutrition support

• Different types of nutritional support

• Indications of enteral and parental

nutrition

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 Learning outcomes
Level 2- Semester 3- Module 6A

• Outline the indications &complications of

EN

• Outline the indications &complications of

TPN

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Level 2- Semester 3- Module 6A

• The more impure bodies are fed ,the more

diseased they will become

Hippocrates

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 Nutritional support
Level 2- Semester 3- Module 6A

Delivery of formulated nutrients by feeding tube or intravenous

infusion

Enteral nutrition
Supplying nutrients using GI tract including tube feeding & oral
diet

Parentral nutrition
Intravenous provision of nutrients, by passing the GI tract

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 Indications of Enteral
nutrition
1.Poor oral intake (won't Eat)
Level 2- Semester 3- Module 6A

Anorexia

Depression

Eating disorders

Nausea

Painful swallowing

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Level 2- Semester 3- Module 6A

2.Unsafe oral intake (Can't Eat)

Altered level of consciousness

Dysphagia

Endotracheal intubation

Gastro -paresis

Impaired sucking and swallowing

Impaired intestinal obstruction

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Level 2- Semester 3- Module 6A

• 3.Elevated needs (can't eat enough)

• Burns

• Open wounds

• Pressure ulcers

• Sepsis

• Trauma

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 Routes of enteral tube
feeding
– Main routes:
Level 2- Semester 3- Module 6A

1-Tube feeding (short term )

–Nasogastric
–Nasoduodenal
–Nasojejunal

2-Catheter inserted (long term)

Gastrostomy
Jejunostomy

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 Level 2- Semester 3- Module 6A

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 Level 2- Semester 3- Module 6A

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 Level 2- Semester 3- Module 6A

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 Level 2- Semester 3- Module 6A

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 Principles of enteral
feeding
Level 2- Semester 3- Module 6A

– Verification of tube placement (X ray)

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 Level 2- Semester 3- Module 6A

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Level 2- Semester 3- Module 6A

– Formula delivery

• Intermittent feedings (bulk over 20-40 min)

• Continuous feedings (pump)

• Bolus feeding (one or several “shots)

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 Level 2- Semester 3- Module 6A

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 Advantages of enteral feeding

• Maintain normal metabolic pathways

Level 2- Semester 3- Module 6A

• Maintain normal intestinal PH ,flora

• Lower costs

• Reduces infectious complications

• Supports the GI tract as an organ of immune system

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 Complications of enteral feeding
Level 2- Semester 3- Module 6A

Food entering the lungs

Constipation

Diarrhea

Improper absorption of nutrients

Electrolyte abnormalities

High blood sugar

Decrease liver proteins

Vitamins and mineral deficiencies

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 Parenteral Nutrition
Level 2- Semester 3- Module 6A

• Parenteral nutrition (PN) is a form of specialized nutrition

support in which nutrients are provided intravenously.

• A basic PN formula is a combination of amino acids, hypertonic

dextrose (10-50%), electrolytes, vitamins, and trace elements.

• Fat emulsions: provides calories and fatty acids

pg 1021 22
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 Indications of PN
•
Level 2- Semester 3- Module 6A

1. Massive resection of small bowel

• 2.High output fistulae

• 3.Patient not expected to feed in 7-10 days

• 4.Sever pancreatitis

• 5. peritonitis

• 6. Paralytic ileus

• 7. Mesenteric ischemia

• 8.Failed enteral trials with post pyloric tube placement

• 9.prolonged intestinal failure

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 Parenteral nutrition
Level 2- Semester 3- Module 6A

• Central venous catheter (CVP)

• Tunneled Hickman catheter

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 Level 2- Semester 3- Module 6A

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CVP
 Level 2- Semester 3- Module 6A

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 Level 2- Semester 3- Module 6A

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 Sites of insertion of CVP
Level 2- Semester 3- Module 6A

• 1-Centrally inserted
– Internal jugular approach
– Subclavian approach

• 2-Peripherally inserted (rarly)

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 Level 2- Semester 3- Module 6A

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 Parenteral Nutrition:
Complications
Level 2- Semester 3- Module 6A

• Catheter-related Problems
– Pneumothorax
• Sudden sharp chest pain, dyspnea, and coughing
• Monitor for 24 hrs.
– Air embolus
• Occurs during insertion of the catheter or when
changing the tubing or cap.

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 Parenteral Nutrition:
Complications
Level 2- Semester 3- Module 6A

• Catheter-related Problems
– Catheter occlusion
• If sluggish or no flow, stop infusion and flush with
normal saline or anticoagulant
– Sepsis
• Fever, chills, or glucose intolerance and positive
blood culture

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 Parenteral Nutrition:
Complications
Level 2- Semester 3- Module 6A

• Metabolic alterations
– Electrolyte and mineral imbalances
– Hyperglycemia
– Hypoglycemia
– Dehydration

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Level 2- Semester 3- Module 6A

Advantages Enteral vs Parenteral

• 1.Preserve gut integrity
• 2.possible decrease bacterial translocation
• 3.Preserve immunological function of gut
• 4.Lower cost
• 5.Fewer infectious complications in critically
ill patients
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 Case
Level 2- Semester 3- Module 6A

Patient who had a stroke and has a

difficulty in swallowing (dysphagia)

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 Level 2- Semester 3- Module 6A

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 Level 2- Semester 3- Module 6A

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 References or further
readings
Level 2- Semester 3- Module 6A

• 1-The ICU book by Paul L. Marino

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