USAGE OF LATEST EQUIPMENTS AND

TECHNIQUES IN FEEDING THE

PATIENTS
Dr. Rosaline Rachel
Principal
MMM College of Nursing
(A Unit of Madras Medical Mission)
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Nutritional therapeutics in critically ill patients

has gone change over the last 4-5 decades
Evidence based medicine has further given
the impetus to nutritional interventions
Nutritional therapy has emerged as a
specialized disciple in critical care practice.

DR.ROSALINE RACHEL 23 August 2018

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Ancient Greeks & Egyptians: Rectal
Feedings
Enemas to infuse nutrients to preserve
health, protect inflamed bowel surface or
treat diarrhea
Made from wine, milk, whey and wheat or
barley broths; eventually, eggs and brandy
added to mix

DR.ROSALINE RACHEL 23 August 2018

4 12th century: Use of Upper GI Tract
Hollow tube with bladder filled
with nutrient solution attached to
end and inserted into esophagus
17th century: Advances Made
in Delivery Systems
Flexible leather tube for
esophageal feeding and
nasogastric feeding
 1628: Intravenous infusions;
beginning of TPN
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18th century: Liquid Formulas
Hollow catheter and syringe deliver blended food
into stomach of patient
Orogastric probe made of whalebone encased
in eel skin designed to deliver nutrients
19th century: Surgically Placed Feeding Tubes
Rubber tubing introduced
 Gastrostomy access for feeding/medications
Early 1800’s: intravenous feeding solution (saline
solution) for treatment of cholera
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20th century: Advent of PEG
Continuous & controlled delivery of liquid
nutrition
Feeding during surgery & with pump
 Importance of Nutrition therapy
 Commercial products
 Modern day formula
1980: PEG (Percutaneous Endoscopic
Gastrotomy) tube developed to provide
nourishment for neurologically impaired children
DR.ROSALINE RACHEL 23 August 2018

with swallowing disorder

7 Ethics and legality

Hyderation is a basic care

Spoon feeding is basic care
Artificial nutrition is not a basic care
Food and fluid should be offered and not
forced
Causes of refusal should be explored

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8 Which is your feeding?

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9 Vessels Vs Equipments

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12 WHAT IS ARTIFICIAL HYDRATION &
NUTRITION (AHN)?

Treatment intervention that delivers fluids

and/or nutrition by means other than a
person taking in his/her mouth and
swallowing it

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13 TYPES OF AHN
ENTERAL: Nutrition and/or fluids delivered
through a tube placed in gastrointestinal
tract
Nasogastric (NG) tube
 Gastrostomy (G) tube
Jejunostomy (J) tube

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 Enteral Nutrition
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Enteral nutrition =
Administration of
nutrients via the existing
GIT
EN is confined to tube feeding
exclusively without regards to
oral nutritional supplement
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When is EN indicated in ICU patients?
“IF THE GUT WORKS,
USE IT OR LOOSE IT”

All patients with functioning gut who are not

expected to be on a full oral diet within 3 days

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Rationale for EN…….
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Favours intestinal
villous trophicity
Promotes gut motility
Reduces translocation
of bacteria from gut
Less costly than PN

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17 What is a Gastrostomy Tube?

A gastrostomy tube (also

called a G-tube) is
a tube inserted through the
abdomen that delivers
nutrition directly to the
stomach

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18 Indications for G-tubes

Nutritional support (feeding)

 Administering medications
 Stomach Decompression

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19 Indication for G-tubes

Swallowing/Aspiration problems/Dyphasia
 CP
Inadequate oral caloric intake/high
caloric needs
 Oral motor feeding problems
 Feeding aversions

DR.ROSALINE RACHEL 23 August 2018

20 Indication for G-tubes ……………
Specific disease processes (CF, CHD,
Chronic renal failure, malignancies
Cancer patients in catabolic state
Need for special diet
IBD and metabolic disease
Medications necessary for health
HIV, anti-seizure
Head trauma/craniofacial abnormalities
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21 Types of Tubes

 G-tubes:
PEG tube
Mic-Key
Foley catheter
Pezzer or Malecot
 G-J tubes
 J-tubes
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22 GASTROSTOMY TUBES
A gastrostomy tube (GT) is
a tube inserted through
the abdominal wall that
can deliver nutrition,
liquids and/or
medications directly into
the stomach. It can also
be used to decompress
the stomach

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23 (PEG) tube
The percutaneous
endoscopic
gastrostomy (PEG)
tube provides nutrition
for patients who are
having difficulty
swallowing.

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24 MIC G (balloon-type device)

MIC G tubes are

sometimes used as
primary (initial)
tubes. They have a
balloon

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25 MIC KEY (balloon-type device)

MIC KEY -a balloon-

type device
 FEATURES There are 2 types of
feeding tube extension sets:
one for continuous feeds and
one for bolus feeds Both can
be used for venting

DR.ROSALINE RACHEL 23 August 2018

26 Nutriport (balloon-type device)

DR.ROSALINE RACHEL 23 August 2018

27 Bard Button (mushroom-type
device)

Bard buttons are a

mushroom-type
device that are
often changed in a
clinic setting or
operating
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28 Jejunostomy Tubes
low profile-type tubes

3 types of J tubes:
 Cook catheter - for
transgastric jejunal feeding
 MIC - for a surgical
jejunostomy
 Foley with no balloon -
replacement tube for a
surgical jejunostomy

DR.ROSALINE RACHEL 23 August 2018

29 Transgastric jejunal feeding tubes

The type of tube is inserted

through an established
gastrostomy tract in the
radiology department.
This tube needs to be well
secured (taped) to the
abdomen to prevent it
from falling out.
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30 Tri-Funnel Replacement
Gastrostomy Feeding Tube

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31
Enteral Feeding Pumps

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32 Milk flow Rates

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Method of Administration

Bolus
Intermittent
Continuous
Cyclic

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DR.ROSALINE RACHEL 23 August 2018

 The best preparation for good work
tomorrow is to do good work today.”
— Elbert Hubbard

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