1. Adult Medical- Surgical Nursing Gastro-intestinal Module: Enteral and Parenteral Feeding

2. Enteral and Parenteral Feeding: Description  Alternative methods of feeding for:  Patients having difficulty in swallowing  Patients suffering from severe injury requiring intensive nutritional support  Patients with malabsorption where nutrients can be directly fed into the blood circulation  Aim to ensure adequate nutrition and reduce risk of aspiration and asphyxia

3. Methods of Feeding: Enteral and Parenteral  Enteral:  Nasogastric tube feeding  Gastrostomy  Jejunostomy (less reflux)  Parenteral:  Total Parenteral Nutrition

4.  Enteral Feeding

5. Nasogastric Tube Feeding  A temporary short-term measure  Used to avoid choking and aspiration pneumonia where the swallowing reflex is impaired (stroke, head injury) until improvement or another feeding method used  Radio-opaque: position of NG tube can be identified by Xray (weighted tip to stabilise)  Aspirate tube pre-feed, patient semi-sitting (bed head 30-45%), flush with water following

6. Gastrostomy / Jejunostomy  A more long-term method of feeding a patient with swallowing problems  Placed surgically, percutaneously; gastric/ jejunal tissue brought to the skin and sutured to avoid leakage (and peritonitis)  Head of bed 30-45% to prevent reflux and aspiration (first check gastrostomy tube is in situ: litmus pH <5)  Flush with water pre- and post-feed; slow entry, maybe by a continuous pump

7. Complications of Enteral Feeding:  Reflux, vomiting, aspiration → asphyxia or pneumonia  Dehydration (↑ osmolality) and thirst  Delayed gastric emptying (large residual volume)  Poor absorption:  Diarrhoea (rest and reduce feed concentration)  Constipation (increase fibre content of feeds)  Infection risk (hand-washing, sealing and refrigeration, monitor and record date of opening feed and expiry date)

8.  Total Parenteral Nutrition

9. Total Parenteral Nutrition  Used when:  The gastro-intestinal tract cannot absorb essential nutrients: Inflammatory bowel disorders  Increased nutritional need for growth/ repair: Cases of severe injury, burns, complex surgery, fistula, infection  Central IV line (subclavian): IV pump  Commercially prepared pre-digested formula: CHO, fats, amino acids, minerals, vitamins, electrolytes according to patient’s daily blood result

10. Complications of TPN:  Dehydration (↑ osmolality) and thirst  Infection risk:  Hand-washing  Refrigeration of formula, record time/ date of opening/ note expiry date  Sterile aseptic technique when dressing IV site (iodine used)  Monitor patient for circulatory overload

11. Enteral and Parenteral Feeding: Special Nursing Measures  Risk of increased osmolality/dehydration  Nursing: All feeding methods require careful monitoring of patient weight, hydration and fluid balance  Risk of reflux with enteral methods  Nursing: Correct positioning of the patient during and after feeds  Risk of infection:  Nursing: Strict hand-washing; aseptic technique for IV line in TPN