What is Enteral Nutrition?

Enteral nutrition (EN) is a nutritional support method that provides nutrients and various other nutrients required for metabolism via the gastrointestinal tract. It depends on the length of time, mental state and gastrointestinal function. There are two types of enteral nutrition: oral and transcatheter. Transcatheter is used to include nasogastric tube, nasoduodenal tube, nasal jejunal tube and gastrojejunostomy tube.

Enteral nutrition

Enteral nutrition history

The development of providing nutrients through nasogastric catheters was mainly seen at the end of the 18th century and has been widely used until the 19th century. The earliest enteral nutrition formulation was Nutramigen, which was introduced to the market in 1942 to treat children's intestinal diseases.

The improvement of the chemical formula mainly benefited from the development of the aerospace industry in the 1950s and 1960s. The chemical composition in this formula is clear, without residue, and can be absorbed without digestion. The application results show that normal people can maintain normal nutrition and physiological status by relying only on this element within 6 months.

Enteral nutrition benefits

With the in-depth study of the structure and function of the gastrointestinal tract in recent years, it has been gradually realized that the gastrointestinal tract is not only a digestive and absorption organ, but also an important immune organ.

Because of this, compared with parenteral nutrition (PN) support, the superiority of EN is reflected in the fact that nutrients are directly absorbed and utilized by the intestines, which is more physiological, convenient to administer, and low in cost. Advantages of maintaining the integrity of the intestinal mucosal structure and barrier function. Therefore, when deciding what kind of nutritional support to provide, the preferred EN has become the consensus of many clinicians.

Enteral nutrition classification

I; macromolecular polymers

Homemade homogeneous meal; milk, soy milk. Fish, meat, vegetables and other foods are made by grinding and adding water.

Macromolecular polymer preparation; contains protein, sugar, fat, vitamins, minerals and water.

Two; elementary diet;

Three; special formula

High branch chain amino acid formula;

Must be amino acid formula;

component formula;

Enteral nutrition indication

Enteral nutrition when the gastrointestinal tract is functional and safe

Difficulty swallowing and chewing

Unconsciousness or coma

Gastrointestinal fistula

Short bowel syndrome

Intestinal inflammatory diseases

Acute pancreatitis

High metabolic status

Chronic wasting disease

Correct and prevent malnutrition before and after surgery

Special diseases

Enteral nutrition contraindications

Paralytic and mechanical intestinal obstruction, active gastrointestinal bleeding, and shock are contraindications to EN. Severe diarrhea, refractory vomiting, and severe malabsorption syndrome should also be used with caution.

Enteral nutrition tube feeding complications and prevention

Mechanical complications

Reason: Its occurrence is often related to the feeding tube itself, such as the size and material of the tube diameter. Aspiration pneumonia is a potentially fatal complication, which may be caused by damage to the lower esophageal sphincter, displacement, or improper posture of a large-diameter feeding tube.

Treatment: The patient's head should be raised 30 degrees during nasal feeding, and it can be placed flat after lh after irrigation; if the gastric residual fluid is withdrawn during nasal feeding, if it is greater than 100ml, nasal feeding should be suspended or the perfusion rate should be slowed down.

blocked feeding tube

Reason: The concentration of nasal feeding solution is too high or the homogenate is not completely broken.

Treatment: After nasal feeding, the tube should be washed with water to ensure that no food remains in the tube.

Gastrointestinal complications

Diarrhea is most common

Causes of diarrhea: long-term absence of food, first nasal feeding, excessive perfusion rate, malabsorption, too high concentration, lactose intolerance, etc.

Treatment: Start with low concentration for the first time, gradually increase the concentration and reduce the perfusion rate; for patients with lactose intolerance, lactose-free formula should be given.

metabolic abnormalities

Such as dehydration, edema room potassium and high magnesium, etc., should pay attention to observation, and adjust the composition of the formula in a timely manner.

Enteral nutrition considerations

Understand the composition and preparation of diet

Total volume does not exceed 2000ml

Head and neck raised during tube feeding

After tube feeding, rinse the tubes with warm water

Enteral nutrition nursing measures

Ensure that the nutrient solution and infusion utensils are clean and sterile. The nutrient solution must be prepared in a sterile environment, placed in a refrigerator below 4 degrees Celsius for temporary storage, and used up within 24 hours.

For patients who protect the mucous membrane and skin for a long time with nasogastric tube or nasointestinal tube, apply ointment daily to keep the nasal cavity lubricated and keep the skin around the fistula mouth clean and dry.

Prevent aspiration

Maintain the position of the gastric tube: For patients with delayed gastric emptying and infusion of nutritional fluid through a nasogastric tube or gastrostomy, take a semi-recumbent position to prevent reflux and aspiration.

Measure the amount of residual fluid in the stomach: During the infusion of the nutrient solution, the residual amount in the stomach is aspirated every 4 hours. If it is greater than 150ml, the infusion should be suspended.

(3) Observation and treatment: Once coughing, coughing out a nutrient solution-like substance, cyanosis, or shortness of breath, it can be determined to be aspiration. Patients are encouraged to cough and inhale. If necessary, clear the person through the bronchoscope.

Preventing gastrointestinal nutrition complications

Catheterization complications: nasopharyngeal and esophageal mucosal damage; blocked ducts, etc.

gastrointestinal complications: nausea, vomiting, abdominal pain, bloating, diarrhea, constipation, etc.

Prevention method:

1) Formulation of nutrient solution concentration and osmotic pressure: start with low concentration.

2) Control fluid volume and infusion rate: The fluid volume starts from a small amount, and the infusion rate increases gradually from slowly.

3) Control the temperature of the nutrient solution: Generally, the temperature is controlled at about 38 ° C.

Infectious complications: aspiration pneumonia.

Metabolic complications: hyperglycemia, hypoglycemia, and electrolyte disturbances are caused by uneven nutrition or improper component formula.

Feeding tube care

Properly fixed;

Prevent twisting, folding and compression;

keep clean and sterile;

Rinse regularly.