Entheral Nutrition Procedures, Uses, And Complications

Entheral Nutrition Procedures, Uses, and Complications

Principles of Nutrition for Healthcare


The success and safety of entheral feeding depends largely on proper attention to the management standards by the nursing staff is in charge of administration. Depending on the nature and severity of clinical condition, many patients unable to eat solid foods benefit fromthe administration of liquid diets, complete or modular, which can be easily delivered orally via a nasogastric tube / entheral tube or an enterostomy.
It is essential that medical staff, nursing and nutrition possess sound knowledge of the processes of digestion and absorption, on the route of administration of nutrients and the composition and characteristics of different entheral formulasavailable (ASPEN,1993).
Before starting a regimen of entheral nutritional support, the nutritionist must complete the assessment of nutritional status, according to the research protocol and define the purposes of the regime (filling, maintenance, weight reduction, etc...) And the management plan based on protein calorie requirements and special conditions of the patient.
Entheral feedingwas defined as the nutritional intervention technique by which all or most of the energy requirements, protein and micronutrients is administered orally (voluntary) or through a tube placed in the gastrointestinal tract (without the active participation the patient). The feeding tubes have been in clinical use for 150 years, while gastrointestinal suction tubes have only been used for about 60years. The current trend is toward increasing use of tubes specifically designed for power supply and decreasing the use of suction tubes.
The tube can be Nasogastric; can be placed blindly or endoscopically under fluoroscopic vision, Enterostomy: Farigostomía, Gastrostomy, or Jejunostomy.
The probe duodenal (first and second portion) really should be treated like gastric, by the phenomenonof duodenogastric reflux and the consequent risk of aspiration.
The probes or tubes are uncomfortable and cause considerable apprehension in the patient, undesirable effects are minimized with the use of new siliconized tubes and polyurethane thin (5-12 Fr), specially designed for entheral nutrition. However, the prospect of prolonged intubation, consider the creation of a gastrostomy, jejunostomyor, in selected cases, a Farigostomía (Robinson, 1987). The gastrostomy is the procedure of choice in most patients. Its main advantage is the simplicity of its management, in that it preserves the osmoregulatory function of the stomach. Through a gastrostomy can place a special catheter gastrostomy, or alternatively, although less desirable, a Foley catheter. The gastrostomy can be created bysurgical or percutaneous (endoscopic or fluoroscopic). The choice between these three methods depends on the patient's condition and experience in the institution. Their results, as recent publications, are comparable in terms of efficiency and complications.
Sometimes gastrostomy should be combined with simultaneous insertion of a jejunal tube, which allows the administration of nutrientswhile gastric suction is performed to prevent aspiration. This method is preferably used in neurological patients with impaired brain function in patients with pyloric obstruction will be subjected to surgical correction and those with postoperative gastric paresis syndrome (gastric atony or delayed gastric emptying) observed after gastric resection or gastrojejunostomy (Sitrin, 1992). The techniqueof gastric aspiration, simultaneous with jejunal feeding, has been advocated with solid justification. It is increasingly used more often and has seen excellent results.
Rombeau described a simple technique of gastrostomy / jejunal intubation using a gastrostomy tube, through which passes a thin catheter that goes to the jejunum. The scope is very useful for positioning the catheter in...