Nutricion

Journal of Parenteral and Enteral Nutrition
http://pen.sagepub.com/ Enteral Nutrition Practice Recommendations
Robin Bankhead, Joseph Boullata, Susan Brantley, Mark Corkins, Peggi Guenter, Joseph Krenitsky, Beth Lyman, Norma A. Metheny, Charles Mueller, Sandra Robbins, Jacqueline Wessel and A.S.P.E.N. Board of Directors JPEN J Parenter Enteral Nutr published online 26 January 2009 DOI:10.1177/0148607108330314 The online version of this article can be found at: http://pen.sagepub.com/content/early/2009/01/27/0148607108330314

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JPEN J Parenter Enteral Nutr OnlineFirst, published on January 27, 2009 as doi:10.1177/0148607108330314

Special Report

EnteralNutrition Practice Recommendations

Journal of Parenteral and Enteral Nutrition Volume XX Number X Month XXXX xx-xx © 2009 American Society for Parenteral and Enteral Nutrition 10.1177/0148607108330314 http://jpen.sagepub.com hosted at http://online.sagepub.com

Enteral Nutrition Practice Recommendations Task Force: Robin Bankhead, CRNP, MS, CNSN, Chair; Joseph Boullata, PharmD, BCNSP; Susan Brantley,MS, RD, LDN, CNSD; Mark Corkins, MD, CNSP; Peggi Guenter, PhD, RN, CNSN; Joseph Krenitsky, MS, RD; Beth Lyman, RN, MSN; Norma A. Metheny, PhD, RN, FAAN; Charles Mueller, PhD, RD, CNSD; Sandra Robbins, RD, CSP, LD; Jacqueline Wessel, MEd, RD, CSP, CNSD, CLE; and the A.S.P.E.N. Board of Directors. NOTICE: These American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Enteral NutritionPractice Recommendations are based upon general conclusions of health professionals who, in developing such recommen­ dations, have balanced potential benefits to be derived from a particular mode of providing enteral nutrition with known associated risks of this therapy. The underlying judgment regarding the propriety of any specific practice recommen­ dation or procedure shall be made by theattending health professional in light of all the circumstances presented by the individual patient and the needs and resources particular to the locality. These recommendations are not a substitute for the exercise of such judgment by the health professional, but rather are a tool to be used by the health professional in the exercise of such judgment. Use of this document is voluntary and should not bedeemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed toward obtaining the same result. TABLE OF CONTENTS Preface I. Introduction II. Ordering and Labeling of Enteral Nutrition A. Formulary Selection Process B. Elements of the Order C. Enteral Nutrition Order Forms D. Labeling of Enteral Nutrition III. Enteral Formula (Medical Foods) and Infant FormulaRegulation A. Background B. Medical Foods C. Infant Formulas IV. Water and Enteral Formula Safety and Stability A. Water Safety 1. Types of Water Used in Enteral Nutrition 2. Indications for Use of Water B. Enteral Formula Safety 1. Contamination 2. Hang Time 3. Stability V. Enteral Access A. Selection of Enteral Access Devices B. Insertion of Enteral Access Devices C. Maintenance ConsiderationsD. Long-Term Enteral Access E. Initiation of Feedings after Placement of Long-Term Enteral Access Device VI. Enteral Nutrition Administration A. Initiation and Advancement of an Enteral Nutrition Regimen B. Enteral Feeding Pumps C. Patient Positioning D. Flushes E. Enteral Misconnections VII. Medication Administration A. Dosage Forms and Administration B. Gastric vs Intestinal Delivery C. Drug...