3. • Outline the indications & complications of
EN
• Outline the indications & complications of
TPN
• Illustrate with diagrams about Tube-
feeding
4. • Nutritional support is the
provision of nutrients to
patients who cannot
meet their nutritional
requirements by eating
standard diets.
5. • To meet the energy
requirement
for metabolic processes.
• To maintain a normal core
body
6. • Avoiding of malnutrition
• Enteral nutrition – Ideal one
• Overfeeding to be avoided
• Timing & Type of nutrition
• Nutrition therapy protein wasting
• Immunomodulators – glutamine,
arginine, omega 3 fatty acids – very
useful
7. • No single “ Gold Standard ”
• Body wt.loss > 10% - 6mths – prognostic index
Body mass index : weight (kg)/ height (m2)
[ <18 .5 – nutritional impairment ]
• Anthropometric measures – Indirect measures
- TSF / MAC – muscle & fat mass
• Transport proteins –
(Sr.alb.-30mg/dl, prealb.-12g/dl,transferrin-150mmol/L)
• Immune incompetence –
TLC / Delayed Hypersensitivity
• MUST - Tool
8.
9. Severely Malnourished
Post – op complications
Trauma
Burns
Malignant disease
Renal & Liver failure
Short bowel syndrome
10. • Patient not expected to feed in 7
days
Prolonged ileus or intestinal
obstruction
Entero - cutaneous fistulas
Pancreatitis, U C, Pyloric stenosis
Major bowel surgery
• Esophageal replacement
• Gastric or colon surgery
• Whipple’s procedure
27. • Central – Catheter is placed
using a needle & guide wire
via -
• Subclavian approach
• Internal jugular approach
• External jugular approach
Superior
Vena Cava
28. • Peripheral Parenteral Nutrition
*Through a peripherally inserted
central venous catheter. [PICC]
Catheter.
*Through a formal peripheral
venous line.
32. Severity
Nutrition
Sepsis
Line
(refeeding syndrome)
Hypoglycaemia/Ca/P/Mg
Chronic deficiency syndromes
(EFA, Zn, mineral and trace
elements)
Glucose- Hyperglycaemia,
Over - feeding
fluid retention, electrolyte abn.
Fat- Hypertriglyceridemia
A.A- Aminoacidaemia,
uraemia, metabolic acidosis
Catheter related
Systemic sepsis
Drug interactions
> On insertion – PT / AE /
bleeding
> Long-term use - occlusion, VT
33. • Preserves gut integrity
• Possibly decreases bacterial translocation
• Preserves immunological function of gut
• Reduces costs
• Fewer infectious complications in critically ill patients
• Safer and more cost effective in many settings
34. • Is occurrence of severe fluid & electrolyte imbalance in
severely malnourished pts. while starting {RE-FEEDING}
EN/TPN. More common in TPN.
• Causes -
* ↓ Mg, ↓ Ca, & ↓ Po4 → myocardial dysfn.,
resp.changes, altered liver fns, convulsions & death.
• Commonly seen → chronic starvation, severe anorexia &
alcoholic pts.
• Gradual feeding & correction of Mg, Po4 & ca. & other
electrolytes & vitamins is important.
35. • It is becoming popular in Western countries.
• Indicated in Pts. who require nutrients for long term –
extensive Crohn’s, mesenteric infarction etc.
• Pt. uses the TPN fluids as advised at home. A
indweling Silastic catheter is designed for long term
use.
• Pt. should attend TPN clinic weekly – follow-up or any
complications.
• Pt. is psychologically comfortable & can attend his job
also.