“international health organizations and nursing organizations”

1. Enteral and Parenteral Nutrition
Applied Nutrition Unit-IV
Objectives
By the end of this unit the students will be able to:
• Define key terms
• Identify the characteristics, nutritional composition and concentration of formula feedings.
• Discuss complications associated with Enteral feeding.
Definition of Key Terms
• Enteral nutrition: Enteral feeding is a method of giving liquid nutrition directly into the
stomach or jejunum through a tube. (N/G or N/J).
• Parenteral nutrition: formula feed that is given intravenously.
• Infant formula: It is a manufactured food designed and marketed for feeding to babies and
infants under 12 months of age, usually prepared for bottle-feeding or cup-feeding from
powder or liquid. OR
• An artificial substitute for breast milk intended for feeding infants. It can come in powdered
form to be mixed with water or in instant liquid form.
Indications for Tube Feeding
• The following conditions require tube feeding:
• Inability to swallow
• Neurologic and neuromuscular disorders,
• Anatomical and post-surgical malformations of the mouth and esophagus
• Cancer
• Digestive disorders.
• Failure to grow or malnutrition

2. Types of Enteral Feeding Tubes
• According to the American College of Gastroenterology, there are six main types of feeding
tubes. These tubes may have further subtypes depending on exactly where they end in the
stomach or intestines.
• The main types of enteral feeding tubes include:
• Nasogastric tube (NGT) starts in the nose and ends in the stomach.
• Orogastric tube (OGT) starts in the mouth and ends in the stomach.
• Nasoenteric tube starts in the nose and ends in the intestines (subtypes include
nasojejunal and nasoduodenal tubes).
• Oroenteric tubestarts in the mouth and ends in the intestines.
• Gastrostomy tubeis placed through the skin of the abdomen straight to the
stomach (subtypes include PEG, PRG, and button tubes).
• Jejunostomy tubeis placed through the skin of the abdomen straight into the
intestines (subtypes include PEJ and PRJ tubes).

3. Classification of Enteral Formula
Standard (polymeric )
• Formula containing intact nutrition ( protein, fat, and CHO) which require normal or near
normal digestive and absorptive capacity and are complete with respect to vitamin, minerals.
• Contain 1-1.2 kcal/ ml and are used as over the counter oral supplement and tube feeding
formula. protein content 30 – 40 gm/L
Example of Standard Formula

4. Elemental & Semi-Elemental
• Contain partially or completely hydrolyzed nutrient (elemental).
• Formula have been hydrolyzed to contain short chain carbohydrate or simple sugar and amino
acid.
• Elemental formulas are easier for the digestive system to digest and absorb, making them
better suited for adults and children with digestive problems.
• Including malabsorption, short bowel syndrome, inflammatory bowel disease, and other
conditions that can cause problems with absorbing nutrition.
Example of Elemental & Semi- Elemental

5. Disease Specific
• Designed for patients with specific disease states.
• Available for patients with respiratory disease, diabetes, renal failure, hepatic failure, and
immune compromise.
Example of Disease Specific

6. Blenderized Feeding
• Used for patient that cannot tolerate semi- synthetic formulas or who wish to consume family
food.
• Formulize with a mixture of blenderized food source .
• They are made from real food ingredients such as chicken, vegetables and fruit, along with
added vitamins, minerals, fiber and other nutrients.
• Maintenance of aseptic technique is essential to prevent bacterial contamination.
Modular Formula
• Modular: provides protein, fat, or carbohydrate as single nutrients or modular mixtures to
allow adjustment of macronutrient mix.
• Created from individual macronutrient preparations called modules are prepared for patients
who require specific nutrient combination to treat their illness.
Example of Modular Products

7. Complications of Enteral Nutrition
• Food entering the lungs
• Constipation
• Diarrhea
• Improper absorption of nutrients
• Nausea, vomiting
• Dehydration
• Electrolyte abnormalities
• High blood sugar
• Vitamin and mineral deficiencies
• Feeding tubes inserted through the nose, such as nasogastric or nasoenteric tubes, can cause
• Irritation of the nose or throat
• Acute sinus infections
• Ulceration of the larynx or esophagus
• Feeding tubes inserted through the skin of the abdominal wall, such as gastrostomy or
jejunostomy tubes, can become clogged (occluded) or displaced, and wound infections can
occur.
Parenteral Nutrition (Types)
• Delivery of nutrients intravenously, e.g. via the bloodstream.
– Central Parenteral Nutrition:often called Total Parenteral Nutrition
(TPN); delivered into a central vein
– Peripheral Parenteral Nutrition (PPN):delivered into a smaller
or peripheral vein

8. TPN vs. PPN

9. Infant Formula Feeding
• Formula Feeding: Feeding an infant or toddler prepared formula instead of or in addition to
breastfeeding.
• Some parents choose formula-feeding either because of personal preference or because
medical conditions of either the mother or the infant make breastfeeding ill-advised.
Reasons for Choosing Formula-feeding
 There is an inadequate supply of maternal breast milk.
 The baby is sucking inefficiently.
 Parents are unable to quantify the amount of breast milk received by the baby.
 Some parents want to know exactly how much their baby is receiving at each feeding, and
formula/bottlefeeding allows exact measurement.
 A significant reason for not breastfeeding is concern about transferring certain drugs the
mother is taking through the breast milk to the infant.

10.  An increasing number of mothers must return to work shortly after their baby's delivery.
 A benefit of bottle-feeding is that the entire
 family can immediately become intimately involved in all aspects of the baby’s care, including
feeding.
References
• Enteral nutrition supplies and equipment. https://www.medicare.gov/coverage/enteral-
nutrition-supplies- equipment Accessed April 21, 2020.
• Bankhead R, et al. Enteral Nutrition Practice Recommendations. In: Journal of Parenteral and
Enteral Nutrition. United States. The American Society for Parenteral and Enteral Nutrition;
2009: 122- 167.
• Mesejo A, Acosta JA, Ortega C, et al. Comparison of a high-protein disease-specific enteral
formula with a high-protein enteral formula in hyperglycemic critically ill patients. Clin
Nutr,2003;22:295-305.
• Tehila M, Gibstein L, Gordgi D, Cohen JD, Shapira M, Singer P. Enteral fish oil, borage oil and
antioxidants in patients with acute lung injury (ALI). Clin Nutr, 2003;22(S1):S20
Believe you can and you’re halfway there.
Theodore Roosevelt