Nutritional support provides nutrients to patients who cannot eat standard diets. There are two main types: enteral nutrition, which delivers nutrients via the gastrointestinal tract through tubes or feeding; and parenteral nutrition, which delivers nutrients intravenously. Enteral nutrition is preferred when possible. Parenteral nutrition is more complex and expensive but can provide nutrition when enteral feeding is not possible or sufficient. Both enteral and parenteral nutrition require monitoring to watch for complications.

1. NUTRITIONAL SUPPORT
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2.  Nutritional support is the provision of
nutrients to patients who cannot meet
their nutritional requirements by eating
standard diets.
Definition
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3. Types of nutrition support
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 Routes of nutrition support
 Enteral nutrition
 Parenteral nutrition

4. Enteral nutrition
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 In general, the preferred method of choice

5. Enteral Nutrition
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 Nutrition delivered via the gut
 Includes oral feedings and tube feedings

6. Long-term nutrition
Enteral nutrition
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• Gastrostomy
Jejunostomy
 Short-term nutrition
•
•
•
Nasogastric feeding
Nasoduodenal feeding
Nasojejunal feeding

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11. Enteral Formulas
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 Liquid diets intended for oral use for
tube feeding
 Ready-to-use or powdered form
 Designed to meet variety of medical
and nutrition needs
 Can be used alone or given with foods

12. Enteral Formula Categories
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 Polymeric
 Monomeric
 Fiber-containing
 Disease-specific
 Immune enhancing
 Rehydration
 Modular

13. Enteral Formula Categories
Polymeric
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 Whole protein nitrogen source
 For use in patients with normal or near
normal GI function
 Protein isolate formulas
 Protein that has been separated from a food
(casein from milk, albumin from egg)
Blenderized formulas


 May contain pureed meat, vegetables, fruits, milk,
starches with v/m added
Made at home or purchased commercially

14. Categories
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Polymeric

15. Enteral Formula Categories
Monomeric
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 Hydrolyzed
 Predigested proteins and simple
carbohydrates
 Free amino acids
 Has low fat content

16. Enteral Formula Categories
Monomeric
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17. Enteral Formula Categories
Monomeric
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 Use in patients with compromised
digestive and/or absorptive capacity
 More expensive than standard formulas

18. Modular enteral formula
A modular formula is an incomplete liquid
supplement that contains specific
nutrients, usually a single macronutrient
(carbohydrate, protein or fat). Different
modules can be combined to result in a
nutritionally complete diet.

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


 Gastrointestinal
Mechanical
Metabolic
Formula related
Complications

20. GI Complications
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 Vomiting
 Diarrhea
 Constipation
 Abdominal pain / bloating
 Gastric irritation
 Aspiration

21. Mechanical Complications
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 Tube occlusion
 Nasopharyngeal effects
 Leakage
 Obstruction

22. Metabolic Complications
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 Hypovolemia
 Hyperkalemia
 Hypophosphatemia
 Hypertonic dehydration
 Fluid overload

23. Formula Complications
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 Incompatibility with medications
 Hyperosmolality
 Contamination

24. Parenteral Nutrition
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25. Parenteral Nutrition
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Allows greater caloric intake
BUT


 Is more expensive
Has more complications
Needs more technical
expertise

26. Who Will Benefit From
Parenteral Nutrition?
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Patients with/who
 Abnormal gut function
 Cannot consume adequate amounts of
nutrients by enteral feeding

27. Two Main Forms of
Parenteral Nutrition
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 Peripheral Parenteral Nutrition
 Central (Total) Parenteral
Nutrition

28. Peripheral Parenteral Nutrition
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Given through peripheral vein
 Short term use
 Mildly stressed patients
 Low caloric requirements
 Contraindications to central
TPN

29. Venous Access for TPN
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Need venous access to a central line
with fast flow to avoid thrombophlebitis
Superior
Vena Cava
• Subclavian approach
• Internal jugular approach
• External jugular approach

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31. 1. Protein as crystalline amino acids.
2. Carbohydrate in the form of glucose
3. Fats as lipids
4. Electrolyte Sodium , potassium, chloride , calcium
and magnesium.
5. Metal /trace elements –Zinc, copper , manganese,
chromium ,selenium.
6. Vitamins A, C, D, E,K, thiamine, riboflavin, niacin,
pantothenic acid, pyridoxine , biotin, choline and folic
acid.
COMPONENTS OF TPN

32. Decide how much fat &
carbohydrate to give
Determine Total Fluid Volume
Determine Caloric needs
Determine Protein requirements
Determine Electrolyte and Trace
element requirements
Determine need for additives
Steps to Ordering TPN
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33. TPN PREPARATION:-
All the TPN bottles are kept in laminar flow hood and ultra
violate rays are switched on .
Two hours later the ultra violate rays are switched off .
The Doctor or Nurse scrubs and puts on a gown,cap mask and
gloves and mixes the solutions as per calculation inside the
laminar flow hood. If ultra violate are not switched off during
mixing the personnel may get conjunctival irritation .
They then connect the bottles to the IV set under strict aseptic
precautions.
The TPN assembly and bottles along with the tubing are
changed every 24 hours.

34. TPN Monitoring Schedule :
Serum electrolytes : 3-4 times/ week initially, then weekly
Blood urea : 3-4 times/ week initially, then weekly
Calcium, magnesium, phosphorus : 3-4 times/ week
initially, then weekly
Glucose :2 times / day
Urine glucose : Daily.
Protein : Weekly
Liver function tests : weekly.

35. TPN Monitoring Schedule :
Haematocrit : Weekly
Serum triglycerides : 4hours after a dose increase initially ,
then weekly.
PHYSICAL ASSESSMENT
Weight, Intake output, Inspection of catheter insertion
site -- Daily

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37. Thank you !!
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