Therapies

Good nutrition is important to everyone but crucial to those with disease-related malnutrition or recovering from surgery. The body will then be working extra hard to restore good health, thus increasing nutritional needs.

The nutrients needed to build body tissue and provide energy for bodily functions include: carbohydrates, protein, fat, vitamins, minerals and water.

Normally these are provided by a balanced diet as a result of everyday eating and drinking. However, if a patient has a problem with their digestive system, it may be necessary for them to receive their nutrition in liquid form through a tube.

The two types of artificial nutrition:

1. Parenteral nutrition is given into a main vein, close to the heart.

The nutrients that the body requires are in a solution which is administered intravenously through a small permanent catheter placed in a main vein. There are two types of catheter: one which has an external segment and one which is an implanted device.

The catheter must be connected to the bag of nutrient solution under aseptic conditions, as the catheter tip lies approximately 3cm from the heart. The connection procedures have been developed to ensure that the risk of allowing bacteria into the bloodstream is virtually nil.

The normal volume infused is between 2 – 3 litres, but some may need larger volumes for a longer time. It is generally given over a 10 – 12 hour period, and most people choose to do this overnight.

Parenteral nutrition (PN) is also referred to as ‘total parenteral nutrition’ (TPN) and ‘home parenteral nutrition’ (HPN).

2. Enteral Nutrition is received via a fine tube that is placed in one of three ways.

2a. Naso-gastric feeding

The naso-gastric feeding tube is inserted through the nose and is advanced until it reaches the stomach. Different-sized tubes may be used. In certain cases the tube can be passed down the nose and advanced into the small bowel: this is called a naso-jejunum tube. There are various ways of administering the feed:

Bolus administers the feed solution over a 15-20 minute period several times a day;

Intermittent gravity drip administers the feed solution over 30-60 minutes several times a day;

Continuous administers the feed solution over a period of between 8-24 hours.

These methods may be used in combination and will involve the use of an enteral feeding pump or gravity drip.

Each episode of delivery is tailored to individual needs.

2b. Gastrostomy feeding

A gastrostomy feeding tube is placed by a doctor through the abdominal wall into the stomach, thus bypassing the mouth and oesophagus. This is also sometimes referred to as a PEG (percutaneous endoscopic gastrostomy) or a Button gastrostomy.

There are various ways of administering the feed:

Bolus administers the feed solution over a 15-20 minute period several times a day;

Intermittent gravity drip administers the feed solution over 30-60 minutes several times a day;

Continuous administers the feed solution over a period of between 8-24 hours.

These methods may be used in combination and will involve the use of an enteral feeding pump or gravity drip.

Each episode of delivery is tailored to individual needs.

2c. Jejunostomy feeding

A jejunostomy feeding tube is placed by a doctor through the abdominal wall directly into a part of the small intestine called the jejunum. This is sometimes referred to as a PEJ (Percutaneous Endoscopic Jejunostomy). Feeding into the jejunum bypasses the mouth, oesophagus and stomach.

There are various ways of administering the feed:

Intermittent gravity drip administers the feed solution over 30-60 minutes several times a day;

Continuous administers the feed solution over a period of between 8-24 hours.

These methods may be used in combination and will involve the use of an enteral feeding pump or gravity drip.

Each episode of delivery is tailored to individual needs.