ROUTES OF NUTRITION SUPPORT GUIDELINE

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Presentation transcript:

ROUTES OF NUTRITION SUPPORT GUIDELINE www.criticalcarenutrition.com Able to meet needs via oral route? Hypermetabolic&/or malnourished: EN contraindicated >7-10 days? No Contraindication to EN? (see blue box) Yes Yes No Yes No Oral diet. EN PN; reassess q 24 - 48 hrs re EN. No PN; reassess q 24-48 hrs re EN. Contraindication to gastric EN? (see purple box) Absolute contraindications: Mechanical bowel obstruction Bowel ischemia Relative contraindications: Hemodynamic instability Small bowel ileus Small bowel fistulae Bowel anastomosis No Yes Gastric EN. Postpyloric EN. Nasoduodenal Feeding Tubes Manual Placement Techniques: Kalliafas S, et al. Erythromycin facilitates postpyloric placement of nasoduodenal feeding tubes in intensive care unit patients: randomized, double-blinded, placebo-controlled trial. JPEN 20:385-388,1996. Nicholas CD, et al. Simple bedside placement of nasal-enteral feeding tubes: a case series. Nutr Clin Pract 16:165-168, 2001. Salasidis R, et al. Air insufflation technique of enteral tube insertion: a randomized, controlled trial. Crit Care Med 26:1036-1039,1998. Ugo PJ, et al. Bedside postpyloric placement of weighted feeding tubes. Nutr Clin Pract 7:284-287,1992. Zaloga G. Bedside method for placing small bowel feeding tubes in critically ill patients. Chest 100:1643-1646,1991. Contraindication to gastric EN: 1) Gastric residual volumes > threshold maximum (250 ml) despite prokinetics agents. 2) Chronic/acute gastroesophageal reflux. 3) High risk pulmonary aspiration (i.e. required to be cared for in prone or supine position). Planned abdominal surgery? Yes No Intraoperative postpyloric feeding tube. Short term: nasoduodenal tube. Long term: feeding jejunostomy. Short term: manual (see pink box), endoscopic, or fluoroscopic nasoduodenal feeding tube. Long term: endoscopic or fluoroscopic gastrojejunostomy. Developed by J. Greenwood, RD, (Vancouver General Hospital) in collaboration with the CCCCPGC (1/1/07).