1. Intestinal Failure AKA Short Gut Syndrome

2. Definition
Inability of the small bowel to digest and absorb enteral nutrients for normal growth and development resulting from an alteration in the process of peristalsis, digestion and absorption

3. Etiology Necrotizing Enterocolitis Atresias (Duodenal, jejunal, ileal)
Gastroschisis
Midgut volvulus
Hirschsprungs disease
Intestinal pseudo-obstruction

4. Common features Altered bowel anatomy and function
Malabsorption of nutrients, vitamins and minerals
Increased nutritional needs
Increased stool/ostomy output
Increased fluid needs

5. Malabsorption and Increased Nutritional Needs
Malabsorption is dependent upon extent and location of bowel resection
Degree of malabsorption is difficult to assess and contributes to higher nutritional needs
Nutritional needs are based on the amount of calories, protein and fluids that promote growth
Requires ongoing monitoring
Potential for growth failure

6. Increased Stool/Ostomy Output
Dependent on length and function of remaining bowel
Prone to gastric/intestinal hypersecretion
Disproportionate to amount of enteral nutrition provided
Potential for increased fluid, sodium, bicarbonate and zinc losses
At risk for bacterial overgrowth

7. Increased Fluid Needs
Vary greatly and are based on remaining anatomy (+/- colon)
Often have excessive output which requires strict monitoring to determine and maintain baseline fluid needs
Needs are generally increased as enteral feedings are advanced due to greater output

8. Monitoring Look at trends rather than day to day fluctuations Weights
Stool output (< 50ml/kg/day)
Laboratory values: CBC with Differential, TPN profile and urine electrolytes weekly

9. Home Care Education

10. Home Health Care Agency
Central Line therapy
Administration of home TPN
Enteral therapy
Monitoring:
Intake and output
Weight
Specific gravity

11. Bedside Nurses Well baby care Reinforce Home Health Care teaching
Feeding tube care (NG/NJ/GT/JT)
Ostomy care
Medications including administration
Formula including recipe and preparation

12. Bedside Nurses Measuring intake and output Diaper weights
Measuring Stool
Documenting with intake and output sheets
Ensure that family has obtained medications and formula before discharge

13. Followup Nutritional and Intestinal Care Clinic Pediatrician
Other specialists (High Risk, Surgery)
Home Health Care Visits

14. Home Care Teaching Sheets

15. Central Line Therapy Central Line care
Flushing, securing, cap and dressing changes
Safety Guidelines for activities
Supplies and equipment
Delivery, storage and use, reordering
Assessment/problems/emergency care
Home Care services

16. Home TPN Preparing for administration Adding vitamins Priming tubing
Pump operation and trouble shooting
Hooking up to central line
Setting rate and volume
Tapering

17. Enteral Therapy Administrating Feedings Formula preparation
Pump operation- setup and trouble shooting
Use of Farrell bag
Daily feeding schedule
Care of feeding tube
Recording intake and output

18. Enteral Therapy Safety Guidelines for activities Possible problems
Aspiration, feeding intolerance, clogged tube, skin care
Supplies and equipment
Delivery, storage and use, reordering
Home Care services