Several different methods and routes of nutritional support are available for a patient, the choice of which depends on the nutritional status of the patient, the adequacy of gastrointestinal function and the foreseen duration of need.
Varieties of Support
Chose If
regular meals
GI tract absorption is adequate and nutritional needs are normal or slightly increased
oral supplements
routine meals are inadequate to meet all the estimated energy needs, high caloric supplements can provide sufficient calories to provide adequate nutrition
tube feedings
GI tract absorption is adequate but meals and oral supplements are insufficient to meet current and projected nutritional needs, feeding tubes can be placed to provide additional nutritional delivery
TPN
GI tract absorption is inadequate
Tube feedings:
(1) If the patient is not at risk for aspiration, a gastric tube can be employed. If aspiration is a risk, the tube should be placed in the duodenum or jejunum
(2) If the duration of tube feeding is relatively short, a nasal tube (nasogastric, nasoduodenal) can be used. For tubes needed for more than 4-6 weeks, a surgically placed enterostomy tube (gastrostomy, jejunostomy) tube should be used.
(3) Formula may be given continuously or by bolus. Bolus administration can be used for ambulatory patients, while hospitalized patients tolerate continuous feedings better.
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