Introduction
V. Transitioning from Enteral Nutrition Support
Before beginning the process of weaning from tube feedings, the patient should have an adequate nutrition status or the ability to return to normal status by eating. In addition, it is important to ensure that the patient’s fluid needs are being met either by tube or orally during the transitional phase.
A. Transitioning from continuous tube feedings. When a patient is tran- sitioning from full enteral nutrition support, physiologic preparation should be initiated by providing the patient bolus feedings through- out the day to simulate meals and snacks. This strategy is imple- mented in an effort to stimulate hunger and to achieve the association of satiety with feedings.11Initially, oral intake can be minimal and coupled with supplemental feedings via tube after each meal to provide the majority of nutrition needs. As oral intake increases, tube-feeding formula volume is decreased, keeping the combined regimen isocaloric.94Another option is to provide a por- tion of the tube feedings by continuous drip at night, ending at least 1 hour before the first meal. This allows freedom from tube feeding during the day and helps promote an appetite. This also is useful in patients who have short-bowel syndrome and require small, frequent feedings to optimize intestinal absorption. If the patient is receiving elemental tube feedings due to intestinal malabsorption or if weight gain is deemed inadequate, additional calories may need to be pro- vided via the feeding tube, but efforts to continue to increase the intake of oral foods should still be encouraged.
B. Discontinuing tube feedings. When the patient is able to consume 75% of nutrition needs by mouth, the tube feeding can be discon- tinued but the feeding tube left in place. Before the feeding tube is removed, factors that should be considered include the type of tube placement (ie, nasogastric vs. a more permanent gastrostomy), the underlying medical condition(s) that necessitated the tube, whether fluid needs can be met, and whether medications can be adminis- tered without the tube. It is especially helpful to observe patients who have received long-term enteral nutrition support during an acute illness to determine the future necessity of the tube.11 (Enteral Nutrition Management chapters from the 1st edition were contributed by Linda Lord, Linda Trumbore, Gary Zaloga, Kristy Gibbons, Nancy Cyr, Michael L. Christensen, and Richard A. Helms)
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90 A.S.P.E.N. Nutrition Support Practice Manual 2nd Ed. © 2005 A.S.P.E.N. www.nutritioncare.org.
Elizabeth A. Krzywda, RN, APN, MSN;
Charles E. Edmiston Jr, PhD
6
Parenteral Nutrition Access and Infusion Equipment
Introduction
The development of central venous access devices is closely linked to the development of total parenteral nutrition. Today, the use of central venous access has become a standard for a multitude of intravenous (IV) therapies. Vascular access is both an art and a science. Decisions and practices related to device selection, placement, and maintenance as well as appropriate use of infusion systems affect the success of par- enteral nutrition administration. This chapter addresses the following: