Tube Feedings and Total Parenteral Nurition

If nutritional requirements are not met by oral intake and patients continue to lose weight, enteral access with tube feedings is the next step. A retrospective study by Scolapio and colleagues (1999) demonstrated that patients with CIP can generally be successfully managed with tube feeds using a standard nonelemental formula. A trial of nasogastric or nasoenteric tube feedings should be tried before placement of percutaneous feeding tubes. If patients are able to tolerate tube feeds with low residuals, few symptoms, and regular bowel movements, then consideration should be given for placement of a percutaneous gastrostomy, G-J tube, or direct placement of a jejunostomy tube. If delayed gastric emptying is present, then direct feeding of the small intestine is preferred. Multiple methods have been described for placement of enteral access, including endoscopy, radiology, or surgery. Continuous feeding or cyclical feeding (12 hours of continuous feeding during the night) is usually better tolerated than bolus feedings (see Chapter 54 "Enteral and Parenteral Nutrition").

Ideally, parenteral nutrition should be avoided due to the risks of cellulitis, sepsis, thrombogenesis, and catheter displacement. However, a large proportion of CIP patients will eventually require parenteral nourishment at some point. Patients should receive approximately 25 kcal/kg/d and lipids should supply approximately 30% of total parenteral calories with 1.0 to 1.5 g/kg/d protein and dextrose providing the remainder of required calories (Scolapio et al, 1999).

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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