Nutrition Needs/Formula Selection

•Medical Foods –Fluids 35 ml/kg/d •May be increased with    increased losses –Calories 20-35 kcal/kg/d –Protein 1.0-1.5 g/kg/d •May be increased in    wounds, acute/chronic    disease, malnutrition –With/without fiber –Disease-specific needs

Because most formulas that yield 1 calorie per ml will contain around 80% water, the patient receiving 1500 ml per day would receive about 1500 calories and about 1200 ml of water. Fever, diarrhea, vomiting, and sweating may require additional fluids.

Calorie needs range widely and will usually fall between 20-35 calories per kg of body weight per day. Protein needs generally range between 1.0 to 1.5 grams per kilogram of body weight per day. Protein and calorie needs may be on the high end or higher in cases of disease, wounds (including burns), and malnutrition.

There are many features of formulas to tailor to the patient needs and tolerances, including formulas that contain fiber, emphasize or de-emphasize particular nutrients, or address dietary needs of specific diseases or conditions.

 

Tube Placement

Tube placement decisions are made based on the issues that need to be dealt with, such as risk for aspiration, length of time that a need for tube feedings are anticipated, and disease or other condition requirements. Tubes are generally placed nasally or through a stoma (enterostomy).   Types of tube placement Location Nasogastric/intestinal –    most common for short term Enterostomy – longer term requirements Methods Nasogastric – beside may be common Distal to pylorus – placed with assistance of endoscopy or fluoroscopy Enterostomy – surgical

Nasogastric feedings are commonly placed for patients who may require tube feeding for a month or less. New tubes that are fine bore have made it easier to avoid irritation, esophageal reflux, and other discomforts associated with larger bore tubes. Trained staff should insert the tubes to reduce the risk of misplacement and perforations. In some cases, gastric feeding may not be well-tolerated. Nasally placed tubes can also be placed to deliver nutrients directly into the intestine at the duodenal or jejunal levels. Feedings into the small intestine may be most appropriate in patients who have gastroparesis, problems with reflux and risk of aspiration, and in cases of pancreatitis.