What is Nutrition Support Therapy?
Nutrition support is “food” provided either by a tube or IV when a person is not able to eat enough, or at all, by mouth. When nutrition support is provided through a tube into the stomach or small intestine it is called enteral nutrition (EN). EN is the first choice for nutrition support when a person is unable to eat by mouth. However if the GI tract is non-functional due to medical reasons, sometimes nutrition support is provided via parenteral nutrition (PN), which is given through the veins. Enteral and parenteral nutrition may be given for as little as a few days to weeks or life-long. The goal of nutrition support is provide adequate nutrition for growth, development, and healing. Each patient’s nutrition support prescription is tailored to their individual needs.
Enteral nutrition, or tube feeding, may be indicated when a person has inadequate oral intake or increased nutrition needs. Inadequate oral intake may be related to dysphagia, feeding difficulties, decreased appetite, GI intolerances, or eating disorders. A person may have increased nutrition needs related to acute illness, chronic disease, or surgery. Tube feeding formulas can provide complete nutrition including carbohydrates, protein, fat, vitamins, minerals, and water. Infants and children, as well as adults may receive tube feedings. If a person is able to eat some by mouth but not meet 100% of nutrition needs, an oral diet may be continued along with tube feeding.
There are a few types of enteral feeding tubes. Minimally invasive feeding tubes intended for short term use (up to 4-6 weeks) are inserted though the nostril and placed in the stomach (nasogastric tube or NG) or small bowel (nasojejunal tube or NJ). If tube feeding is needed for a longer-term period, a surgically placed tube may be indicated. A PEG or G-tube is placed in the stomach and a J-tube is placed in the jejunum portion of the small bowel.
Gastric vs Small Bowel Feeding
Gastric feedings are typically well tolerated by patients who cannot meet their nutrition needs orally but otherwise have a normally functioning GI tract. Gastric feedings can be given by bolus, gravity, or continuous infusion. Small bowel feedings are given when a person is unable to tolerate gastric feeding; usually due to gastroparesis, nausea and vomiting, or ileus. Small bowel feedings must be given by continuous or intermittent infusion.