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Enteral nutrition has been implemented into medical practice for a long time and is considered to be a fundamental and essential part of the patient care. The practice of enteral nutrition is viewed as a specialized nutrition support for patients with different illnesses. The aim of this paper is to overview principles, indications, and complications of enteral nutrition, as well as to summarize routs of access, procedural pearls, and indications. Enteral nutrition is considered to be one of the safest methods of patient`s nutrition, which helps improve patient care and recovery. Nutritional patients` support is rather helpful and cost-effective in the medical practice of treating different diseases. A great number of recovered patients stay alive due to this method of nutrition. Research shows that patients, who receive enteral nutritional support, feel improvement in body weight and reduce the risk of fatal outcome (Chapman & Hall, 1994). Enteral nutrition has met world-wide recognition among physicians and professionals. Though this method has been known for over 100 years, it is widely used in the treatment and medical practice today.
Principals and Indications of Enteral Nutrition
Enteral nutrition is a method of patient`s care, which provides endoscopic and surgical access on a continuing basis. Those patients, who are unable to eat food, are supposed to be feed enterally with the help of physicians and different methods. Enteral nutrition or tube feeding is a method, which is commonly used in cases when people are ill, may have low appetite, difficulties in swallowing or some surgery side-effects. In such cases, nutrition is supposed to be ensured in any other possible way of feeding, in order to support the functioning of the human`s body and his or her wellbeing.
Though it may have a number of complications, enteral nutrition is considered to be the safest and most cost-effective method of nutrition for patients with various chronic and acute diseases, which is widely used in medical practice for years (Skipper, 2007). Enteral nutrition is recommended for patients as an effective support, in case they experience dysfunctions of gastrointestinal tracts. It can also help to reduce post-operative morbidity of patients. It is worth mentioning that according to the recent research, enteral nutrition prevents intestinal muscular atrophy, attenuates hypermetabolic response to injury and surgery and also is available to support gut associated shield (Skipper, 2007). Enteral nutrition is based on diets, such as elemental diet and polymeric liquid diet. Elemental diet consists of L-amino acids and simple sugars. Polymeric liquid diet comprises short peptides, vitamins, polysaccharides, medium chain triglycerides, and trace elements. Blenderized diets are strongly recommended to patients, who need enteral nutrition, because they are not supplemented with micronutrients and proteins. Thus, nasoesophageal or jejunostomy tubes are used as commercial enteral formulas provided for patients in hospitals and at home, to support them in enteral feeding. Enteral nutrition is usually taken orally or by NGT (nasogastric tube feeding), which supports a patient with special liquid food mixture that contains proteins, vitamins, sugars, fats and minerals. This liquid is given into the stomach through special tubes. NGT is usually put through fine bore. Patients who need long-term feeding can be fed by needle catheter jejunostomy, surgical gastrostomy, percutaneous endoscopic gastronomy, and surgical jejunostomy.
Rate of infusion during enteral feeding starts at a low rate and further increases. Strength of enteral feeding is gradually increasing due to the norms of treating a certain disease. In the process of enteral feeding, some complications may occur, such as feed intolerance, blockage or malposition of the tube, and gastro esophageal reflux.
All enteral nutrition techniques serve to make enteral feeding available to patients with certain dysfunctions of gastrointestinal tracts. Modern medical technology offers different enteral access and techniques, which can be used in accordance with the duration of enteral support, functional integrity of each part of the gastrointestinal tract, the risk of gastroesophageal reflux, and aspiration. For short-term use, for example, nasoesophageal tubes are the most effective technique. If patients need longer support, for example, more than two weeks, then it would be efficient to use more permanent tubes.
Chapman and Hall (1964) assert that, several indications for nutritional support are available. Firstly, preexisting nutritional deprivation is considered to be the most common indication for enteral nutrition. Malnutrition, which may be oftentimes observed in medical practice, may lead to patients` complications and risks of infections or iatrogenic starvation. Secondly, in some cases, inadequate oral energy intake may cause breakdown of glycogen stores, gluconeogenesis, amino acid oxidation from muscle stores, and peripheral lipolysis. To prevent such consequences, it is advisable to start enteral nutrition from a short-term period, such as 7-14 days, then going further for a longer period of feeding. Thirdly, significant multiorgan system disease is the most common indication for enteral support. Gastrointestinal, pulmonary, hematologic, cardiac, hepatic, and renal diseases need proper and adequate intake of oral nutrition.
TEN (Total Enteral Nutrition) is an effective method to feed patients with various diseases, in order to support them and prevent from weight loss and risk of fatal outcome; that is why physicians must be aggressive in their medical practice while dealing with such patients. Critically ill patients can survive owing to enteral nutrition, which has a lower rate of complications compared to parenteral nutrition. Optimal formulas of enteral nutrition must be chosen for each individual patient according to the disease and general physical state of the patient. Such nutritious components as RNA nucleotides, arginine, glutamine, omega-3 fish oilsand fiber have an important influence on patients` wellbeing, stimulate the immune system, maintain gut integrity, and prevent bacterial translocation from the gut. Parenteral nutrition can be used only in those cases, when enteral nutrition is not acceptable. Tube feeding is considered to be an ethical and legal solution for most patients instead of medical treatment (Skipper, 2007).
Many professionals consider enteral nutrition to be a preferable way of feeding patients, unless there are no dysfunctions or contraindications while using it. If there are any, parenteral feeding is used instead of enteral one. According to recent clinical studies, enteral nutrition may have fewer side effects if they are started in the early stages of diseases (Chapman, & Hall, 1994). Therefore, the effects and timing of enteral nutrition may be controversial. Nevertheless, in spite of positive results of enteral nutrition, physicians must take into consideration the possibility of various complications in TEN processing.
Complications of Enteral Nutrition
Side effect complications may occur due to mechanical, metabolic, and gastrointestinal reasons of enteral nutrition. Complications due to the mechanical problems may be the ones, which deal with the delivery of liquid, the size of the tube, its malposition, tube clogging, sterility, and composition of the feed. These complications are relatively easy to avoid or overcome. As to the metabolic and gastrointestinal complications, they are more difficult to prevent because of the numerous circumstances, patients` specifications, level and type of their diseases, and other features. According to the recent research, the most common complications in enteral nutrition are gastrointestinal side effects according to which patients may face the following complications (Skipper, 2007). Nausea and vomiting may be observed oftentimes among patients, who are receiving enteral nutrition. The estimated number of these patients is 10-15 percent. These symptoms are usually observed, when elemental diet is used. Patients may also suffer from diarrhea, which is usually associated with nasogastric tube feeding. Diarrhea may occur as a result of changes in patient`s flora because of intestinal content of antibiotics. The substance of antibiotics must be regulated at the beginning of enteral feeding in order to prevent it. Another complication of enteral nutrition is vitamin and trace element deficiencies, which can be shortened in the process of treating, though the amount of vitamins in the human body is not known. Infectious complications may also be observed in enteral nutrition of patients because of aspiration of the feed into the lungs. Therefore, bacterial contamination may cause infectious complications. Infectious complications are common in most cases of enteral nutrition, and it is complicated to prevent them. Preventive measures are required to protect patients from complications. In conclusion, incorrect enteral nutrition may be harmful; thus, only highly qualified physicians are supposed to do this job. Subsequences of enteral feeding must be taken into consideration, in order to achieve desired results in treating.
In conclusion, it is worth mentioning that enteral nutrition plays an important role in the process of feeding patients, who are unavailable or unwilling to eat. Enteral nutrition or feeding is occurred as an essential part of the treatment of various diseases, because the liquid, which is used in enteral nutrition, is reach in vitamins, proteins, fibers and other components, which are essential for the human health and wellbeing. Though the exact number of these components is not known, they are very helpful in the process of feeding and supporting ill patients. Unfortunately, there are some complications, which must be averted and overcome in order to make enteral feeding an effective tool in the medical practice. Enteral nutrition has become an essential part of patients` recovering from abdominal surgeries, which supports thousands of patients all over the world. Thanks to enteral nutrition patients can be back to normal life and casual activities.