Nasogastric Feeding, Intravenous Nutrition or Peg Tube Feeding

Many conditions may render a patient unable to, or unwilling to, consume sufficient nutrition orally, for more than a few days.

Such conditions may include:

• Systemic scleroderma involving the GIT (gastrointestinal tract)
• MND (Motor Neurone Disease) or ALS (Amyotrophic Lateral Sclerosis)
• Cancers of the jaw, mouth, tongue, larynx, pharynx, esophagus or stomach ( after surgery or during radiation and / or chemotherapy )
• Dementia or Advanced Alzheimer’s
• Guillain-Barre Syndrome
• Head Trauma or Traumatic Brain Injury
• Cerebrovascular Accident ( Stroke )
• During respiratory failure ( patient on a ventilator )
• Anorexia Nervosa
• Cystic Fibrosis
• Severe acute pancreatitis / Severe liver failure
• Mayor Trauma or Burns
• Severe GI ( gastro intestinal) bleeding
• High output fistulas
• Intractable vomiting or diarrhea
• Short bowel syndrome after minor or mayor resection

Nutrition Support  should be given either:

• enterally ( nutrition provided into the gastrointestinal tract, via a tube or a stoma / opening) or
• parenterally ( provision of nutrients intravenously )

Enteral nutrition (EN) implies feeding into the gut / GIT via a feeding tube with the tip in the  stomach or small bowel.  This method of feeding is appropriate only for short – term feeding ( 3-4 weeks maximum )

Feeding tubes are classified by their “French size” which is the measure of the outer tube diameter. A French size of 5 – 12 is typically considered  “small bore” and a French size more than 14 is considered “large bore”  Typically the tube is inserted at the bedside by a skilled nurse, or when risk factors are present, in the X- ray department.

Placement of tubes into the stomach are commonly used, but some patients may not tolerate  nasogastric feeding, (for eg if the risk of aspiration pneumonia exists ) and a nasoduodenal  or nasojejunal tube  (placed further down into the small intestine ) may be needed.

When  EN is required for more than 4 weeks, nasal and upper GIT irritation should be avoided and  placement of a surgically or endoscopically guided gastrostomy or jejunostomy feeding tube should be considered. Percutaneous endoscopic gastrostomy  ( PEG ) is a surgical technique for placement of a tube directly into the stomach through the abdominal wall, using an endoscope and local anaesthesia (usually )

Parenteral Nutrition (PN) provides nutrition directly into the blood stream, intravenously.

PN may be used as an adjunct to oral or EN to meet nutrient needs. Your clinician will choose between central ( the catheter tip is placed into a large vein such as the superior vena cava ) or peripheral (placement into a small vein typically in the forearm). Commercially available PN solutions contain essential amino acids, carbohydrate as dextrose monohydrate, intravenous lipid emulsions and electrolytes, vitamins and trace elements.