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History of Enteral Nutrition:
Enteral nutrition refers to the delivery of nutrition directly into the gastrointestinal (GI) tract, typically through the use of a feeding tube. This method is employed when a person is unable to consume food orally or has difficulty absorbing nutrients through the digestive system. The history of enteral nutrition is closely tied to advancements in medical science and technology. Here is a brief overview:
- Early Developments (20th Century): The use of enteral feeding dates back to the early 20th century. In the 1920s, doctors began experimenting with nasogastric tubes, which are tubes inserted through the nose into the stomach. However, these early attempts faced challenges, including complications and limited understanding of nutritional requirements.
- World War II: The need for efficient and practical nutritional support became more apparent during World War II. Enteral feeding techniques were refined during this period, and the use of nasogastric tubes became more common for soldiers who were unable to eat.
- Development of Enteral Formulas: The 1960s and 1970s saw significant progress in the development of enteral formulas. Researchers and healthcare professionals worked on creating nutritionally balanced liquid formulas that could be delivered through feeding tubes. This marked a crucial step in providing a comprehensive and controlled source of nutrition.
- Advancements in Feeding Tube Technology: Over the years, there have been continual advancements in feeding tube technology. The development of more sophisticated tubes, such as gastrostomy tubes (directly inserted into the stomach through the abdominal wall) and jejunostomy tubes (entering the small intestine), improved the safety and effectiveness of enteral nutrition.
- Widespread Clinical Use: Enteral nutrition became a standard method of nutritional support in various clinical settings, including hospitals and long-term care facilities. It is commonly used for patients with conditions such as malnutrition, dysphagia, gastrointestinal disorders, or those recovering from surgery.
- Home Enteral Nutrition: As technology and medical understanding improved, the use of enteral nutrition expanded to home settings. This allowed patients who required long-term nutritional support to receive care in the comfort of their homes.
- Ongoing Research and Innovation: Research in the field of enteral nutrition continues to explore ways to optimize formulations, minimize complications, and improve patient outcomes. Innovations in tube design, nutritional supplements, and delivery methods are ongoing.
Overall, the history of enteral nutrition reflects the evolution of medical knowledge and technology in addressing the nutritional needs of individuals who cannot obtain adequate nutrition through oral intake.
Types of Enteral Nutrition:
The American College of Gastroenterology identifies six main types of feeding tubes, each with potential subtypes based on their ending location in the stomach or intestines. The choice of tube placement is determined by factors such as the required tube size, duration of enteral feeds, and digestive capabilities. Additionally, a medical professional selects an enteral formula based on tube placement, digestive abilities, and nutritional needs.
The main types include:
Nasogastric tube (NGT):
- A Nasogastric Tube (NGT) is a flexible tube that is inserted through the nose, down the throat, and into the stomach. It is commonly used for medical purposes to deliver nutrition, fluids, medications, or to remove substances from the stomach.
Orogastric tube (OGT):
- An Orogastric tube (OGT) is a medical device that is inserted through the mouth into the stomach. It is used for various purposes, including administering fluids, medications, or nutrients directly into the stomach, as well as removing stomach contents through suction.
Nasoenteric tube (with subtypes nasojejunal and nasoduodenal): A Nasoenteric tube is a type of medical tube that is inserted through the nose and extends into the small intestine. There are two main subtypes of Nasoenteric tubes: nasojejunal and nasoduodenal:
- Nasojejunal Tube:
- This type of tube is inserted through the nose and advanced into the jejunum, which is the second part of the small intestine.
- It is designed to bypass the stomach and deliver nutrients or medications directly into the jejunum.
- Nasoduodenal Tube:
- This type of tube is inserted through the nose and advanced into the duodenum, which is the first part of the small intestine.
- It is used for various medical purposes, including enteral feeding and medication administration.
- An “oroenteric tube” typically refers to a type of medical tube that is inserted through the mouth (oro-) and extends into the small intestine (enteric). These tubes are often used for various medical purposes, such as feeding, administering medications, or draining fluids from the stomach.
Gastrostomy tube (with subtypes PEG, PRG, and button tubes): A Gastrostomy tube (G-tube) is a medical device that is inserted through the abdominal wall into the stomach. It serves as an alternative route for delivering nutrition, fluids, and medications directly to the stomach when oral intake is not possible or is insufficient.
The subtypes of G-tubes include:
- PEG (Percutaneous Endoscopic Gastrostomy): This type of G-tube is inserted using an endoscope, a flexible tube with a light and camera at its end. The endoscope helps guide the placement of the tube through the abdominal wall into the stomach.
- PRG (Percutaneous Radiologic Gastrostomy): Similar to PEG, a PRG tube is inserted with the assistance of radiologic imaging. This method may be chosen when endoscopy is not feasible or appropriate.
- Button Tubes: These are low-profile G-tubes that sit flush against the skin surface. They have a disc-like shape and are designed to be less visible and more comfortable for the individual. Button tubes are suitable for long-term use and can be easily replaced during routine care.
Each subtype has its own advantages and considerations, and the choice of G-tube type depends on factors such as the patient’s medical condition, anatomy, and the preferences of the medical team involved.
Jejunostomy tube (with subtypes PEJ and PRJ tubes): A jejunostomy tube is a medical device that is inserted into the jejunum, which is the second part of the small intestine. This tube is used for enteral nutrition, providing a way to deliver nutrients directly into the small intestine when a person is unable to consume food orally. Jejunostomy tubes are typically inserted through the abdominal wall.
There are two main subtypes of jejunostomy tubes:
- PEJ (Percutaneous Endoscopic Jejunostomy) Tube:
- Inserted through the abdominal wall into the jejunum using endoscopic guidance.
- The insertion is typically done under visual control using an endoscope.
- It allows for direct access to the jejunum for feeding purposes.
- PRJ (Percutaneous Radiologic Jejunostomy) Tube:
- Similar to PEJ tubes, PRJ tubes are inserted through the abdominal wall into the jejunum.
- The insertion is guided by radiologic imaging techniques, such as fluoroscopy.
- This type of jejunostomy tube is placed with the assistance of radiological guidance rather than endoscopy.
Both PEJ and PRJ tubes serve the same purpose of providing enteral nutrition directly into the jejunum, but the method of insertion differs between the two subtypes.
Benefits of Enteral Nutrition:
Enteral nutrition refers to the delivery of nutrition directly into the gastrointestinal tract through a feeding tube. This method is commonly used when a person is unable to consume food orally, either temporarily or long-term. Here are some benefits of enteral nutrition:
- Nutritional Support: Enteral nutrition ensures that individuals receive the necessary nutrients, calories, and fluids to maintain optimal nutrition and prevent malnutrition.
- Maintains Gastrointestinal Function: By delivering nutrients directly to the digestive system, enteral nutrition helps maintain the normal function of the gastrointestinal tract, including the stimulation of digestive enzymes and the preservation of gut mucosal integrity.
- Preservation of Muscle Mass: Enteral feeding can help preserve muscle mass by providing a consistent supply of protein and other essential nutrients. This is particularly important for individuals who may be at risk of muscle wasting.
- Improved Wound Healing: Adequate nutrition is crucial for wound healing, and enteral nutrition can contribute to faster recovery by supplying the necessary nutrients for tissue repair and regeneration.
- Reduced Infection Risk: Enteral nutrition helps to maintain the integrity of the gut barrier, reducing the risk of bacterial translocation and infections. This is important for individuals with compromised immune systems.
- Patient Comfort and Compliance: Enteral feeding can be more comfortable for patients compared to other methods, such as parenteral nutrition (intravenous feeding). It may also enhance compliance with nutritional therapy.
- Cost-Effectiveness: In many cases, enteral nutrition is more cost-effective than alternative methods of nutrition support, making it a viable option for healthcare providers and patients.
- Flexible Delivery Options: Enteral nutrition can be administered through various types of feeding tubes, allowing for flexibility in choosing the most suitable method based on the patient’s condition and needs.
- Prevention of Aspiration: For individuals at risk of aspiration (inhaling food or liquids into the lungs), enteral feeding provides a safer alternative by bypassing the oral route.
It’s important to note that the use of enteral nutrition should be carefully monitored and tailored to the individual’s specific medical condition and nutritional requirements. Additionally, healthcare professionals play a key role in assessing and managing enteral nutrition to ensure its effectiveness and safety.
Complications of Enteral Nutrition:
Enteral nutrition, which involves providing nutrients through the gastrointestinal tract, can have various complications. Some common complications include:
Potential Complications of Enteral Nutrition:
- Aspiration: Inhaling formula into the lungs, which can lead to pneumonia. Proper positioning during feeding and monitoring can help prevent aspiration.
- Tube Displacement: The feeding tube may move out of its intended position, affecting the proper delivery of nutrients. Regular checks and securement of the tube can help prevent displacement.
- Tube Blockage: Accumulation of formula residue or medication can cause blockages in the feeding tube. Regular flushing and proper administration techniques can minimize the risk of blockage.
- Diarrhea or Constipation: Changes in bowel habits may occur as the body adjusts to enteral nutrition. Adjusting the formula composition or rate may help manage gastrointestinal symptoms.
- Nausea and Vomiting: Some individuals may experience nausea or vomiting, particularly if the formula is not well-tolerated. Adjusting the formula, rate, or administration schedule can help alleviate these symptoms.
- Hyperglycemia or Hypoglycemia: Monitoring blood glucose levels is crucial, especially in individuals with diabetes, as enteral nutrition formulas can affect blood sugar levels.
- Electrolyte Imbalance: Enteral nutrition may impact electrolyte balance, leading to imbalances such as low or high levels of sodium, potassium, or other electrolytes. Regular monitoring and adjustments to the formula may be necessary.
- Infection: Infections at the site where the feeding tube enters the body (stoma) or within the gastrointestinal tract can occur. Strict adherence to hygiene practices and regular site care can help prevent infections.
- Allergic Reactions: Some individuals may be allergic to specific components of enteral nutrition formulas, leading to allergic reactions. Selecting an appropriate formula based on allergies and monitoring for adverse reactions is important.
- Metabolic Complications: Enteral nutrition can impact metabolic processes, potentially leading to issues such as hyperglycemia, hypertriglyceridemia, or other metabolic disturbances.
It’s important for healthcare professionals to closely monitor patients receiving enteral nutrition and address any complications promptly to ensure the safety and effectiveness of the nutritional support.
Resources for Enteral Nutrition:
- The Oley Foundation
- American Society for Parenteral and Enteral Nutrition
- Book: ASPEN Enteral Nutrition Handbook Second Edition 2019
This handbook contains recommendations on safe practices, ENFit®, and information on preparation, labeling, and dispensing of EN. It is a step-by-step, practical guide to caring for patients receiving EN therapy.
- Book: ASPEN Enteral Nutrition Handbook Second Edition 2019