Enteral Nutrition – Definition and Clinical Use
Enteral nutrition refers to the delivery of nutrients directly into the gastrointestinal tract, typically via a feeding tube. It is used when patients cannot consume adequate nutrition by mouth.
Wissenswertes über "Enteral Nutrition"
Enteral nutrition refers to the delivery of nutrients directly into the gastrointestinal tract, typically via a feeding tube. It is used when patients cannot consume adequate nutrition by mouth.
What is Enteral Nutrition?
Enteral nutrition (also called enteral feeding) is a form of clinical nutrition therapy in which nutrients are delivered directly into the gastrointestinal (GI) tract. This is typically achieved through feeding tubes or catheters when a patient is unable to consume enough food or fluids by mouth. Unlike parenteral nutrition, which delivers nutrients intravenously (directly into the bloodstream), enteral nutrition uses the body´s own digestive system, making it the preferred route whenever the GI tract is functional.
Indications – When is Enteral Nutrition Used?
Enteral nutrition is indicated when the GI tract is functioning but oral intake is insufficient or impossible. Common clinical indications include:
- Swallowing disorders (dysphagia) following stroke or in neurological diseases
- Head and neck cancers affecting the mouth, throat, or esophagus
- Severe burns or major trauma
- Unconsciousness or coma
- Critically ill patients in intensive care with elevated nutritional needs
- Inflammatory bowel diseases (e.g., Crohn's disease) during specific phases
- Premature infants or newborns with immature swallowing reflexes
- Severe cases of anorexia nervosa or other eating disorders
Access Routes and Feeding Tube Systems
The appropriate access route depends on the diagnosis, expected duration of therapy, and the individual condition of the patient:
Nasogastric Tube (NGT)
A thin tube is passed through the nose into the stomach. This method is typically used for short-term feeding (up to approximately 4 weeks).
Nasojejunal or Nasoduodenal Tube
The tube is advanced further into the small intestine (jejunum or duodenum). This is preferred when gastric emptying is impaired or when there is a high risk of aspiration.
PEG – Percutaneous Endoscopic Gastrostomy
For long-term enteral feeding (more than 4 weeks), a PEG tube is commonly placed. Using an endoscope, a tube is inserted through the abdominal wall directly into the stomach. This method provides greater comfort and stability for long-term patients.
PEJ – Percutaneous Endoscopic Jejunostomy
Similar to a PEG tube, but positioned in the jejunum. It is used when the stomach needs to be bypassed.
Composition of Enteral Formulas
Enteral formulas (tube feeds and oral nutritional supplements) are commercially manufactured, nutritionally complete preparations that provide all essential nutrients in defined amounts:
- Macronutrients: Carbohydrates, proteins, and fats in balanced proportions
- Micronutrients: Vitamins, minerals, and trace elements
- Dietary fiber: Included in some formulas to support bowel function
- Specialized formulas: Tailored for patients with diabetes, renal insufficiency, or elevated protein requirements
Formula selection is guided by the individual nutritional needs of the patient, the underlying disease, and the current nutritional status.
Administration and Dosage
Enteral nutrition can be administered continuously (via pump over 24 hours) or intermittently (in bolus portions simulating meals). The exact volume and infusion rate are determined and regularly adjusted by the treating physician or nutrition support team. A gradual increase in feed volume at the start of therapy helps minimize gastrointestinal intolerance.
Advantages Over Parenteral Nutrition
Enteral nutrition is always preferred when the GI tract is functional, as it offers several key benefits:
- Preservation of the intestinal mucosa and gut microbiome
- Lower risk of infection compared to intravenous feeding
- More physiological nutrient absorption
- More cost-effective in clinical practice
- Supports the immune function of the gut-associated lymphoid tissue
Possible Complications and Risks
As with any medical intervention, enteral nutrition carries potential risks:
- Aspiration: Entry of formula into the airways – particularly in unconscious or dysphagic patients
- Diarrhea: A common side effect when the feeding rate is increased too quickly or the formula is poorly tolerated
- Constipation: Particularly with low-fiber formulas or reduced mobility
- Tube blockage or displacement: Technical complications related to the access device
- Refeeding syndrome: A potentially life-threatening metabolic complication when severely malnourished patients are refed too rapidly
- Local infections or pressure ulcers at the tube insertion site
Clinical Monitoring and Multidisciplinary Care
Enteral nutrition requires close monitoring by a multiprofessional team including physicians, nurses, registered dietitians, and speech therapists where relevant. Regular laboratory assessments (e.g., electrolytes, blood glucose, renal function), as well as monitoring of body weight and fluid balance, are essential to the success and safety of nutritional therapy.
References
- Lochs H et al.: Introductory to the ESPEN Guidelines on Enteral Nutrition. Clinical Nutrition, 2006; 25(2): 180-186.
- ESPEN – European Society for Clinical Nutrition and Metabolism: Clinical Nutrition Guidelines. Available at: www.espen.org
- Mahan LK, Raymond JL: Krause's Food and the Nutrition Care Process. 14th edition. Elsevier, St. Louis 2017.
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Related search terms: Enteral Nutrition + Enteral Feeding + Enterally Administered Nutrition