Nutrition in ICU
6. Methods of nutritional replacement in ICU patients
Enteral Feeding and Feeding Tubes
Enteral feeding is the delivery of feed via a tube into the stomach, duodenum or jejunum. Tube feeding can be considered in those who have a functional and accessible gastro-intestinal tract and are unable to take oral feed safely, or unable to take adequate oral feed. Most people are fed into the stomach unless there is upper gastro-intestinal dysfunction. In that event, or if the upper GI tract is inaccessible, post-pyloric (duodenal or jejunal) feeding can be considered.
Most practitioners now administer continuous enteral feed to avoid erratic glucose control. Bolus feeding may seem more physiological but has no proven advantage.
Salem Sump tube (see picture below), a large bore NG tube for patients with high gastric losses and who require continuous nasogastric suction. It has a port through which air is entrained to equalise pressure in the stomach during suctioning. It is not ideal for long term feeding.
Vygon tubes come in various gauges; they are poorly visible on X-ray.
Merck Corflo tubes are high grade polyurethane and designed for long term feeding. Sizes 8-10Fr have a guidewire to aid insertion; the 12Fr does not. These are relatively easily visible on CXR.
Fresenius Kabi makes the Freka Sil and other manufacturers provide variations on the theme.
Post-pyloric Feeding: Insertion of naso-jejunal feeding tubes may be accomplished at the bedside, in radiology, by endoscopy, or by surgeons in theatre. They are used in patients with gastroparesis and often in acute pancreatitis. Another route of post-pyloric feeding is the jejunostomy tube, which is inserted surgically after certain major upper gastrointestinal procedures. Tubes include:
The Merck Corflo for bedside insertion
The Freka Sil for surgical or endoscopic insertion
Freka Enteral Feeding tubes e.g. Endo 250 for surgical or endoscopic insertion.
Gastrostomy feeding can be considered in people likely to need long-term enteral feeding, such as those with a neurological condition. This can be achieved by performing a percutaneous endoscopic gastrostomy (PEG) and the insertion of a PEG tube (see below). Complications include aspiration of feed and peritonitis.