Complications- Gastrostomy
- Perforation
- Bit of colon trapped between stomach and abdominal wall (blind procedure)
- Peritonitis
- Pain
- Remember they may be unable to express
- Parenteral
- Infection from line
- Thrombosis
- Electrolyte/LFT derangement
Parenteral nutrition
- Placement
- Lower third of SVC
- Careful you don't go into the RA
- Feeds
- Off-the-shelf
- Often don't contain any micronutrients
- Can be modified in lab
- Customised
- Indications
- Obstruction
- Perforation
- Short bowel
- High output small bowel fistula
- Prolonged ileus (in extreme cases)
- NOT for PN
- Post-GI surgery
- Passage of food normally helps anasatmoses
- Acute pancreatitis
- Absent bowel sounds
- These come mostly from the colon - so small bowel may still be working
Nutritional requirements
- Energy 25-35 kcal/kg
- Protein 0.8-1.5 g
- Fluids 30-35 ml/kg
- Electrolytes
- Micronutrients
Refeeding syndrome
- Key change is hypophosphataemia
- NB affects oxygen dissociation curve
- Also:
- Changes in Na/K as ATPase starts working again
- Co-factors taken up by cells (thimine, Mg)
- Salt and water retention
- Can cause oedema
- Beware giving fluids if urine o/p falls!
- Avoidance:
- Start at 50% of requirements
- Increase slowly
- Give:
- Thiamine 200 mg OD
- Vitamin B co-strong TT QDS
Medico-legal
- Withdrawing nutrition support is equivalent to withholding
- Artificial support is deemed medical treatment, not basic care
Notes
- Nursing homes will typically take PEGs but not NGs
- => Questionable indication
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