Foods as Medicinal value and its footprint on long term Tube feeding Patient
Certain functional foods have medicinal value which one has to recognize. Since years, food is used as therapeutic medicine treatment for many diseases and for the patient’s convalescence, quoted by Ancient physicians, such as Hippocrates, Celsius, and Avicenna.
Why do we use tube feeding (Ryle’s tube)?
It is often observed that patients on tube feeding does not get required nutrition. There are patients who are unable to fulfill their nutritional requirement , as per their clinical condition . Example are many reasons such as can’t swallow, dysphagia ,mouth cancer, esophagus cancer, severe accidents, stroke ,Parkinson and various other physiological conditions. In order to fulfill their increased metabolic and prolonged needs through tube, feedings are being given. Their nutrition requirement should get fulfilled by giving in blenderized form with added nutritional supplement. There is a consensus that nutritional support, which provided to patients on tube feeding, influences their recovery. A Practical approach to educate and train staff was initiated to highlight importance of right nutrition ,at right time and right amount.
Aim:
- To assess nutritionally patients on long term tube feeding based on medical condition, as per standards
-To Bridge the gap between learned theory and actual administered feeding practices
- To evaluate the practical problems associated with delivery of planned tube feeds
- To ensure administration of prescribed doses of nutritional supplements to meet the calculated needs
- To Correct root cause and train concern staff
Methodology: A exploratory study using convenience sampling settings was used. In total 81 patients with varied health conditions admitted were taken into consideration. Data using four major assessment tools were carefully collected, considered and correctly interpreted in order to make a nutritional diagnosis namely dietary and fluid intake, clinical assessment, anthropometry and biochemistry.
Dietary and fluid intake: The assessment of dietary and fluid intake included questions on current and past dietary intake like:
• since when patient is on Tube feeding
• When was the last feed given ?
• Degree of malnutrition /weight loss ?
• Known allergies?
• on Special diets?
•
If Oral/nasogastric (NG)/percutaneous
endoscopic gastrostomy ?
• If (PEG)/jejunal percutaneous endoscopy (JPE)? since when?
•
Texture of food/fluids
•
If Nutrients
supplied by IV fluids?
• Other factors considered includes: Amount of fat, maintenance of glucose, nutrients supplied by dialysis fluids, Medication (oral and/or IV) is noted daily. Drug-medication interactions, blood and blood products, appetite, nausea, vomiting, satiety, constipation, diarrhea, cramping, flatus, pain, fatigue, depression, religion, preferences (likes/dislikes) were considered.
History suggest Years | |
1980s | Great advances have occurred in the development of
chemically defined and organ-specific diets, development of more advanced
techniques for access. Feeding tubes have been improved so that they are
thinner, more comfortable and safer. In addition, gastrointestinal tract
accesses through radiological, surgical and endoscopic techniques for
nasoenteric intubation and gastrojejunostomy tube placement have been
improved |
In the
last decades | Multi organ failure became the
main cause of death among critically ill patients |
1988,
Wilmore | Hypothesized that bacterial translocation could
be the main source and trigger for sepsis. Therefore, research focused on
studying the gastrointestinal tract, which went from being considered a mere
nutrient digestion and absorption organ to the spotlight as a barrier against
bacteria and intraluminal toxins and an organ with significant hormonal,
metabolic and immune functions |
Data Analysis:
|
Renal |
Cardiac |
Pulmonary |
Liver |
Oncology |
Others conditions |
Neurology |
|
8 patients |
6 patients |
8 patients |
3 patients |
15 patients |
21 patients |
20 patients |
· 75.3% were
administered as per planned nutrition on start.
· 20 Patients of 81 were on NBM and
the feeds were stopped for duration of 24 to 48 hours for various reasons like
colonoscopy, surgery, RT Aspiration that is 24.6%
· 16 patients were in wards of which
1 patient’s RT feed quantity was changed from 250CC/2hrly to
200CC/2hrly after 5 days
· 65 patients were in Critical care
unit of which 18 patients RT feed quantity/ dosage was changed over the period
of enteral feed duration.
· Minimum of 25cc/2hrly and
maximum of 100cc/2hrly was seen to be changed as per tolerance and
changes in their physiological state.
· After 6-7 days of administrating
the feed, Improvement was seen in
overall condition transition to semisolid foods ,full diet.
· When the patient’s condition deteriorates or patient’s tolerance is reduced the quantity is reduced for tube feeding
· We found out, as per standards Guidelines 25-50% of the recommend being met on day one followed about 60-80% by day three according to tolerance of the patients.
The findings of this study:
The data collection of each patient’s feed quantity was measured and monitored . The time was checked for every feed and if not given on time the reasons for the same was noted. Reason for delays and other time factor were noted. the root cause was corrected by informing the issue and sorted it out.
Note: However, if enteral nutrition
cannot be used, parenteral nutrition should be immediately started.
Justification for the Nutritional Support:
The main purpose is to prove foods as medicine and its impression on long term tube feeding patient. As a researcher , we realized that nutrition is very dynamic role. If careful planned it works as wonder, resulting in patient's improvement. The metabolic changes that occur in response to stress lead to weight loss as well as negative protein balance resulting in a significant loss of lean body mass, other complications especially infectious ones and long stay in critical care unit. so monitoring is very very crucial side by side education of assigned staff is very important role. Even in patients whose nutrient requirements is not met by oral intake, yet have a functional gastrointestinal tract, can be given through gut . In critically ill patients, malnutrition exists leading to prolonged ventilator dependency results in infectious morbidity and mortality.
Recommendation: Nutritional education and training has crucial role in recovery of patient so full team as shown in figure, required to work together. Further detailed researches with different types of feeds such as PEG, Jejunostomy feeds needs to be done in future and disease specific nutritional supplements are required.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401731/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564561/
By: Ushakiran Sisodia R.D Msc Gold medallist, PGDBM ,CDE; A.N Radha winner (Best Practicing dietician three consecutive years )
Neha Sawant M.sc Food processing and preservation Assistant Manager Nutrition and dietetics
Sanjana Rao M.sc Dietetics and applied nutrition (MNT)
Shruti Nair M.sc Dietetics and applied nutrition (Pediatric)
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