Enteral and Parenteral Nutrition Seminar

ENTERAL AND
PARENTERAL
NUTRITION
Chairperson: Presented by,
Dr. ANUSHA KULKARNI Ameen Aksher
MSc Nutrition and
LECTURER
Dietetics , JNMC
DEPARTMENT OF PUBLIC
HEALTH, JNMC , KAHER
Content
• Introduction
• Enteral Nutrition
• Parenteral Nutrition
• Enteral vs Parenteral Nutrition
• Benefits of Enteral and Parenteral Nutrition
• Risks and Side Effects of Enteral and Parenteral Nutrition
• Nutritional Assessment
• Conclusion
• References
Introduction
• This presentation on enteral and parenteral nutrition. in this

presentation, we will explore the world of nutrition support,
specifically enteral and parenteral nutrition, and how it can improve
patient outcomes.
• We will discuss the different types of nutrition support, when they are
used, their benefits and drawbacks, as well as potential risks and side
effects.
What is Enteral Nutrition?
1. Enteral nutrition refers to the delivery of nutrients directly into the
gastrointestinal tract through a feeding tube. This method is used when a patient
is unable to consume food orally due to medical conditions such as dysphagia,
neurological disorders, or surgery.
2. Enteral nutrition can be administered through different types of tubes, including

nasogastric, gastrostomy, or jejunostomy tubes.
3. The administration of enteral nutrition requires careful monitoring and

management to ensure that the patient receives the appropriate amount of
nutrients and hydration.
Types of Food
1. Natural liquid foods: These are foods that are naturally liquid or can be easily
liquefied, such as milk, eggs, juice, soup, or yogurt.
They can provide adequate nutrition for some patients who can tolerate them 1
.
2. Blenderised feeding: These are foods that are blended to make a thin liquid that
can pass through the feeding tube. They can include cooked cereals, vegetables,
fruits, meats, or dairy products.
They can provide more variety and flavor than commercial formulas, but they
also have some drawbacks, such as clogging the tube, bacterial contaminatio
n, or nutrient imbalance
234
.
3. Elemental diets: These are foods that are made of protein or amino acids, fats,
and carbohydrates in easily digestible forms. They can also include vitamins,
Types of Feeding Requirements
1. Continuous feeding: This method involves adding formula to a bag and feeding
it over an extended period, usually 16-24 hours.
It is typically used for bedridden patients or those who cannot tolerate large
volumes of feed at once
1
.
2. Intermittent feeding: This method involves giving a set amount of formula at
regular intervals, usually 4-6 times a day. It can be done by using a pump,
syringe, or gravity drip.
It is suitable for patients who have some oral intake or who are more active 12.
3. Bolus feeding: This method involves giving a large amount of formula in a short
time, usually 10-15 minutes. It can be done by using a syringe or gravity drip. It
mimics normal meal patterns and allows more freedom for the patient.
However, it cause abdominal discomfort, nausea, or aspiration12.
4. Cyclic feeding: This method involves giving continuous feeding for a shorter
period, usually 8-12 hours, often at night. It allows the patient to have some oral
When is Enteral Nutrition Used?
 Enteral nutrition be used in a variety of medical conditions, such as severe

burns, cancer, and gastrointestinal disorders. In these cases, patients have
difficulty eating or absorbing nutrients through their digestive system,
making enteral nutrition a crucial source of sustenance.
 By providing essential nutrients directly to the patient's digestive tract,

enteral nutrition can improve patient outcomes by promoting healing,
reducing complications, and increasing overall strength and energy levels.
What is Parenteral Nutrition?
I. Parenteral nutrition is a method of providing

nutrients to the body through an INTRAVENOUS
(IV) LINE. This means that nutrients are
delivered directly into the bloodstream,
bypassing the digestive system.
II. Parenteral nutrition is typically used when a

patient is unable to tolerate or absorb nutrients
through their gastrointestinal tract. This may be
due to a variety of medical conditions, such as
inflammatory bowel disease, pancreatitis, or
certain types of cancer.
Types of Parenteral Nutrition
There are two main types of parenteral nutrition:
Total Parenteral Nutrition (TPN) and
Partial Parenteral Nutrition (PPN)1.
•TPN is complete nutrition delivered intravenously

to people who can’t use their digestive systems at
all.
TPN might be required when certain conditions impa
ir your ability to process food and absorb nutrients th
rough your digestive tract, or when you need to avoid
using your digestive system for a while so it can heal
1
.
• TPN is delivered into a central vein, usually in the
chest, neck, or groin
, through a long catheter that is inserted by a doctor
•PPN is similar to TPN, but it provides less than
100% of your nutritional needs.
PPN might be used when you can still eat
some food by mouth
, but not enough to meet your nutritional requirement
s, or when you are transitioning from TPN to oral fee
ding
1
.
• PPN is delivered into a peripheral vein

, usually in the arm or hand, through a short catheter
that is inserted by a nurse
2
When is Parenteral Nutrition Used?
 It is typically used when a patient is unable to tolerate enteral nutrition or has a
condition that prevents them from absorbing nutrients properly through their
digestive system.
 Medical conditions that require parenteral nutrition include severe malnutrition,

Crohn's disease, short bowel syndrome, and certain types of cancer.
Total parental nutrition formula for children and
adults
 Water: Children need more water per kilogram of body weight than adults,
especially if they have fever, diarrhea, or vomiting.
• The usual range is 40 to 60 mL/kg/day for children and 30 to 40 mL/kg/day fo
r adults
12
.
 Energy:
• The main source of energy is glucose, which is usually given at
a rate of 4 to 6 mg/kg/min for adults and 5 to 8 mg/kg/min for children to avoi
d hyperglycemia
2
• The usual range is 40 to 60 kcal/kg/day for children and 30 to 35 kcal/kg/day f

or adults
12
.
 Amino acids: Children need more protein per kilogram of body weight than adults,
 Essential fatty acids:
These are fats that the body cannot synthesize and must obtain from the diet.
• They are usually given as a fat emulsion (lipids) composed of triglycerides,
phospholipids, glycerol, and water.
• The recommended dose is 0.5 to 1 g/kg/day for both children and adults, not ex
ceeding 2.5 g/kg/day
13
.
 Vitamins and minerals:

• These are micronutrients that are involved in various metabolic processes and are
necessary for normal growth and development.
• The daily requirements vary depending on the patient’s age, weight, and clinical
condition.
• A standard multivitamin and mineral solution is usually added to the TPN for
mula
1
.
Patient Monitoring While On TPN
1.Nutritional Assessment: Assess the patient's specific nutritional needs based on
their medical condition and goals.
2.TPN Formulation: Collaborate with the healthcare team to formulate and adjust the
TPN regimen to meet the patient's unique nutritional requirements.
3.Monitoring Nutrient Intake: Track the patient's nutrient intake to ensure that the
TPN formula provides adequate nourishment.
4.Evaluate Tolerance: Assess the patient's tolerance to TPN and recommend
modifications if signs of intolerance, such as nausea or abdominal discomfort, arise.
5.Weight and Anthropometric Measurements: Regularly measure and monitor the
patient's weight and other anthropometric measurements to assess the
effectiveness of the TPN regimen.
6.Electrolyte and Fluid Balance: Monitor laboratory results and suggest adjustments
to the TPN formula to maintain proper electrolyte and fluid balance
Enteral vs. Parenteral Nutrition
 Enteral and parenteral nutrition are both methods of providing nutrients to patients who
are unable to consume food orally.
 Enteral nutrition involves the delivery of nutrients directly into the gastrointestinal tract,
typically through a tube that is inserted through the nose or mouth and down into the
stomach or small intestine.
 Parenteral nutrition, on the other hand, involves the delivery of nutrients directly into
the bloodstream, typically through a catheter that is inserted into a vein.
 There are situations in which one method be preferred over the other. For example,
enteral nutrition is generally preferred when the patient's digestive system is functioning
normally but they are unable to eat or swallow due to an injury or illness.
 Parenteral nutrition be necessary when the patient's digestive system is not functioning
properly, such as in cases of severe malabsorption or bowel obstruction.
Benefits of Enteral and Parenteral Nutrition
 Enteral and parenteral nutrition have numerous benefits for patients. One
of the most significant is improved patient outcomes.
 When patients receive adequate nutrition, their bodies are better

equipped to fight off infections and heal from injuries or surgeries. This can
lead to shorter hospital stays and a faster recovery time.
 In addition to improving patient outcomes, enteral and parenteral nutrition

can also reduce healthcare costs.
Risks and Side Effects of Enteral and Parenteral Nutrition
 Infection is a common risk associated with both types of nutrition, as the feeding tubes
can introduce bacteria into the body.
 Metabolic complications, such as electrolyte imbalances or high blood sugar, can also
occur with both enteral and parenteral nutrition.
 Gastrointestinal problems, such as diarrhea or constipation, also arise with enteral

nutrition.
 However, it's important to note that these risks can often be managed through proper
monitoring and care.
 Additionally, patients should be educated on the signs and symptoms of potential

complications and instructed on how to properly care for their feeding tubes.
Nutritional Assessment
1. Nutritional assessment is a critical step in determining the need for enteral or
parenteral nutrition.
2. This assessment involves evaluating a patient's nutritional status, including their

weight, body mass index, and laboratory values such as albumin and pre-
albumin levels.
3. In addition to these objective measures, it is also important to consider

subjective factors such as the patient's appetite, dietary intake, and
gastrointestinal function.
4. For example, a patient with a poor appetite or difficulty swallowing benefit

from enteral nutrition, while a patient with severe malabsorption require
parenteral nutrition.
Conclusion
 In conclusion, enteral and parenteral nutrition are vital tools in improving patient
outcomes.
 Enteral nutrition is administered through the gastrointestinal tract, while parenteral

nutrition is given intravenously.
 Both types of nutrition can be used to treat a range of medical conditions, including
cancer, malnutrition, and gastrointestinal disorders.
References
1. American Society for Parenteral and Enteral Nutrition. (2016). A.S.P.E.N. clinic
al guidelines: nutrition support of hospitalized pediatric patients with obesity.
Journal of Parenteral and Enteral Nutrition, 40(4), 472–486.
2. Barr, J., Hecht, M., & Flavin, K. (2000). Outcomes in critically ill patients befor
e and after the implementation of an evidence-based nutritional managemen
t protocol. Chest, 118(3), 787–793.
3. 1. csun.edu
4. 2. msdmanuals.com
5. 3. nurseslabs.com
6. 1. webmd.com
7. 2. my.clevelandclinic.org
8. https://aci.health.nsw.gov.au/networks/nutrition/resources/parenteral/fact-s
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ENTERAL AND

• This presentation on enteral and parenteral nutrition. in this

2. Enteral nutrition can be administered through different types of tubes, including

3. The administration of enteral nutrition requires careful monitoring and

 Enteral nutrition be used in a variety of medical conditions, such as severe

 By providing essential nutrients directly to the patient's digestive tract,

I. Parenteral nutrition is a method of providing

II. Parenteral nutrition is typically used when a

•TPN is complete nutrition delivered intravenously

• PPN is delivered into a peripheral vein

 Medical conditions that require parenteral nutrition include severe malnutrition,

• The usual range is 40 to 60 kcal/kg/day for children and 30 to 35 kcal/kg/day f

 Vitamins and minerals:

 When patients receive adequate nutrition, their bodies are better

 In addition to improving patient outcomes, enteral and parenteral nutrition

 Gastrointestinal problems, such as diarrhea or constipation, also arise with enteral

 Additionally, patients should be educated on the signs and symptoms of potential

2. This assessment involves evaluating a patient's nutritional status, including their

3. In addition to these objective measures, it is also important to consider

4. For example, a patient with a poor appetite or difficulty swallowing benefit

 Enteral nutrition is administered through the gastrointestinal tract, while parenteral

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