Editing Artificial nutrition (section)

=== Routes: ===

* '''Oral, including supplements'''
** Patients who can drink but have impaired appetite or intake for other reasons
* '''Tube-feeding (NGT/NJT/PEG/PEJ)'''
** '''Route selection'''
*** Standard NGT is ok, but use a fine-bore feeding tube if planning to do it for more than a week - causes fewer gastric and oesophageal erosions
*** If planning for more than 4-6 weeks, use a PEG to minimise risk of complications from long-term NGT
*** In most patients, it is appropriate to start with gastric feeding and then progress to jejunal feeding if required
*** Jejunal feeding may be preferable in pancreatitis or if there is another reason to want to bypass the stomach
** Techniques
*** Fine-bored NGT insertion
**** See 'NGT insertion'
*** PEG insertion
**** See description under 'gastroscopy procedures'
** Regime
*** Should have regime by dietician
**** Boluses of 200-500mL pushed by syringe several times per day - the most physiologic and easiest method - only for gastric feeding
**** Intermittent infusions over 20-30 mins - generally tolerated well in gastric/small bowel feeding tubes
**** Continuous - common in ICU - can be run overnight to increase appetite for eating during the day
*** Aim to reach goal rate at 2 or 3 days
*** Start at 20-30mL/hr
*** Discontinue feeding for 4-5 hours overnight to allow gastric pH to return to normal
*** Aspirates on a regular basis, and if they exceed 200mL over a two hour period, then feeding temporarily discontinued