Enteral nutrition: type, definition and uses with patients

In our daily life we ingest food continuously, Several times a day, in most things without thinking about the complex process that we are carrying out both at the level and at the level of behavior.

But sometimes, it is not possible to eat voluntarily: we imagine that we are in a coma or that we suffer from some kind of disease that prevents us from ingesting. If left unchecked, the body would eventually starve to death.

Fortunately, we have mechanisms that allow us to continue to artificially maintain a supply of nutrients: enteral nutrition.

    Enteral nutrition: what is it?

    Enteral nutrition is, along with parenteral pathways, one of the two types of artificial nutrition that we have in medicine. It is a supportive technique in which the various nutrients that the patient may need are introduced into the body, usually using a tube that goes directly to the intestine or stomach.

    This technique prevents food from passing through the mouth and trachea. not requiring voluntary movements to acquire nutrients. However, the application of enteral nutrition requires that the digestive system is able to perform its normal functions when it comes to absorbing the nutrients provided.

    Enteral nutrition it helps prevent among other things protein autocatabolism (In other words, that the body consumes itself for nutrients), weakened immune system (with the resulting risk of infections), bacterial translocation (that bacteria in the digestive tract cause us to become infected ) and atrophy of the digestive system. Administration can be continuous or discontinuous depending on the needs of the patient.

      Types of enteral nutrition

      There are different methods by which enteral nutrition can be performed. One of the ways to classify the different types of enteral nutrition it depends on the location of the probe and its range.

      1. Enteral nutrition by nasogastric tube

      In this procedure, a probe is placed which will enter through the nose and go take a trip to the stomach, Where the nutrients will be supplied. This is usually the most common mechanism, except that there is a risk of pulmonary aspiration of the contents of the intestine.

      If the patient is conscious it will be introduced through the nostrils and you will be asked to swallow saliva in order to point the probe into the digestive tract, not the respiratory tract. Despite this, the subject’s collaboration or awareness is not required to place it.

      2. Enteral nutrition by naso-enteral tube

      The procedure is the same as above, except that in this case, the probe will be transported to the intestine.

      3.enterostomy

      When feeding by nasogastric or nasogastric tube is not possible there is another procedure: enterostomy. In this case, a probe is not inserted through the usual routes, but is placed directly through the skin. More than a probe, we would be dealing with a type of catheter. It is also typically used when the patient is believed to be unable to feed themselves for more than four weeks. In enterostomías, three main techniques stand out.

        Pharyngostomy

        A probe is placed directly until it reaches the pharynx.

        gastrostomy

        These procedures are based on the placement of a catheter that reaches the stomach, but in this case crossing the skin.

        jejunostomy

        Like a gastrostomy, a tube is inserted through the skin to reach the target organ. in this case in the area of ​​the intestine called the jejunum.

        What types of substances are introduced into the body?

        Enteral nutrition consists of introducing certain nutrients into the body, vary these substances according to the patient’s needs. They will vary if, for example, the patient has kidney or liver failure, diabetes, or breathing problems. Also from the developmental state of the subject (for example, in infants, breast milk is used). Among other things, the calorie and protein contents are taken into account (which can be hyper, normal or low in calories / protein).

        As for the presentation of nutrients, one can usually find polymeric formulas (in which intact proteins are provided), peptides (hydrolyzed proteins) or elemental (directly in the form of amino acids). There are also special diets for patients with specific problems.

        The most common formula is which involves a polymeric, normocaloric and normoprotein dietBut as we have said, the choice of components will depend on the patient and his needs.

        In which cases does it apply?

        Enteral nutrition is the technique of choice in all situations in which the patient is malnourished or at risk of suffering due to the inability to swallow or the refusal to do so voluntarily, due to injury, illness or mental disorder. In other words: it is used equally well in patients without ingestion capacity, with greatly reduced capacity or who refuse to do everything and have functional capacities for it.

        However, in order to be able to apply it, the digestive system must have a minimum of functionality when it comes to digesting and / or absorbing nutrients. It can be used on people of all ages, from babies to the elderly.

        It is essential in situations where the subject he has no ability to swallow, Such as coma or changes in the pharynx that make swallowing impossible.

        It is also useful in certain diseases in which, although having the functional ability to do so, the patient cannot ingest due to problems such as bronchodysplasia or certain heart conditions. Or where the catch is impossible cause reactions such as vomiting. Another case occurs in situations where the body needs more nutrients than the subject, despite the food, is able to provide.

        On the other hand also it is recommended for premature babies, In order to prevent different diseases. Finally, it is used in mental disorders such as anorexia, forcing nutrition in severe underweight that can lead to death,

        Contraindications and risks

        Enteral nutrition is a very beneficial technique that allows the body to provide the necessary nourishment when it cannot eat on its own. However, in some cases this type of diet may be contraindicated due to the existence of problems in the digestive tract itself.

        The main contraindication is given in the presence of blockages, bleeding, or perforations in the stomach or intestine.

        The use of enteral nutrition may also present certain risks. There may be obstructions or displacement of the catheter or possible metabolic complications if adequate nutrition has not been administered. Vomiting and nausea may occur, as well as diarrhea and reflux. Although rare, pulmonary aspiration of the contents of the digestive tract can occur.

        Bibliographical references:

        • Alvarez, J .; Peláez, N. and Muñoz, A. (2006). Clinical use and enteral nutrition. Hospital nutrition, 21 (Suppl. 2) .; 87-99. Alcalá de Henares, Madrid.
        • Lama, RA (sf). Enteral nutrition. Diagnostic and therapeutic protocols for gastroenterology, hepatology and pediatric nutrition. SEGHNP-AEP. University Hospital for Children of Peace. Autonomous University of Madrid.
        • Ostabal, MI (2002). Enteral nutrition. Integral medicine, 40 (7). 310-317. Elsevier.

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