ABSTRACT
The technique of continuous pump/tube enteric feeding is being utilized with ever increasing frequency and success. Commercially available formulas are being repackaged in 1-liter plastic containers for ease in clinical use. The nutrient solution often hangs at the patient's bedside at room temperature for periods of 8 to 12 hrs and the possibility of significant and serious bacterial growth must be recognized as a potential problem. Though this has never appeared to be a clinical problem in over 15,000 pump/tube feeding days, the bacteriology has not been previously studied. This preliminary study suggests that the major source of nutrient solution contamination relates to the technique of transfer from the commercial can to the clinical liter plastic container and that "hang" times of 8 to 12 hrs at room temperature are quite reasonable if appropriate care is exercised in the transfer process.
Subject(s)
Enteral Nutrition , Food Microbiology , Food, Formulated , Bacteria/isolation & purification , HumansSubject(s)
Enteral Nutrition/methods , Esophageal Diseases/complications , Body Weight , Carcinoma/therapy , Diet , Duodenum , Enteral Nutrition/instrumentation , Esophageal Diseases/therapy , Esophageal Neoplasms/radiotherapy , Esophageal Neoplasms/therapy , Esophageal Perforation/therapy , Esophagitis/therapy , Humans , Jejunum , Male , Middle AgedSubject(s)
Dietary Carbohydrates/administration & dosage , Dietary Fats/administration & dosage , Dietary Proteins/administration & dosage , Enteral Nutrition , Nutrition Disorders/therapy , Body Weight , Cholesterol/blood , Diarrhea/etiology , Electrolytes/administration & dosage , Enteral Nutrition/adverse effects , Humans , Middle Aged , Nitrogen/metabolism , Serum Albumin/analysis , Triglycerides/bloodABSTRACT
The enteric route remains an overlooked site of alimentation. An intact functioning gastrointestinal tract can and should be used, even if the patient will not or cannot eat. The use of continuous pump-tube feeding of liquid diets through a small caliber feeding tube into the distal part of the duodenum or proximal portion of the jejunum is superior to previous methods of bolus tube feeding through large bore tubes placed in the stomach. A small tube has been developed which is inserted easily and positioned in the distal portion of the duodenum or proximal part of the jejunum. This tube has excellent patient tolerance. A suitable pump is essential to success. Elemental diets are not needed for routine enteric alimentation. They are expensive and, because of their hyperosmolarity, require a period of patient adaptation. Isocal, a complete liquid diet, essentially isotonic and lactose-free, provides 1 calorie per milliliter and has been used successfully as a pump-tube feeding diet. It rapidly converts the nitrogen balance of patients from negative to positive when given in quantities exceeding 30 calories per kilogram of body weight.
Subject(s)
Diet , Enteral Nutrition/methods , Feeding and Eating Disorders/diet therapy , Aged , Body Weight , Humans , Intubation, Gastrointestinal , MaleABSTRACT
The organization, function, and results of a total parenteral nutrition (TPN) team consisting of a surgical staff physician, a senior surgery resident, a nurse and a pharmacist are described. The TPN team has treated 160 patients. The incidence of septicemia as a complication of TPN has been less than 1% and the rate of serious metabolic derangements of TPN has been 2.7% for electrolyte aberrations and 5% for significant glycosuria in this series. It is recommended that hospitals that cannot provide such a team should refer patients requiring TPN to a center with a TPN team.
