Enteral nutrition - what is it? Nutrient mixtures for patients in the postoperative period
There are different situations in life when an adult can not eat in the usual way. This happens mostly after surgery. During the recovery period, a person can not chew and rise to digest food. But also at this time the patient needs constant supply of nutrients to the body for the functioning of all organs and restoration of vital activity. In this case, this type of food intake into the body is used, like enteral nutrition.
Enteral nutrition - what is it?
This is a kind of therapy for a patient, the peculiarity of it is that the food comes through a probe or a special system. Most often with this form of nutrition, special mixtures are used. They differ from the usual food for an adult, because in certain conditions the patient can not take other foods.
Advantages of such nutrition
This type of nutrition has its advantages for patients:
- Physiology - the food goes directly to the digestive organs, which allows it to be easily absorbed and give strength to the patient after surgery.
- Cheap food - to use this method does not need too much cost.
- Easy to use additional tools - there is no requirement for increased sterility, as it is easy to handle the probe for enteral feeding or the system for oral feeding with mixtures.
- Does not cause serious complications - the probe is inserted without any problems, therefore there is no probability of development and occurrence of life-threatening complications of the patient.
- Allows to provide the body with all the necessary substances, this is due to the selection of the optimal mixtures for humans.
- Helps prevent the occurrence of atrophic phenomena in the digestive tract.
Indications for enteral nutrition
The development of medicine in the last two centuries has made it possible to determine what will be better for a person after surgery, methods that will help him to recover faster and get the necessary strength with the least risk. So the nutrition of mixtures after operations with the help of additional medical means has its advantages and indications. There are certain indications specifically to the mixtures that a person needs, as well as to the very method of eating. Artificial nutrition is prescribed if:
- The patient, by virtue of his condition, can not eat when he is unconscious or unable to swallow.
- Patient should not eat food - this is a condition of acute pancreatitis or bleeding in the gastrointestinal tract.
- A sick person refuses food, then forced enteral nutrition is used. What is it, when does this state arise? This happens with anorexia nervosa, which can not immediately load the stomach with normal food, since there is a risk of death after a prolonged lack of nutrition. Also, for various infections, the patient may refuse to eat, in this case the enteral feeding system is used to fill the body with the necessary nutrients to fight this infection.
- Food does not meet the needs, it happens with injuries, catabolism, burns.
This type of nutrition is also prescribed in the following pathological conditions of the body:
- deficiency in the body of protein and energy if it is not possible to ensure the supply of these substances by natural means;
- at occurrence of various neoplasms in the field of a head, a stomach and a neck;
- if there are progressive diseases of the central nervous system, for example, Parkinson's disease, cerebrovascular stroke, various states of unconsciousness;
- for oncological conditions after radiation and chemotherapy;
- is often prescribed for severe gastrointestinal diseases: pancreatitis, pathological processes in the liver and biliary tract, malabsorption and small intestinal syndrome, and Crohn's disease;
- immediately after the surgical intervention in the body;
- for burns and acute poisoning;
- with fistula, sepsis;
- if complex infectious diseases develop;
- with severe depression;
- for various degrees of radiation damage to humans.
Methods for the administration of nutritional formulas
Enteral nutrition of patients differs in the way they are eaten:
- Use a probe to inject the mixture into the stomach.
- Method of feeding "sipping" - taking special food orally with small sips.
These methods are also called passive and active. The first is enteral feeding, the infusion takes place with the help of a special system and a dispenser. The second - active, manual, is carried out mainly with the help of a syringe. To use this method, you need to recruit a certain amount of the mixture and inject it neatly into the mouth of the sick person. To date, the advantage is given to infusion pumps, which automatically feed the mixture.
Probes for providing enteral nutrition
Many relatives of patients ask: enteral nutrition - what is it and what tools are needed for this? Indeed, for this method of filling the body with food, different probes are needed. They are divided into:
- nasogastric( nasoenteral) - thin plastic probes that have holes at a certain level, as well as weighting agents for ease of administration;
- percutaneous - are administered after surgery( pharyngoscopy, gastrostomy, esophagostomy, ejinostomy).
Modes of providing nutrition to the body
Understand such an issue, enteral nutrition - what it is, is not enough to implement it. There are many nuances of introducing food into the body in this way, for example, the feed rate of the mixture. There are several regimes for patient to receive food.
- Feed the mixture at a constant speed. Through the probe the patient receives food at a certain rate, it is 40-60 ml / h. Then the specialist looks after the patient's reaction. If the mixture is well tolerated, the speed can be gradually increased. On average, it increases by 25 ml / h for 8-12 hours, then during the same time you can add as many more until the necessary speed is reached. If the operation has only passed and the patient is in serious condition, the mixture should be administered no more than 20-30 ml / h. It is necessary to carefully monitor the condition of a person. With nausea, diarrhea, convulsions or vomiting, either the rate of administration of the mixture or its concentration decreases. At the same time, some one indicator changes so that there is no stress for the body.
- Artificial nutrition can be administered cyclically. Such cyclic feeding consists in the fact that after a continuous diet the patient gradually reduces it at night, reducing to a break for the night. This method is convenient for the patient and it can be done through a gastrostomy.
- Session power( periodic) is not for everyone. It is indicated for those patients who have diarrhea or have had an operation on the gastrointestinal tract. Such food is called periodic, since it is carried out for periods of 4-6 hours.
- Bolus feeding. This mode is similar to the usual meal. The mixture is injected with a syringe or through a probe, but the entry rules are strictly observed. At the same time, the speed does not exceed 240 ml in half an hour. The number of meals a day 3-5 times. But start entering the mixture is with a hundred ml. If the patient suffers without problems, then gradually add 50 ml. But this regime is dangerous by the frequent occurrence of diarrhea, so it should be prescribed and under the supervision of a specialist.
Naturally, these regimes can not be adjusted to all patients who need enteral nutrition. Selection of the method, speed and volume of such delivery of food into the body takes into account individual characteristics.
Features of the choice of mixtures
Mixtures for enteral feeding should also be selected according to the individual needs of patients. Their choice depends on several factors.
- Good nutrition for post-operative patients should have a good energy density. It is not less than 1 kcal / ml.
- The mixture should not contain lactose and gluten. These substances can cause allergies.
- It should have an osmolarity of no more than 340 mOsm / l.
- To avoid problems with the assimilation of power, it must be inviscid.
- The qualitative mixture does not cause unnecessary intestinal motility.
- It is necessary that it contain information about the manufacturer and the presence of a genetic modification of proteins.
It should be noted that the mixture for children, as well as solutions prepared from natural products, are not suitable for enteral feeding. They are not balanced for an adult, so they can not bring the desired result. For patients who need such nutrition, their kinds of mixtures have been developed, which we will consider below.
The name of the mixtures determines their purpose. They do not contain the entire necessary set of trace elements, but they also apply in the postoperative period. Such mixtures consist of glucose and salts, which allows to restore the functionality of the small intestine immediately after surgery. In the presence of vomiting or diarrhea, this nutrition well supports the water-electrolyte balance in the human body. Such mixtures include "Gastrolit", "Mafusol", "Regidron", "Citroglyukosolan", "Orasan" and some others.
Element mixes for power supply
This power supply for patients is made up on the basis of precisely selected chemical elements. They are used in specific cases of metabolic disorders in the body in such pathologies as hepatic and renal insufficiency, diabetes mellitus and pancreatitis. In this case, the pancreas, liver and kidneys can not perform their specific functions, so such mixtures help a person at least partially restore vital functions. For nutrition of this type include "Vivonex", "Flexicum", "Lofenalak" and others.
These nutrient mixtures for patients are used more often than the previous ones. This is due to the fact that they are already more balanced and suitable for a wide range of patients who need enteral nutrition. Here the proteins are already in the form of amino acids and peptides, which allows them to be more easily absorbed in the body. Such solutions are used immediately after surgery in violation of the digestive function of the body. They include "Nutrien Elemental", "Nutrilon Pepti TCS", "Peptisorb", "Peptamen".
Standard polymer blends
This kind is used in many diseases after operations when a person is in a coma. They are the most suitable for the adult body in its composition. Such solutions contain all the necessary minerals, trace elements, proteins, fats, carbohydrates. They are divided into three types.
- Dry, which must be diluted and injected into the body through a probe. This is the next enteral diet: Nutrizone, Berlamin Modular, Nutricompstand Standard.
- Liquid, which can immediately enter. They are designed for situations where you can not lose a minute, giving vital nutrition to a person. These include "Berlamin Modular", "Nutrikomp Liquid", "Nutrizon Standard" and some others.
- Mixtures that are used orally. They are "Berlamin Modular", "Nutridrink", "Forticrum" and so on.
This kind of food for its intended purpose is similar to the elemental view of mixtures. They are designed to restore the functionality of the organism in a specific pathology. They correct the metabolic disorders with respiratory failure, impaired renal and hepatic function, and immunity.