Enteral nutrition

Enteral nutrition: types, definition and uses with patients

In our daily lives we are continuously ingesting food , several times a day, in most of the things without thinking about the complex process that we carry out both at a behavioral level. 

But sometimes it is not possible to feed ourselves voluntarily: imagine that we are in a coma or that we suffer from some kind of illness that prevents us from eating. If nothing is done, the organism would end up dying of starvation. 

Fortunately, we have mechanisms that allow us to continue maintaining a supply of nutrients in an artificial way: enteral nutrition .

Enteral nutrition: what is it?

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

This technique avoids the need for food to pass through the mouth and trachea, not requiring voluntary movements to acquire nutrients . However, applying enteral nutrition requires that the digestive system be able to exercise its normal functions when it comes to absorbing the nutrients supplied.

Enteral nutrition helps prevent, among other things, protein autocatabolism (in other words, the body consuming itself to obtain nutrients), the weakening of the immune system (with the consequent risk of infections), the bacterial translocation (which bacteria from the digestive tract itself cause an infection) and atrophy of the digestive system. The administration can be continuous or discontinuous according to the needs of the patient.

Types of enteral nutrition

There are different methods by which enteral nutrition can be carried out. One of the ways to classify the different types of enteral nutrition is according to where the probe is placed and where it reaches.

1. Enteral nutrition by nasogastric tube

In this procedure, a probe is inserted that will penetrate through the nose and will travel to the stomach , where nutrients will be supplied. It is usually the most common mechanism, unless there is a risk of pulmonary aspiration of the contents of the intestine. 

If the patient is conscious , he will be introduced through the nostrils and he will be asked to swallow saliva in order to direct the catheter to the digestive tract and not to the respiratory system. Despite this, the collaboration or awareness of the subject is not necessary to place it.

2. Enteral nutrition by nasoenteral tube

The procedure is the same as the previous one, except for the fact that in this case the probe will be taken to the intestine.

3. Enterostomy

When it is not feasible to feed through nasoenteric or nasogastric tube, there is another procedure: the enterostomy. In this case, a probe is not introduced through the usual routes, but is placed directly through the skin. More than a catheter, we would be facing a type of catheter. It is also usually used when the patient is expected to be unable to feed himself in more than four weeks. Within the enterostomies, three main techniques stand out.

Faringostomy

A probe is placed directly until it reaches the pharynx.

Gastrostomy

This procedure is based on the placement of a probe that reaches the stomach, but in this case through the skin .

Jejunostomy

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

What kind of substances are introduced into the body?

Enteral nutrition involves introducing certain nutrients in the body, varying these substances depending on the needs of the patient . They will vary if, for example, the patient has kidney or liver failure, diabetes, or respiratory problems. Also of the state of development of the subject (for example in babies breast milk is used). Among other things, the caloric and protein content (being hyper, normal or hypocaloric / protein) is taken into account.

Regarding the way in which nutrients are presented, in general we can find polymeric formulas (in which intact proteins are contributed), peptide (hydrolyzed proteins) or elemental (directly in the form of amino acids). There are also special diets for those patients with specific problems. 

The most usual formula is the one that supposes a polymeric, normocaloric and normoproteic diet , but as we have already said the choice of components will depend on the patient and his needs.

In what cases does it apply?

Enteral nutrition is the technique of choice in all situations in which the patient presents malnutrition or risk of suffering due to the existence of the inability to swallow or the refusal to do so voluntarily, due to an injury, illness or mental disorder . In other words: it is used both in patients with no capacity to ingest, with a very diminished capacity or who refuse to do so despite having functional capacity for it.

However, in order 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 in subjects of any age, from babies to the elderly.

It is essential in situations in which the subject does not have ability to swallow , such as  coma , or alterations of the pharynx that make it impossible to swallow. 

It is also useful in some diseases in which although it has functional capacity to do so, the patient can not take it because of problems such as bronchodysplasia or heart disease. Or that ingestion is impossible because it causes reactions such as vomiting . Another case occurs in situations in which the body needs more nutrients than the subject, despite eating, is able to provide.

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

Contraindications and risks

Enteral nutrition is a very beneficial technique that allows the body to supply the necessary food when it can not eat itself. However, in some cases this type of food may be contraindicated due to the existence of problems in the digestive tract itself.

The main contraindication is in the presence of obstructions, hemorrhages or perforations in the stomach or intestine .

The use of enteral nutrition can also pose some risks. There may be obstructions or displacements of the probe or possible metabolic complications if an adequate diet has not been administered. Vomiting and nausea may occur, as may diarrhea and reflux. Although it is rare, pulmonary aspiration of the contents of the digestive tract may occur.

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