WHAT is nutrition therapy by tube or IV and WHY is it important?
Cancer and cancer treatments can affect the way you eat and drink. Nutrition therapy, also known as nutrition support, involves finding ways to get nutrients and fluids when cancer or its treatment changes your ability to eat. Nutrition therapy is often used for a short time to help you heal while taking treatments or for a longer time if your ability to eat is permanently affected. The goal of nutrition therapy is to offer enough nourishment to avoid unhealthy weight loss and/or dehydration.
WHO might need nutrition therapy?
- People who have significant weight loss due to low desire or difficulty eating
- People with low food intake for more than a week
- People who need to improve nutrition before a surgery
HOW is nutrition therapy given? (feeding types)
If the gastrointestinal tract (gut) is working and can still move food through the body, a tube feeding is used. An IV feeding is used if the gut does not work or is not working well.
Parenteral nutrition – Feeding through a large IV (intravenous catheter) into the bloodstream. Parenteral nutrition therapy is usually recommended when nutrition therapy will be required for a longer time.
Enteral nutrition – Feeding liquid nutrition through a tube into the stomach or intestines. Enteral nutrition therapy can be used for either a short or long time period.
An enteral feeding tube can be placed in a number of different locations depending on you and your health. The most common sites are described below.
- Nasogastric tube (NG tube or NGT) – A tube is placed from the nose into the stomach.
- Nasoduodenal (ND) – A tube is placed from the nose into the duodenum (the beginning of the small intestine)
- Nasojejunal (NJ) – A tube is placed from the nose into the small intestine, past the duodenum
- Gastrostomy (G tube) – A tube is placed from the skin surface of the abdomen directly into the stomach.
- Gastro-jejunal (GJ) – A tube is placed from the skin surface of the abdomen into the stomach then a tube is threaded to the small intestine
- Jejunostomy (J tube) – A tube is placed from the skin surface directly into the small intestine.
WHERE is nutrition therapy given?
While nutrition therapy may be used in a hospital setting, it is most often given at home through a nutrition therapy service (home health). If you or a loved one is thinking about home health, you may be worried about tube feeding or intravenous feeding. Either can be an intimidating thought. But with proper information and preparation, home feedings can be done and can even be rewarding. Below are some details to understand before you begin home feedings.
Important Facts Before Starting Home Feeding
Formula
There are many different types of formula available. Each has certain components that are good for your nutritional needs. It is important to understand the amount (volume or feeding rate) and frequency (hang time) of the formula planned. Talk to your healthcare team about your feeding plan. Be sure to know where you can buy the formula and how it should be stored (some formulas need refrigeration).
Water Flushes
Water flushes clear the feeding tube and give you enough fluids. Know when flushes are needed (before, after, or during feedings) and how much water to use. It is important to follow the directions closely to prevent dryness or excess fluids.
Sanitation
Sanitation is very important in stopping infection and maintaining good health. Make sure to wash your hands properly before feedings. Also, wash the top of the formula can before opening to decrease possible contamination. Follow any other directions given by your healthcare team.
Sitting
Patients receiving enteral nutrition should try to sit up straight during tube feeding and for at least 30 minutes after feeding to stop backward flow of the food and possible aspiration (taking food particles or liquids into the lungs through the windpipe). If you are receiving parenteral nutrition, you do not need to worry about sitting.
Possible Side Effects
The benefits of nutrition therapy are often greater than the side effects, but you may have some problems. You will be able to handle some issues on your own, but always ask your healthcare team what they recommend. Be sure to have an emergency number to use when something happens outside your team’s regular office hours.
Possible Side Effects of Enteral Nutrition:
- Constipation – Difficult bowel movements due to lack of activity, poor fluids and fiber intakes, or use of pain medication
- Dehydration – Lack of fluids that can be due to concentrated formulas, not enough free water flushes, too high protein intake, or high blood sugar levels
- Diarrhea – Loose bowel movements that can be from medications, feeding too quickly, sorbitol-containing formula, or infection
- Gastrointestinal reflux and aspiration – Reflux is the backward flow of gut contents into the throat. Aspiration results when these food items get into the lungs. This can lead to infection and pneumonia. Feeding while lying down is the most common cause. The bed should be elevated to at least 45°.
- High gastric residuals – Gastric residuals are the food particles that remain in the gut after feedings. Your doctor or registered dietitian can assist if residuals are too high. They may try to order a low-fat and low-fiber formula or decrease feeding rate.
- Malabsorption – Occurs when the gut can’t absorb the nutrients from food, which can lead to diarrhea and lack of proper nutrition
- Re-feeding syndrome – When a starved body receives feeding too quickly, issues can arise. If you have been without food or only taking a small amount, be sure to begin feeding slowly and with the direction of a healthcare team.
Possible Side Effects of Parenteral Nutrition:
- Infection – Infections can occur at the feeding site because of poor sanitation or can enter the body through the feedings if handled improperly.
- Overfeeding – Too much feeding can cause the body to receive more nutrients than needed which can lead to other issues such as overworking the lungs.
- Re-feeding syndrome – When a starved body receives feeding too quickly, issues can arise. If you have been without food or only taking a small amount, be sure to begin feeding slowly and with the direction of a healthcare team.