Enteral feeding

Question

This piglix contains articles or sub-piglix about Enteral feeding

Answer 1

Medical food

This piglix contains articles or sub-piglix about Medical food

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Wikipedia

Answer 2

Axona

Axona

Axona is a medical food marketed for the clinical dietary management of the impairment of metabolic processes associated with mild to moderate Alzheimer's disease. It is a proprietary formulation of fractionated coconut oil (caprylic triglyceride), a medium-chain triglyceride. Accera, Inc., the company that makes Axona, states that during digestion, caprylic triglyceride is broken down into ketones, which provide an alternative energy source for the brain. Its use is based on the idea that the brain's ability to use its normal energy source, glucose, is impaired in Alzheimer's disease. Axona was first sold in March 2009.

Axona has not been approved by the US Food and Drug Administration (FDA) as a drug to treat Alzheimer's and the efficacy of managing the health of Alzheimer's patients by use of this medical food has been questioned by experts in the field, including the Alzheimer's Association.

Axona is a medical food marketed to assist with dietary management of mild to moderate Alzheimer’s disease. Axona is formulated for oral administration and is sold by prescription. The largest ingredient in Axona is caprylic triglyceride, also known as fractionated coconut oil, a medium-chain triglyceride.caprylic triglyceride is Generally Recognized As Safe (GRAS) by the FDA.

A medical food in the US is an official FDA product classification, and was originally defined by Congress as part of the Orphan Drug Amendments of 1988 as "a food which is formulated to be consumed or administered through a feeding tube under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation." Medical foods are not drugs and cannot be marketed as treating or preventing a disease or condition; the FDA does not evaluate the efficacy and safety of medical foods.

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Wikipedia

Answer 3

Feeding tube

A feeding tube is a medical device used to provide nutrition to patients who cannot obtain nutrition by mouth, are unable to swallow safely, or need nutritional supplementation. The state of being fed by a feeding tube is called gavage, enteral feeding or tube feeding. Placement may be temporary for the treatment of acute conditions or lifelong in the case of chronic disabilities. A variety of feeding tubes are used in medical practice. They are usually made of polyurethane or silicone. The diameter of a feeding tube is measured in French units (each French unit equals 0.33 millimeters). They are classified by site of insertion and intended use.

There are dozens of conditions that may require tube feeding. The more common conditions that necessitate feeding tubes include prematurity, failure to thrive (or malnutrition), neurologic and neuromuscular disorders, inability to swallow, anatomical and post-surgical malformations of the mouth and esophagus, cancer, Sanfilippo syndrome, and digestive disorders.

The effectiveness of feeding tubes varies greatly depending on what condition they are used to treat.

Feeding tubes are used widely in children with excellent success for a wide variety of conditions. Some children use them temporarily until they are able to eat on their own, while other children require them longterm. Some children only use feeding tubes to supplement their oral diet, while others rely on them exclusively.

Patients with advanced dementia who are unable to feed themselves should have another person feed them in preference to the medical intervention of having a feeding tube. In such patients, feeding tubes do not increase life expectancy or protect the patient from aspiration pneumonia. Feeding tubes can also increase the risk of pressure ulcers, require pharmological or physical restraints, and lead to patient distress. There is evidence which shows that patients who get feeding assistance rather than tubes have better outcomes. In the final stages of dementia, assisted feeding may still be preferred over a feeding tube to bring benefits of palliative care and human interaction even when nutritional goals are not being met.

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Answer 4

Gastrostomy

Gastrostomy

Gastrostomy is the creation of an artificial external opening into the stomach for nutritional support or gastric decompression. Typically this would include an incision in the patient's epigastrium as part of a formal operation. It can be performed through surgical approach, percutaneous approach by interventional radiology, or percutaneous endoscopic gastrostomy (PEG).

The opening may be used for feeding, such as with a gastrostomy tube.

The Stamm gastrostomy is an open technique, requiring an upper midline laparotomy and gastrotomy, with the catheter brought out in the left hypochondrium.

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Answer 5

Graz tube weaning model

The Graz tube weaning model (German: Graz Sondenentwöhnung) is a method that supports parents, caregivers and professionals to help and empower medically fragile children with early and post-traumatic eating behavior disorders, particularly tube dependency.

Enteral feeding via a tube (nasogastric tube, PEG or jejunostomy) is commonly used in the treatment of premature infants and young children to support them during periods of severe illness and health disorders when a child is unable to swallow food safely. In specific cases, tube feeding is a necessary intervention, however, it can cause problems when it comes to tube weaning and resuming an oral diet.

Children may suffer from food aversion when fed without a tube and resist natural oral feeding. This effect is caused by a combination of physical and psychological disorders, which are addressed during a tube weaning program.

The Graz tube weaning model was developed by a multidisciplinary team based at the Children’s Hospital, Graz during the 1990’s and first published in 2000.

Tube weaning program is specifically designed for premature infants and children who are fed via a nasogastric, nasojejunal, gastrostomy or jejunostomy tube. The treatment is performed either when the feeding tube is no longer needed or if children experience side effects and poor response to enteral feeding. The program is suitable both for primary weaning and children that had been unsuccessfully weaned in the past. It is especially recommended for children that are struggling with oral feeding or have developed tube dependency.

Tube weaning is contraindicated in children who do not have a safe swallowing response. It is not recommended if there is a high possibility of an upcoming surgery or intervention that will require further usage of a feeding tube.

Weight loss: losing up to 10% of a child’s weight is expected in the transition from exclusive enteral feeding to oral intake and is acceptable during the initial phase of treatment. Risk of choking and aspiration: children are assessed for risk of choking and aspiration prior to starting the tube weaning process and are excluded from learning to eat if aspiration or choking is a medically confirmed finding.

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Wikipedia

Answer 6

Jejunostomy

Jejunostomy

Jejunostomy is the surgical creation of an opening (fistula) through the skin at the front of the abdomen and the wall of the jejunum (part of the small intestine). It can be performed either endoscopically, or with formal surgery.

A jejunostomy may be formed following bowel resection in cases where there is a need for bypassing the distal small bowel and/or colon due to a bowel leak or perforation. Depending on the length of jejunum resected or bypassed the patient may have resultant short bowel syndrome and require parenteral nutrition.

A jejunostomy is different from a jejunal feeding tube which is an alternative to a gastrostomy feeding tube commonly used when gastric enteral feeding is contraindicated or carries significant risks. The advantage over a gastrostomy is its low risk of aspiration due to its distal placement. Disadvantages include small bowel obstruction, ischemia, and requirement for continuous feeding.

The Witzel jejunostomy is the most common method of jejunostomy creation. It is an open technique where the jejunosotomy is sited 30 cm distal to the Ligament of Treitz on the antimesenteric border, with the catheter tunneled in a seromuscular groove.

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Answer 7

Medical food

Medical foods are foods that are specially formulated and intended for the dietary management of a disease that has distinctive nutritional needs that cannot be met by normal diet alone. They were defined in the Food and Drug Administration's 1988 Orphan Drug Act Amendments and are subject to the general food and safety labeling requirements of the Federal Food, Drug, and Cosmetic Act.

Medical foods are distinct from the broader category of foods for special dietary use and from traditional foods that bear a health claim. In order to be considered a medical food the product must, at a minimum:

Medical foods can be classified into the following categories:

Medical foods for management of allergic conditions may contain both gamma-linolenic acid (GLA), a short chain omega-6 fatty acid primarily sourced from the seeds of the borage plant, and eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid sourced from fish. These fatty acids help to inhibit the production of leukotrienes in the system. Sufficient quantities of GLA and EPA necessary for reduction of leukotrienes cannot be obtained from a normal diet. Leukotrienes are inflammatory molecules produced by immune cells (neutrophils, basophils, mast cells, macrophages and eosinophils) in the body. They are involved in the inflammatory response and cause the narrowing of the airways, increased mucus production and tissue swelling associated with both allergies and asthma. In order to control allergic symptoms, research shows that it helps to inhibit the production of leukotrienes in the body.

Medical foods for management of diabetes mellitus generally contain slowly digested carbohydrates, which helps minimize peaks in blood sugar. Consistent maintenance of optimal blood sugar levels (avoiding highs and lows) over time can help reduce the complications of diabetes.

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Answer 8

Nasogastric intubation

Nasogastric intubation

Nasogastric intubation is a medical process involving the insertion of a plastic tube (nasogastric tube or NG tube) through the nose, past the throat, and down into the stomach. Orogastric intubation is a similar process involving the insertion of a plastic tube (orogastric tube) through the mouth.

As a sump tube where the physician desires to keep the stomach continuously and completely evacuated of swallowed air, swallowed saliva, gastric secretions or fresh blood the nasogastric (NG) tube is used with a vacuum source. The original Levin tube failed Dr. Harold W. Andersen in 1958 and he endeavored to engineer a double-lumen NG tube to reduce the vacuum of the aspiration lumen by adding a vent lumen to the outside including an anti-reflux filter at the proximal end of the vent lumen and additional markings for placing the tube in the patient. This was the first double-lumen nasogastric tube. [1][2]

A nasogastric tube is used for feeding and administering drugs and other oral agents such as activated charcoal. For drugs and for minimal quantities of liquid, a syringe is used for injection into the tube. For continuous feeding, a gravity based system is employed, with the solution placed higher than the patient's stomach. If accrued supervision is required for the feeding, the tube is often connected to an electronic pump which can control and measure the patient's intake and signal any interruption in the feeding.

Nasogastric aspiration (suction) is the process of draining the stomach's contents via the tube. Nasogastric aspiration is mainly used to remove gastrointestinal secretions and swallowed air in patients with gastrointestinal obstructions. Nasogastric aspiration can also be used in poisoning situations when a potentially toxic liquid has been ingested, for preparation before surgery under anaesthesia, and to extract samples of gastric liquid for analysis.

If the tube is to be used for continuous drainage, it is usually appended to a collector bag placed below the level of the patient's stomach; gravity empties the stomach's contents. It can also be appended to a suction system, however this method is often restricted to emergency situations, as the constant suction can easily damage the stomach's lining. In non-emergency situations, intermittent suction is often applied giving the benefits of suction without the untoward effects of damage to the stomach lining.

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Wikipedia

Answer 9

Nutrient enema

A nutrient enema, also known as feeding per rectum, rectal alimentation, or rectal feeding, is an enema administered with the intent of providing nutrition when normal eating is not possible. Although this treatment is ancient, dating back at least to Galen and a common technique in 19th century medicine, nutrient enemas have been superseded in modern medical care by tube feeding and intravenous feeding.

A variety of different mixes have been used for nutrient enemas throughout history. A paper published in Nature in 1926 stated that because the rectum and lower digestive tract lack digestive enzymes, it is likely that only the end-products of normal digestion such as sugars, amino acids, salt and alcohol, will be absorbed.

This treatment was given to U.S. President James A. Garfield after his shooting in 1881, and is asserted to have prolonged his life.

When the United States Senate Intelligence Committee published an unclassified summary of its 6,000 page classified report on the CIA's use of torture, its previously unknown use of "rectal rehydration" for punishment and torture became apparent.

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Wikipedia

Answer 10

Percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) is an endoscopic medical procedure in which a tube (PEG tube) is passed into a patient's stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate (for example, because of dysphagia or sedation). This provides enteral nutrition (making use of the natural digestion process of the gastrointestinal tract) despite bypassing the mouth; enteral nutrition is generally preferable to parenteral nutrition (which is only used when the GI tract must be avoided). The PEG procedure is an alternative to open surgical gastrostomy insertion, and does not require a general anesthetic; mild sedation is typically used. PEG tubes may also be extended into the small intestine by passing a jejunal extension tube (PEG-J tube) through the PEG tube and into the jejunum via the pylorus.

PEG administration of enteral feeds is the most commonly used method of nutritional support for patients in the community. Many stroke patients, for example, are at risk of aspiration pneumonia due to poor control over the swallowing muscles; some will benefit from a PEG performed to maintain nutrition. PEGs may also be inserted to decompress the stomach in cases of gastric volvulus.

Gastrostomy may be indicated in numerous situations, usually those in which normal or nutrition (or nasogastric) feeding is impossible. The causes for these situations may be neurological (e.g. stroke), anatomical (e.g. cleft lip and palate during the process of correction) or other (e.g. radiation therapy for tumors in head & neck region).

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