Initiation of enteral and parenteral feeding and why we interrupt them in the critical care setting
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KeywordsDrug Administration Care Setting Critical Care Parenteral Nutrition Nutrition Support
Initiation and appropriate delivery of nutrition support is fundamental in the care of critically ill patients. To optimise delivery of the prescribed energy and protein there is the added challenge of minimising the frequency and duration of interruptions in order to meet nutritional needs.
We explored the current practice of our CCU looking specifically at time to initiation of feed; and interruptions to feed once started.
We collected retrospective data from 50 consecutive CCU patients receiving ≥7 days of enteral/parenteral feed from July to November 2014. Data included; time from CCU admission to initiation of feed and interruptions over the first 7 days including type, duration and frequency. We compared our practice with guidelines that suggest feed should be started within 48 hours. [1, 3]
66% of our patients were started on a regime within 48 hours of their CCU admission. 34% started their feed after >48 hours.
We found 8 types of interruption, with 4 being more frequent. The most common was related to nasogastric (NG) medications. The second was due to poor absorption, indicated by high aspirates and vomiting. Imaging and procedures came after. We calculated the mean duration for each interruption type. This showed high vasopressor requirement caused the longest interruption, however this pertains to only 2 patients. Absorption issues were the next longest duration of interruption with a mean time of 9.65 hours. We found a large amount of interruptions not documented.
Days 1 and 2 of feeding were the least interrupted. Day 5 was the mode and 12% of patients managed 7 uninterrupted days of enteral/parenteral feed.
- 1.Singer , et al: 'ESPEN guidelines on parenteral nutrition: Intensive care', Clinical Nutrition. 2009, 28: 387-400.Google Scholar
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- 3.McClave , et al: 'Guidelines for the Provision and Assessment of Nutritional Support Therapy in the Adult Critically Ill Patient:ASPEN', Journal of Parenteral and Enteral Nutrition. 2009, 33: 277-316.Google Scholar
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