Parenteral nutrition
Sometimes people with gastroparesis need to have food through a
tube going into a vein or into their stomach or bowel. Tube feeding is used to
give vital nutrition to people who are unable to eat or absorb food
normally, and to help maintain weight and hydration. This is called 'Total
Parenteral Nutrition' (TPN)
Liquid feed can be given via a drip directly into the bloodstream (intravenously) or via a tube into the stomach or bowel (enteral nutrition). Although this treatment in normally reserved for a hospital environment, if TPN is deemed as the only viable long term option available to aid nutrition and hydration then with training and support it can be administered in the home environment.
Your consultant, dietician and nurse will work together to advise you on which option would benefit you most based on your situational needs.
Not all hospitals have facilities to train patients on the use of TPN, so your consultant may need to refer you to a regional nutrition centre. Training and adjustments to the tailored feed usually requires a hospital admission, and may take several weeks to reach an effective balance, depending on your reaction to the treatment.
As TPN is not a 'natural' way for your body to receive nutrients it can have serious implications, and therefore you will require close monitoring throughout this treatment. You will be taught how to monitor for problems and infection, for example by checking glucose levels and temperature, and how to deal with minor issues should they occur, and what to do in an emergency situation.
Generally naso-gastric and naso-jejunal feeding tubes are usually used for treatment in the short term and percutaneous endoscopic gastronomy tubes and percutaneous endoscopic jejunostomy feeding tubes are used for longer term treatment. (see below).
All feeding pumps are designed to administer nutritional feeds at varying rates over varying time periods, however as there are several pump manufacturers and feed types, you can either refer to the manufacturers website for further information regarding set up of the pump or select the appropriate video on www.youtube.com by typing in 'How to set up a feed pump'.
Liquid feed can be given via a drip directly into the bloodstream (intravenously) or via a tube into the stomach or bowel (enteral nutrition). Although this treatment in normally reserved for a hospital environment, if TPN is deemed as the only viable long term option available to aid nutrition and hydration then with training and support it can be administered in the home environment.
Your consultant, dietician and nurse will work together to advise you on which option would benefit you most based on your situational needs.
Not all hospitals have facilities to train patients on the use of TPN, so your consultant may need to refer you to a regional nutrition centre. Training and adjustments to the tailored feed usually requires a hospital admission, and may take several weeks to reach an effective balance, depending on your reaction to the treatment.
As TPN is not a 'natural' way for your body to receive nutrients it can have serious implications, and therefore you will require close monitoring throughout this treatment. You will be taught how to monitor for problems and infection, for example by checking glucose levels and temperature, and how to deal with minor issues should they occur, and what to do in an emergency situation.
Generally naso-gastric and naso-jejunal feeding tubes are usually used for treatment in the short term and percutaneous endoscopic gastronomy tubes and percutaneous endoscopic jejunostomy feeding tubes are used for longer term treatment. (see below).
All feeding pumps are designed to administer nutritional feeds at varying rates over varying time periods, however as there are several pump manufacturers and feed types, you can either refer to the manufacturers website for further information regarding set up of the pump or select the appropriate video on www.youtube.com by typing in 'How to set up a feed pump'.
Total parenteral
nutrition (TPN) also now called parenteral nutrition (PN) or home
parenteral nutrition (HPN):
- This is a method of being fed directly into your bloodstream through a drip into a vein. The feeds bypass your normal digestive system.
- The PN is given through a central line or a PICC line, or femoral line. A PICC line goes up a blood vessel in your arm and into a chest vein - these are usually used shorter term (PICC 6-8 weeks - Central & Femoral 7-14 days). They may have several lumens to perform different tasks and can be used for TPN, fluids, IV medication and blood products.
- Other types of central lines such as Hickman line or Broviac line & Portacaths, are used long term and are inserted into the chest and directly into a major blood vessel - the end of the line hangs out of the chest. If not being used, the central line is sealed off with a cap, and is connected to the drip feed as required. They can be used for TPN, fluids and IV medication.
- This procedure is done by a specially trained nurse or doctor, usually under local anaesthetic.
- The feeds are quite complex and are made up based on your specific nutritional needs.
Feed directly into
the stomach or bowel (enteral nutrition):
• Specially prepared liquid feeds via a tube into the stomach or small intestine.
• Feed still go through the usual path of digestion
• Variety of formulas available - a dietician will choose the most appropriate one, depending on individual nutritional needs.
• Some people may have all their food and drink this way whilst others people may take some food normally and the rest as liquid through the tube.
There are several types of enteral feeding tubes:
Nasogastric tube NGT:
• A thin tube, that is put into the nose, and down the throat into the stomach.
• Procedure normally done by a nurse or a doctor.
• Specially prepared liquid feeds via a tube into the stomach or small intestine.
• Feed still go through the usual path of digestion
• Variety of formulas available - a dietician will choose the most appropriate one, depending on individual nutritional needs.
• Some people may have all their food and drink this way whilst others people may take some food normally and the rest as liquid through the tube.
There are several types of enteral feeding tubes:
Nasogastric tube NGT:
• A thin tube, that is put into the nose, and down the throat into the stomach.
• Procedure normally done by a nurse or a doctor.
Nasojejunal tube NJT:
• The same as a NGT but the tip goes to the first part of the bowel (jejunum)
Percutaneous endoscopic gastrostomy tubes PEG tube:
A tube that goes into the stomach through an opening on the outside of the abdomen.
Procudure is done under sedation using an endoscopy.
Formulated feed usually run for most of the day through a pump.
A tube that goes into the stomach through an opening on the outside of the abdomen.
Procudure is done under sedation using an endoscopy.
Formulated feed usually run for most of the day through a pump.
Percutaneous endoscopic jejunostomy tubes JEJ or PEJ tubes:
The tube is put into the part of the small intestine called the jejunum, just past the stomach.
The tube is put through an opening in the abdomen, using an endoscopy. and into your jejunum.
Usually feed flows slowly all the time, via a variable pump.
The tube is put into the part of the small intestine called the jejunum, just past the stomach.
The tube is put through an opening in the abdomen, using an endoscopy. and into your jejunum.
Usually feed flows slowly all the time, via a variable pump.
Common feed types are listed on the
'Diagnosis & Treatment' page
or see the following manufacturers websites for feed and pump information & online support:
www.abbottnutrition.co.uk/
www.nutricia.co.uk
PINNT support for those on tube feeds:
www.pinnt.com/
Feedingtubeawareness.org - support for those caring for tube fed children:
www.feedingtubeawareness.org/
Clinical documents related to parenteral feeding can be found on the 'Clinical papers' page
'Diagnosis & Treatment' page
or see the following manufacturers websites for feed and pump information & online support:
www.abbottnutrition.co.uk/
www.nutricia.co.uk
PINNT support for those on tube feeds:
www.pinnt.com/
Feedingtubeawareness.org - support for those caring for tube fed children:
www.feedingtubeawareness.org/
Clinical documents related to parenteral feeding can be found on the 'Clinical papers' page