Favourite Enteral Nutrition Resources

Hello, all. Welcome to my first post of 2013 -- just in time for the Vernal Equinox. Much as I love to blog, I've had to set aside this activity to create time and mental space for another series of workshops at which I'm a presenter.

As part of my preparation, I've been digging deep into the literature. (And yes, I'm still digging in the garden -- more on this soon). I've added new resources to my frequently used favourites and would like to share some of them with you now.

Enteral Nutrition (Tube Feeding)

Key references for guidelines, standards and safe practices

American Society for Parenteral & Enteral Nutrition (A.S.P.E.N.) Professional Resources

Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, Lyman B, Metheny NA, Mueller C, Robbins S, Wessel J and A.S.P.E.N. Board of Directors. A.S.P.E.N. Enteral Nutrition Practice Recommendations. JPEN J Parenter Enteral Nutr. 2009;33:149-167.

National Collaborating Centre for Acute Care, February 2006. Nutrition support in adults - Oral nutrition support, enteral tube feeding and parenteral nutrition. 

Ethics

Blackmer J. Artificial feeding post-stroke: A medical and ethical perspective. 2010. [Presentation slides in PDF format. Available for download from the Champlain Regional Stroke Network Web site] 

Fluid & electrolyte balance

Basic Principles of Fluid and Electrolyte Balance (free e-book available on the ESPEN site.)

Dickerson RN, Brown RO. Long-term enteral nutrition support and the risk of dehydration. Nutr Clin Pract. 2005;20:646-653.

Whitmire SJ. Nutrition-focused evaluation and management of dysnatremias. Nutr Clin Pract. 2008;23:108-121.

Gastroenterology

Matarese LE. Nutrition and fluid optimization for patients with short bowel syndrome. JPEN J Parenter Enteral Nutr. 2013;37:161-169. 

University of Virginia School of Medicine, Articles in Practical Gastroenterology, Enteral Nutrition

 Home Tube Feeding

Brown PA, Quesada O, Scott F. Tube feeding using the bolus method. [Patient information fact card. ©2006 Memorial Sloan-Kettering Cancer Center, 2009.]

The OLEY Foundation  - Founded in 1983 by Lyn Howard, MD and her patient, Clarence "Oley" Oldenburg, the Oley Foundation is a national, independent, non-profit 501(c)(3) organization that enriches the lives of patients dependent on home intravenous (parenteral ) and tube feeding (enteral ) through education, outreach, and networking. The Foundation also serves as a resource for consumer's families, clinicians and industry representatives, and other interested parties.

Coping Well with Home Enteral Nutrition: Words of Wisdom from Resilient Adult Consumers - The Utah Dietetic Association developed this self-help manual.  “Resilient HEN consumers who participated in a research study provided the majority of the information and strategies. They offered suggestions and insights based on their personal experiences."  This document is stored on Lucy's Real Food for the Tube, another site worth exploring.

A.S.P.E.N. Enteral Nutrition Practice Guidelines (2009)

Clinicians working with tube feeding patients/clients will be interested in these practice guidelines that A.S.P.E.N. published online yesterday. You can access them without a password.

Enteral Nutrition Practice Recommendations

Quotes, notes and references

"Up-to-date, practical information from dynamic, knowledgable speakers; overall, a valuable learning experience worth the trade-off of being indoors on a rare sunny Saturday in October; I feel inspired, challenged and better informed."

This was my evalution of the recent Education Day I attended. Listening to expert speakers in a supportive, collegial atmosphere boosted my morale as well as knowledge. The next step: translate this into daily practice.

So this week I've been reviewing my handouts. I thought I'd post some quotes, notes and key references pertaining to best practice in nutrition support (enteral and parenteral feeding) and vitamin-mineral supplementation.

Session: Enteral feeding: the practice vs the evidence (Carol Rees Parrish, MS, RD)

"To date, adequately powered studies have not been conducted to demonstrate a significant relationship between GRV [gastric residual volume] and aspiration pneumonia."

"Good evidence exists for maintaining a backrest elevation of greater than 30 degrees to decrease gastric reflux and aspiration events."

Parrish CR, McClave SA. Checking Gastric Residual Volumes: A Practice in Search of a Science? Practical Gastroenterology 2008; XXXII(10):33-47 (PDF)

Session: Parenteral feeding: passé in patients with pancreatitis? (Carol Rees Parrish, MS, RD)

"Jejunal feeding is safe, effective, low risk; best route (NJ, N-G-J vs PEG/J, surgical J) has yet to be determined by a prospective controlled trial."

Krenitsky, J., Makola D., Parrish, C. Parenteral Nutrition in Pancreatitis is Passé: But Are We Ready for Gastric Feeding? A Critical Evaluation of the Literature-Part I (PDF)

Krenitsky J, Makola D, Parrish CR. Pancreatitis Part II - Revenge of the Cyst: A Practical Guide to Jejunal Feeding (PDF)

"In patients with predicted severe acute pancreatitis, probiotic prophylaxis with this combination of probiotic strains did not reduce the risk of infectious complications and was associated with an increased risk of mortality.

Probiotics can no longer be considered to be harmless adjuncts to enteral nutrition, especially in critically ill patients or patients at risk for non-occlusive mesenteric ischemia."

Besselink MG, van Santvoort HC, Buskens E, Boermeester MA, van Goor H, Timmerman HM, et al. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial Lancet 2008; 371(9613):651-9.

Session: Drug-induced nutrient depletion and supplementation -- Literature picks (Liz da Silva, RD)

Bardia A, et al. Efficacy of antioxidant supplementation in reducing primary cancer incidence and mortality: a systematic review and meta-analysis. Mayo Clin Proc;83(1)23-34. (PDF)

Bjeklakovic G, et al. Antioxidant supplements for prevention of mortality in healthy participants and patients with various disease. Cochrane Database of Systematic Rev 2008 Apr 16;(2):CD007176

Expert Group on Vitamins and Minerals. Safe upper levels for vitamins and minerals, food standards agency, London. 2003 (PDF)

Mulholland CA, Benford DJ. What is known about the safety of multivitamin-multimineral supplements for the generally healthy population? Theoretical basis for harm. Am J Clin Nutr 2007;85(suppl):318S-322S. (PDF)

Wildish ED. An evidence-based approach for dietitian prescription of multiple vitamins with minerals. J Am Diet Assoc 2004;104:779-86.

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Complete schedule and speakers' biographies (PDF)

Home tube feeding challenges

I find it easiest to write from "I'm in the midst of it right now" experience so that's what I'm going to do today. As I mentioned, I have an intern with me this week and I've given her the challenge of simplifying our home tube feeding handouts for clients who either do not speak/understand English or have low literacy skills.

I hop to share our finished handouts on this blog, but in the meantime, here is the link to the home tube feeding resource we are using. From it we are selecting the most important information, simplifying the wording, and using pictures instead of words where possible.  

Tube Feeding at Home: a guidebook for patient, families and caregivers