Enteral and Parenteral Nutrition Management

For patients who cannot be adequately fed by mouth, energy, protein, and micronutrient support is delivered via gastrointestinal tube (enteral) or intravenous line (parenteral).

Indication

• Inability to safely take food by mouth due to swallowing difficulty (dysphagia), altered consciousness, stroke, or neurological disease
• Temporary or permanent need for tube feeding after head and neck, esophageal, or gastric cancer and surgeries
• Increased nutritional needs in intensive care patients, severe trauma, burns, and critical illness
• Parenteral nutrition in inflammatory bowel disease, short bowel syndrome, ileus, or fistula
• Supportive nutrition for severe malnutrition, cachexia, or insufficient oral intake
• Pediatric patients with growth/development disorders and chronic illness-related inadequate intake

Preparation

• The physician and dietitian together evaluate the patient's clinical status, gastrointestinal function, and nutrition history
• Blood tests (CBC, electrolytes, kidney/liver function, albumin, CRP) are reviewed
• For enteral nutrition, the tube type (nasogastric, nasojejunal, PEG, PEJ) and duration are planned
• For parenteral nutrition, the need for central or peripheral IV access is determined
• The patient and family are taught tube/IV care, hygiene, and signs of complications

How it's performed

1. Daily energy needs (typically 25-30 kcal/kg) and protein needs (1.0-1.5 g/kg) are calculated
2. In enteral nutrition, an appropriate formula (standard, high-protein, fiber-containing, disease-specific) and infusion rate are selected
3. Bolus, intermittent, or continuous pump enteral feeding is planned; head elevation of 30-45° is maintained
4. In parenteral nutrition, a mixture of carbohydrate, amino acid, lipid, vitamins, and trace elements is prepared
5. Gradual calorie escalation is applied for patients at risk of refeeding syndrome
6. Daily intake, gastric residual, glucose, electrolytes, and clinical findings are monitored

Post-procedure

• Electrolytes, glucose, triglycerides, and liver values are checked daily during the first week, then 2-3 times weekly
• Weight, fluid balance, edema, and fever are monitored daily
• Daily evaluation of tube position, skin exit site, and IV insertion site for infection is required
• When tolerance is good, gradual transition to oral intake is planned and enteral/parenteral support is reduced
• For long-term home feeding, patient/family education and regular communication with the care team continue

Risks

• In enteral nutrition: aspiration (food entering the lungs), diarrhea, constipation, tube blockage, and dislodgement
• In PEG/PEJ tubes: skin exit site infection, bleeding, granulation tissue
• In parenteral nutrition: catheter-related infection, thrombosis, air embolism (rare)
• Refeeding syndrome: low phosphate, potassium, magnesium, and arrhythmia risk after rapid feeding
• Hyperglycemia, fatty liver, biliary sludge, and decreased bone density in the long term

FAQ

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