What is nutrition therapy by tube or IV and Why is it important?
Cancer and cancer treatments can affect the way you eat and drink. Nutrition therapy, also known as nutrition support, provides the body with nutrients and fluids when treatment affects the ability to eat. Nutrition therapy is often used for a short time to help patients heal while undergoing treatment. It can also be used for a longer time if the ability to eat is permanently affected. The goal of nutrition therapy is to offer enough nourishment to avoid unhealthy weight loss and/or dehydration.
Who might need nutrition therapy?
- Patients who have significant weight loss due to low desire or difficulty eating
- Patients with low food intake for more than a week
- Patients who need to improve nutrition before a surgery
How is nutrition therapy given? (feeding types)
If the gastrointestinal tract (gut) is working and can still move food through the body, a tube feeding can be used. An IV feeding is used if the gut cannot process well food well or at all.
Parenteral nutrition – Feeding through a large IV (intravenous catheter) into the bloodstream. Parenteral nutrition therapy is often recommended when nutrition therapy will be required for a longer time.
Enteral nutrition – Feeding liquid nutrition through a tube into the stomach or intestines. Enteral nutrition therapy can be used for either a short or long time period.
An enteral feeding tube can be placed in different locations depending on you and your health. The most common sites include:
- Nasogastric tube (NG tube or NGT) – A tube is placed from the nose into the stomach.
- Gastrostomy (G-tube) – A tube is placed from the skin surface directly into the stomach.
- Jejunostomy (J-tube) – A tube is placed from the skin surface directly into the intestine.
Where is nutrition therapy given?
While nutrition therapy may be used in a hospital setting, it is most often given at home through a nutrition therapy service (home health). If you or a loved one is thinking about home health, you may be worried about tube feeding or intravenous feeding. Both can be an intimidating, but with proper information and preparation, nutrition therapy can be done at home. Below are some details to understand before you begin home feedings.
There are many different types of formula available. Each has individual components that are suitable for nutritional needs. It is important to understand the amount (volume or feeding rate) and frequency (hang time) of the formula planned. Talk to your healthcare team about your nutrition plan. Be sure to know where you can buy the formula and how you should store it (some formulas need refrigeration).
Water flushes clear the feeding tube and provide fluids. Know when flushes are needed (before, after or during feedings) and how much water to use. It is important to follow the directions closely to prevent dryness or excess fluids.
Cleanliness is critical to prevent infection and maintain good health. Make sure to wash your hands properly before feedings. Clean the top of the formula before opening to decrease possible contamination. Follow any other directions given by your healthcare team.
Patients receiving enteral nutrition should try to sit up straight during tube feeding. Sitting up straight for at least 30 minutes after feeding is recommended to stop backward flow of the food and possible aspiration (taking food particles or liquids into the lungs through the windpipe). If you are receiving parenteral nutrition, you do not need to worry about sitting.
Possible Side Effects
The benefits of nutrition therapy are often greater than the side effects, but issues can occur. You will be able to handle some issues on your own, but always ask your healthcare team what they recommend. Be sure to have an emergency number to use when something happens outside your team’s regular office hours.
Possible Side Effects of Enteral Nutrition:
- Constipation – difficult bowel movements due to lack of activity, poor fluids and fiber intakes, or use of pain medication
- Dehydration – lack of fluids that can be caused by concentrated formulas, not enough free water flushes, high protein intake, or high blood sugar levels
- Diarrhea – loose bowel movements that can be from medications, feeding too quickly, sorbitol-containing formula or infection
- Gastrointestinal reflux and aspiration – reflux is the backward flow of gut contents into the throat. Aspiration results when these food items get into the lungs, which can lead to infection and pneumonia. Feeding while lying down is the most common cause. The bed should be elevated to at least 45 degrees.
- High gastric residuals – gastric residuals are the food particles that remain in the gut after feedings. Your doctor or registered dietitian can assist if residuals are too high. A low-fat and low-fiber formula or decrease feeding rate may be recommended.
- Malabsorption – occurs when the gut can’t absorb the nutrients from food, which can lead to diarrhea and lack of proper nutrition
- Re-feeding syndrome – occurs when a starved body receives feeding too quickly and issues arise. If you have been without food or only taking a small amount, feed slowly with the direction of a healthcare team.