Artificial nutrition apply in cases where the patient's nutrition through the mouth is difficult or impossible.The causes may be diseases of the esophagus (esophageal stenosis with burns or compression tumor), gastric ulcer (gastric carcinoma), intestinal diseases (tumors, Crohn's disease, etc.).Artificial nutrition is used in preparation for surgery in frail, malnourished patients with the aim of raising the vitality and better possibilities transfer surgery.Artificial feeding may be carried out using a probe introduced into the stomach through the mouth or nose, or gastrostomy.
can drive the nutrient solutions with the help of an enema, and parenterally, bypassing the digestive tract.
I. tube feeding
nurse should be proficient in the procedure the patient's nutrition through a tube, causing minimal discomfort to the patient.
For this procedure, you need to prepare:
• sterile thin rubber tube with a diameter of 0.5-0.8 cm;
• Vaseline or glycerin;
• funnel or syringe Janet;
• liquid food.
1. Process Probe petroleum jelly or glycerine.
2. After the lower nasal passage to enter the probe to a depth of 15-18 cm.
3. fingers of his left hand to determine its position in the nasopharynx and press it to the back of the throat.Without such control finger probe can get into the trachea.
4. patient's head tilted slightly forward and your right hand to advance the probe to the middle third of the esophagus;if the air during exhalation does not come out, and the voice of the patient is saved, it means that the probe into the esophagus.
5. Connect the free end of the probe with a funnel.
6. Slowly pour into the funnel of the prepared food.
7. Then pour into the funnel clean water for the purpose of washing the probe and remove the funnel.
8. The outer end of the probe to enhance the patient's head so that it does not interfere with it.
probe not extract throughout the feeding period, which typically lasts for 2-3 weeks.
as food for tube feeding, you can use sweet tea, raw eggs, juice, mineral water without gas, broth, cream.One time through the probe can enter no more than 600-800 ml.For this purpose there is a special drug ENPIT representing a homogenized emulsion, balanced for protein, fat, carbohydrates, vitamins and mineral salts.
II.Feeding the patient through the gastrostomy
This operation (the imposition of gastrostomy) is performed at obstruction of the esophagus and stenosis (narrowing) gatekeeper.Gastrostomy in Greek (gaster- «stomach», stoma - "mouth opening") - "gastric fistula."
gastrostomy tube is a rubber tube, the output of which is usually located in the left rectus abdominis muscle.Method of feeding through gastrostomy simple: the free end of the probe is attached a funnel through which small portions (50 mL) six times per day administered in liquid food heated stomach.Gradually increase the amount of food introduced to 25-500 ml and the number of feedings is reduced to just four.Sometimes the patient allowed to independently chew food, then it is diluted with the liquid in the glass and in diluted form is poured into the funnel.In this embodiment, the feed is stored reflex excitation of gastric secretion.
III.Power using enemas
Drip (nutritional) enemas are designed to rezorbitivnoe effects on the body.Used for introducing nutrient into the intestine of the patient drugs.Use of 0.85% sodium chloride solution, 5% glucose solution, a 15% solution of amino acids.This way of eating is used in the impossibility of any natural food or parenteral.The dropping enema put in 20-30 minutes after cleansing.For drip enema should be prepared:
• mug douches (rubber, enamel or glass);
• two rubber tube connected to a dropper;
• thick gastric tube.Rubber tube and the glass tube are connected to the probe.In the rubber tube above dropper should be mounted screw terminal;
• drug solution, heated to 38-40 ° C.It is poured into a mug Esmarch suspended on a tripod.To the solution is cooled, mug wrapped with a cotton cover or heater;
1. Place the patient in a comfortable position for him (you can on the back).
2. Opening the clamp, fill the system with a solution (of gavage solution should appear) and close the clamp.
3. Enter into the rectum vaselined probe to a depth of 20-30 cm.
4. Clip adjust the speed drops proceeds no faster than 60-100 per minute.During this procedure, a nurse must follow to maintain a constant speed, and the solution remained warm.
It is prescribed to patients with symptoms of obstruction of the digestive tract, if it is impossible the normal power supply, after operations on the esophagus, stomach, intestines, etc., depleted patients during their preparation for the operation.
During the infusion of nutrients through the subclavian vein may develop complications such as infection of the catheter, cholestasis (bile stasis), bone disease, micronutrient deficiency.Therefore, parenteral nutrition is to resort in exceptional circumstances and on strict conditions.For this purpose, the preparations containing protein hydrolysates, amino acids: gidrolizina, casein protein hydrolyzate, fibrinosol and artificial mixtures of amino acids - alvezinnovy, levamin polyamine;fat emulsions - Lipofundin, indralipid, 10% glucose solution to 1 - 1.5 liters per day.Also, be sure to introduce up to 1 liter solutions of electrolytes, vitamins, ascorbic acid.Means for parenteral administration is administered intravenously.Before the introduction of preheated water bath at body temperature to 37 ° C.It is necessary to strictly observe the speed of drug administration: gidrolizina, casein protein hydrolyzate, fibrinosol polyamine in the first 30 minutes at a speed of 10-20 administered drops per minute, and good tolerability of the rate of introduction is increased to 40-60 drops per minute.The polyamine in the first 30 minutes at a speed of 10-20 administered drops per minute, followed by 25-30 drops per minute.A more rapid introduction of impractical because excess amino acids are not digested and excreted in the urine.Lipofundin S (10% solution) is administered in the first 10-15 minutes at a rate of 15-20 drops per minute, followed slowly over 30 minutes to increase the delivery rate of 60 drops per minute.All drugs are administered for 3-5 hours in 500 ml.With the rapid introduction of protein preparations of the patient may experience a sense of warmth, flushing of the face, difficulty in breathing.