Nasojejunal v PN

[Tixylix]

I am currently reviewing practice on my ICU. currently patients are
fed enterally via nasogastric tube usually within 48 hours but often
not established at ttarget rate for 4- 5 days. however majority of
patients have large GRV and are subsequently commenced on prokinetics
as per protocol, if this is not succesful patients are then assigned
PN. Im keen to introduce more post pyloric feeding on ICU and would be
interested to hear of experiences and practices. do most units go
straight onto PN once gastric EN has failed or is Nasojejunal feeding
considered as routine practice? are there ay recommended papers to
read.

[Daren Heyland]

Hi
I would discourge you from jumping to early PN for failed NG feedings unless
the patient was a high nutrition risk, see attached NIBBLE for recent study
reviewed justifying my point of view.

I would also have you consider several other easier stratgies to optimize
intragastric delivery of nutrients, like starting motility agents and
protein supplements empirically- see attached description of PEP up
protocol.

Lastly, we are just updating our meta-analysis on small bowel vs gastric
feedings. I don't have anything written I can share with you but the signal
persists that there is a lower vap rate with small bowel feeding. The
problem with small bowel feeding is that is it hard to establish access
without delays. If you have the ability to easily achieve small bowel
feeding, then move quickly to achieve it for EN intolerant patients. if not
so easy, try the ideas described in the PEP Up protocol.
Hope that helps
Daren

Dr. Daren K. Heyland
Director, Clinical Evaluation Research Unit
Kingston General Hospital
Kingston, ON
K7L 2V7
office: 613-549-6666x4847
fax: 613-548-2428
cell: 403-915-5573

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[lmus...@numc.edu]

I also would not jump to PN therapy. The use of motility agents has
worked well in our MICU, only a few exceptions in the past 6 months
(prone positioning, persistently high GRV). In these cases a NJT was
successfully placed at bedside. We are presently using an
electromagnetic tracking system (Cortrak device) to aid in these
placements at bedside. The RD is the keeper of the device, under the
direction of a MD, and works with an available RN or MD to place the
FT. The RD identifies candidates or receives consults for the FT
placement. In our SICU, the use of NJT is more widely used, for
almost all CHI, and other dx. The surgical block overall is very
fearful of aspriation and would otherwise not enterally feed patients
without transpyloric access. The Pep Up protocol also works very
nicely!!! Good luck, Lisa