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Chapter 073. Enteral and Parenteral Nutrition (Part 2)

Decision-making for the implementation of specialized nutrition support (SNS). CVC, central venous catheter; PICC, peripherally inserted central catheter. (Adapted from previous chapter by Lyn Howard, MD.) The first step in deciding to administer SNS is to consider the nutritional implications of the disease process. Is the condition or its treatment likely to impair food intake and absorption for a prolonged period of time? For example, a well-nourished individual can tolerate approximately 7 days of starvation while experiencing a systemic response to inflammation (SRI). The second step is to determine if the patient is already significantly malnourished to the degree that. | Chapter 073. Enteral and Parenteral Nutrition Part 2 Decision-making for the implementation of specialized nutrition support SNS . CVC central venous catheter PICC peripherally inserted central catheter. Adapted from previous chapter by Lyn Howard MD. The first step in deciding to administer SNS is to consider the nutritional implications of the disease process. Is the condition or its treatment likely to impair food intake and absorption for a prolonged period of time For example a well-nourished individual can tolerate approximately 7 days of starvation while experiencing a systemic response to inflammation SRI . The second step is to determine if the patient is already significantly malnourished to the degree that critical functions such as wound healing immune function or ventilatory function are impaired Chap. 72 . An unintentional weight loss of 10 during the previous 6 months or a weight height 90 of standard when associated with physiologic impairment represents significant PCM. Weight loss 20 of usual or 80 of standard reflects severe PCM. The presence or absence of SRI should be noted since inflammation injury and infection increase the rate of lean tissue loss. SRI also has pathophysiologic effects that influence nutritional responses such as fluid retention and hyperglycemia as well as impairment of anabolic responses to nutritional support. Once it is determined that a patient is already or at risk of becoming malnourished the next step is to decide whether SNS will impact positively on the patient s response to disease. In the end stages of many chronic illnesses with accompanying PCM particularly those due to cancer or terminal neurologic disorders nutrition may not reverse the PCM or improve quality of life. While the provision of food and water is part of basic medical care nutrition delivered by tube or catheter either enterally or parenterally is associated with risk and discomfort. Thus SNS should be recommended only when potential benefits .