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ENTERAL NUTRITION: WHAT ARE THE MAIN COMPLICATIONS?

Only adopting enteral nutrition (EN) when it’s necessary isn’t enough. Having proper monitoring during the nutritional therapy is essential to avoid a few complications. That’s what the nutritionist from Ganep Nutrição Humana (the largest institution specialized in medical nutrition therapy in Brazil) and specialist in Nutrition, Michelle Barone, says.

According to the professional, most complications can be avoided if the prescriptions, the development of the enteral nutrition therapy (ENT) and the nutritional monitoring are followed properly. In order for that to happen, establishing protocols and quality indicators regarding the ENT is extremely important, and these tools should be able to guarantee the treatment success. The main complications are divided into some categories: metabolic, gastrointestinal, mechanical, infectious and operational.

The metabolic complications are related to dehydration and hyperhydration, when the water ingestion is inadequate, and are the most common during an ENT. Along with these issues, there’s also hyperglycemia and hypoglycemia, which are related to the inadequate ingestion of calories, unprogrammed interruptions of the ENT and to the clinical conditions of the patient.

According to the nutritionist, another important alteration is the Refeeding Syndrome. It happens when malnourished patients or people who have been fastening for a long period of time start being fed too quickly and too much again. When that happens, the micronutrients that were lacking in the body are diverted, provoking a steep and substantial drop in their plasmatic concentrations. Such diversion causes changes in the cardiovascular, hepatic, pulmonary, renal and hematologic systems.

Among the most common gastrointestinal complications during ENT, there are diarrhea, vomit, nausea and constipation, which may be related to the excess of fat of the diet, to quick brewing or to some intolerance to the formula components. Apart from that, gastroparesis, which affects the gastric emptying, making it slower, may also occur, and it may be caused by some medicament intake, by hydroelectrolytic disorders, or even by the clinical conditions of the patient. The conditions related to the administration of the enteral diet include the formula type, the temperature of the mixture and the brewing speed, according to Michelle.

Microbial contamination during the preparation of the enteral diet may cause poisoning, which is considered an infectious complication. Furthermore, aspiration pneumonia may also occur if the tube isn’t positioned properly, if the patient position is wrong or if there are any gastrointestinal alterations.

Finally, mechanical and operational complications regard the technical and operational tools of the ENT. Among the possible causes there are tube obstruction, erosions and nasal necrosis. The improper handling during the administration of the diet may be another cause. According to the professional, some numbers show the statistics of the complications during enteral nutrition therapies. Some national and international studies show that nausea and vomit happen to 12% to 20% of the patients. Diarrhea can be one of the most frequent complications, and happens up to 95% of the people.

You will find below a list of some actions that, if taken seriously, according to the nutritionist, may help minimize the problems that may happen during the enteral nutrition therapy.

Some actions may prevent complications

  • Checking the position of the tube before starting the enteral nutrition
  • The patient’s trunk must be elevated before and after the administration
  • The volume of the diet and the speed of the brewing must evolve gradually
  • Proper water ingestion
  • Assessment of the enteral diet composition
  • Discussing the need for specific formulas when there are alterations
  • Opting for isotonic and fiber-free diets, in case of gastroparesis
  • Avoiding brewing diets that are too cold
  • Avoiding using thick tubes
  • Checking the proper fixation of the tube
  • Avoiding using a nasoenteral tube for longer than four weeks
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