Enteral nutrition refers to nutrition provided through tube feedings. We spent this rotation in the medical intensive care unit (MICU) and the neuro ICU. We worked with patients who could be fed orally still but put most of our focus on patients who needed to be fed through a tube. Tubes can be put through the mouth, nose, or abdominal wall into the stomach or small intestines.
NOTE: This is NOT a picture of a patient from our hospital; it is a picture that I found on the internet. The red arrow is pointing to a nasally-placed feeding tube.
Some experiences from this rotation:
- We watched the placement of a nasojejunal feeding tube for a patient with severe acute pancreatitis. This means that the feeding tube was passed through the patient's nose, through his stomach and into the jejunal portion of his small intestine. Unfortunately, the placement didn't go too well because the patient wasn't very happy to be having a tube crammed down his throat while he was nauseated. Once the placement was done, they did an x-ray (which they always do to make sure we're feeding into the right portion of the digestive tract and not into the lungs) and found that the tube had gotten stuck in his stomach. So, they took it back out and didn't feed the patient (it's not advisable to feed a patient with pancreatitis prior to their small intestine because earlier feeding in the GI tract will lead to pancreatic stimulation. In the case of pancreatitis, the production of more enzymes leads to pancreas autodigestion and breakdown so the patient could potentially lose their pancreas and develop type 1 diabetes).
- We also saw patients who needed Blakemore tubes to stop bleeding in their esophagus. Blakemore tubes are balloons that blow up inside the esophagus to put pressure on bleeding areas similar to compressing a cut to stop bleeding externally.
- We spent some time with a respiratory therapist who showed us all of the options for ventilation. Many of our patients were intubated so learning about the machines attached to them was important for us to use in assessing the clinical status of our patients. We saw patients on ventilators, oscillators, ECMO and other respiratory machines.
Unfortunately, the unit where we worked this time held many of the sickest patients in the entire hospital. It was not uncommon to have a patient die most days of the week that we were in the unit (including at least two of my patients). - Types of patients we saw in this rotation: stroke, suicide attempts, alcohol withdrawal, brain damage, seizure, respiratory failure/distress, end stage COPD, pneumonia, trigeminal neuralgia, intracranial hemorrhages (many that had occurred while shoveling snow), pseudo-aneurysm, septic shock, bacteremia, and fungemia. Many patients were intubated and sedated (with propofol, which provides 1.1 calories per mL, some patients were receiving over 1000 calories per day just from their sedation).
- We used many types of feeding formulas such as Jevity 1.2 (the numbers refer to the amount of calories per mL), Osmolite 1.5, Glucerna 1.5, Nepro with Carb Steady, and Oxepa.
