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Optimal practice review: recommendation reminders detail

Recommendation reminder 2: General surgical patients should not have enteral tube feeding within 48 hours post-surgery unless they are malnourished or at risk of malnutrition (as defined above) and have inadequate or unsafe oral intake and a functional, accessible gastrointestinal tract.

Guidance:Nutrition support in adults
Date issued:February 2006

The term nutrition support refers to any method of feeding that aims to improve or maintain the level of nutrients in the body. Nutrition support includes the use of special nutrient-rich foods, nutritional supplements and fortified foods, as well as liquid feed given by a tube into the gut or blood

Malnutrition can occur when a person’s diet does not provide enough nutrients, such as calories, protein and vitamins, to keep them healthy. A person is defined as malnourished if they have any of the following:

     a body mass index (BMI) of less than 18.5 kg/m2

     unintentional weight loss greater than 10% within the last 3–6 months

     a BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3–6 months.

A person is defined as at risk of malnutrition if they:

     have eaten little or nothing for more than 5 days and/or are likely to eat little or nothing for the next 5 days or longer or

     have a poor absorptive capacity, and/or have high nutrient losses and/or have increased nutritional needs.

Currently, knowledge of the causes, effects and treatment of malnutrition among healthcare professionals in the UK is poor.

Enteral tube feeding (ETF) is the delivery of a nutritionally complete feed directly into the gut via a tube. The tube is usually placed into the stomach, duodenum or jejunum via either the nose, mouth or the directly through the skin.

ETF is used to feed patients who cannot attain an adequate oral intake from food and/or oral nutritional supplements, or who cannot eat/drink safely. The aim is to improve nutritional intake and so improve or maintain nutritional status. It is used most commonly in patients with dysphagia (difficulties with swallowing) either because they cannot meet their nutritional needs despite supplements and/or modifications to food texture/consistency, or because they risk aspiration if they try to do so.

The gastrointestinal tract must be accessible and functioning sufficiently to absorb the feed administered, and ETF should be stopped if the patient is established on adequate oral intake. ETF is not exclusive and can be used in combination with oral and/or parenteral (intravenous) nutrition.

There is some evidence that post-operative oral nutritional supplements, introduced at or after recovery of gastrointestinal function, may reduce some complications in general surgery patients and patients with hip fracture requiring orthopaedic surgery. However, these studies have been small and underpowered. Nutritional principles suggest that giving post-operative oral supplements to more malnourished patients might lead to greater benefits but larger, targeted trials are needed to prove this. For these reasons, the NICE Guideline Development Group recommended that general surgery patients should not have enteral tube feeding within 48 hours post-surgery unless they meet the criteria specified in the recommendation.

 

This page was last updated: 10 March 2009

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.