Introduction
Enteral Nutrition: It is also known as tube feeding. It is administered in cases when a person is not able to eat directly from the mouth due to some disease or disorder. Instead, the nutrition is delivered directly to either the stomach or small intestine with the help of a feeding tube. Enteral nutrition can be administered in the hospital as well as outside at home too. Enteral nutrition can be given to all age groups, from infants and children to older adults.
Parenteral Nutrition: It is a procedure of nutrition supply that is done intravenously. It includes carbohydrates, proteins, fats, minerals, electrolytes, and vitamins for patients who can not eat or absorb food through the enteral route. It is faster to supply nutrients to cells and tissues than the enteral route, which depends on stomach and intestinal digestion and absorption. The nutrients are administered in the form of a sterile liquid chemical formula directly into the bloodstream intravenously.
When Does a Patient Need Enteral Nutrition?
As the food administered through the enteral technique undergoes digestion in the stomach and intestine, so it is suggested in cases of impaired chewing and swallowing.
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Neurological Problems: In cases such as stroke (interruption of blood supply to the brain, preventing oxygen and nutrition from reaching brain tissue) and amyotrophic lateral sclerosis (a progressive neural disorder causing loss of muscular control from the brain); the patient is unable to properly function muscle of mastication. This causes difficulty in chewing and swallowing the food.
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Gastrointestinal Problems: In some cases of gastrointestinal disorders such as gastroparesis (delayed stomach emptying) and intestinal obstruction (partial or complete blockage of food and fluids in the passage of the intestine), the patient needs enteral nutrition.
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Cancer: Malignancies affecting the head, neck, or esophagus can make it very difficult for patients to chew and swallow food. Such cases need enteral nutrition.
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Trauma: In cases of injury or trauma to the face, neck, or digestive system, the patient may need direct administration of food to the stomach or intestine through enteral mode.
When Does a Patient Need Parenteral Nutrition?
Conditions with severe digestion problems need a parenteral route of nutrition:
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Short Bowel Syndrome: It can be a congenital issue or occur as a result of a surgical procedure of removal of a segment of the bowel. Thus it is difficult to digest and absorb food with a short intestine, so the parenteral route of nutrition is preferred.
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Cancer: Malignancy of the digestive tract can lead to obstruction of the intestine leading to difficulty in food digestion and absorption. Even cancer treatment modalities such as chemotherapy can alter the absorption of nutrition.
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Crohn’s Disease: Crohn's disease is an inflammatory disorder of the digestive system that may cause bowel narrowing, pain, vomiting, and nausea. These symptoms can affect food intake and digestion.
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Ischemic Bowel Disease: Reduced blood flow to any part of the stomach or intestine can cause problems such as necrosis, muscle function loss, and death of tissue. Food digestion and absorption are difficult in such cases.
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Abdominal Adhesion: Sticking the wall of organs with each other or the abdominal wall is known as abdominal adhesion. In cases of abdominal adhesion, there can be bowel movement alterations leading to difficulty in digestion and absorption.
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Diarrhea and Vomiting: Cases of excessive loss of fluids and improper digestion of food leading to loose stools may need parenteral nutrition immediately.
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Hyper Catabolic State: Due to conditions such as sepsis (infection spreading to different body parts), fractures, and polytraumas.
What Are the Types of Enteral Feeding Tubes?
The tubes used to administer nutrients directly to the stomach and intestine are known as feeding tubes. Types of a feeding tube for enteral nutrition depend on the passage of the nutrition supply.
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Nasogastric/Nasojejunal: The feeding tube which is inserted through the nose (nasal cavity) to the stomach (nasogastric) or to the small intestine (nasojejunal). This tube is favorable in cases with the need for enteral nutrition for a month or less.
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Gastrostomy/Jejunostomy: The feeding tube is inserted through the skin in the abdomen into the stomach (gastrostomy) or into the small intestine (jejunostomy). This method is preferred in cases of a longer need for enteral nutrition.
How Is Parenteral Nutrition Administered?
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A thin, flexible tube (catheter) is inserted into a large vein leading to the heart. Administration through a large vein delivers nutrients quickly and at lower risk of catheter infection. The procedure is performed under heavy sedation or anesthesia.
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Types of catheter use for parenteral nutrition are:
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A Tunneled Catheter: It has a segment of the tube located outside the skin and another portion tunneled under the skin before entering the vein. An example is the Hickman catheter.
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An Implanted Catheter: The catheter is inserted completely beneath the skin and accused with a needle for infusion of parenteral nutrition.
What Are the Risk Factors for Parenteral Nutrition?
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The most common and severe complication of parenteral nutrition is catheter infection. Prolonged use of a catheter can manifest microorganisms that can infect the catheter and sometimes cause infection in the body of an individual.
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Other short-term complications of the parenteral nutrition are fluids and minerals imbalance, blood clots, or issues with blood sugar metabolism.
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Long-term complications of the parenteral route include either excess or deficiency of
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Some trace elements, such as zinc or iron, can lead to the development of liver diseases.
Conclusion
Enteral and parenteral nutrition are two modes of supply of food and nutrients to the body externally. Enteral supply is carried out with the help of a feeding tube, whereas parenteral is carried out intravenously by a catheter. The choice of route of administration depends on the status of the digestive system of an individual. Therefore, proper care and professional assistance are important for nutrient administration through the enteral and parenteral pathways.
