Enteral nutrition: types, definition and uses with patients

In our daily life we are constantly eating food, several times a day, in most cases without thinking about the complex process we carry out both at the behavioral level.

But sometimes it is not possible to feed ourselves voluntarily: imagine that we are in a coma or that we suffer from some type of illness that prevents us from eating. If nothing is done, the organism would end up dying of starvation.

Fortunately, we have mechanisms that allow us to continue maintaining a supply of nutrients artificially: enteral nutrition.

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Enteral nutrition: what is it?

Enteral nutrition is, along with parenteral nutrition, one of the two types of artificial nutrition that we have in medicine. It is a support technique in which the different nutrients that the body contains are introduced into the body. patient may require, generally using a probe that goes directly to the intestine or the stomach.

This technique avoids the need for food to pass through the mouth and trachea,

not requiring voluntary movements to acquire nutrients. However, applying enteral nutrition requires that the digestive system be able to perform its normal functions when absorbing the nutrients provided.

enteral nutrition helps prevent, among other things, protein autocatabolism (in other words, the body consumes itself to obtain nutrients), the weakening of the immune system (with the consequent risk of infections), bacterial translocation (bacteria in the digestive tract itself causing an infection) and atrophy of the digestive system. Administration can be continuous or discontinuous according to the patient's needs.

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Types of enteral nutrition

There are different methods by which enteral nutrition can be carried out. One of the ways to classify the different types of enteral nutrition It depends on where the probe is placed and how far it goes.

1. Enteral nutrition through nasogastric tube

In this procedure, a probe is placed that will penetrate the nose and will take a trip to the stomach, where the nutrients will be supplied. This is usually the most common mechanism, unless there is a risk of pulmonary aspiration of the intestinal contents.

If the patient is conscious It is going to be introduced through the nostrils and you will be asked to swallow saliva in order to direct the probe towards the digestive tract and not towards the respiratory system. Despite this, the subject's collaboration or awareness is not necessary to place it.

2. Enteral nutrition via nasoenteral tube

The procedure is the same as the previous one, except for the fact that in this case the probe will be taken to the intestine.

3. Enterostomy

When feeding through a nasoenteric or nasogastric tube is not feasible There is another procedure: enterostomy. In this case, a probe is not introduced through the usual routes, but rather is placed directly through the skin. More than a probe we would be looking at a type of catheter. It is also usually used when the patient is expected to be unable to feed themselves for more than four weeks. Within enterostomies, three main techniques stand out.

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Pharyngostomy

A tube is placed directly until it reaches the pharynx.

Gastrostomy

These procedures are based on the placement of a tube that reaches the stomach, but in this case going through the skin.

Jejunostomy

Like a gastrostomy, a tube is inserted through the skin until it reaches the target organ, in this case to the area of ​​the intestine called the jejunum.

What type of substances are introduced into the body?

Enteral feeding involves introducing certain nutritional substances into the body, varying these substances depending on the patient's needs. They will vary if, for example, the patient has kidney or liver failure, diabetes, or breathing problems. Also the state of development of the subject (for example, breast milk is used in babies). Among other things, the calorie and protein content is taken into account (it can be hyper, normo or hypocaloric/protein).

Regarding the way in which nutrients are presented, in general we can find polymeric formulas (in which intact proteins), peptide (hydrolyzed proteins) or elemental (directly in the form of amino acids). There are also special diets for patients with specific problems.

The most common formula is which involves a polymeric, normocaloric and normoprotein diet, but as we have already said, the choice of components will depend on the patient and her needs.

In what cases is it applied?

Enteral nutrition is the technique of choice in all those situations in which the patient has malnutrition or risk of suffering from it due to the existence of the inability to swallow or the refusal to do so voluntary, due to an injury, illness, or mental disorder. In other words: it is used in patients without the ability to ingest, with a greatly reduced capacity, or who refuse to do so despite having the functional capacity to do so.

However, in order to apply it, the digestive system needs to have a minimum of functionality when it comes to digesting and/or absorbing nutrients. It can be used on subjects of any age, from babies to the elderly.

It is essential in situations where the subject does not have the ability to swallow, for example the coma, or due to alterations of the pharynx that make it impossible to swallow.

It is also useful in some diseases in which, although the patient has the functional capacity to do so, they cannot eat due to problems such as bronchodysplasia or heart disease. Or in which ingestion is impossible because it causes reactions such as vomiting. Another case occurs in situations in which the body needs more nutrients than the subject, despite eating, is able to provide it.

On the other hand also It is recommended in premature babies, in order to prevent different diseases. Finally, it is used in mental disorders such as anorexia, forcing nutrition in cases of severe underweight that can lead to death,

Contraindications and risks

Enteral nutrition is a very beneficial technique that allows the body to be supplied with the necessary food when it cannot eat on its own. However, in some cases this type of feeding may be contraindicated due to the existence of problems in the digestive tract itself.

The main contraindication occurs in the presence of blockages, bleeding or perforations in the stomach or intestine.

The use of enteral nutrition may also pose some risks. There may be obstructions or displacement of the tube or possible metabolic complications if adequate nutrition has not been administered. Vomiting and nausea may occur, as well as diarrhea and reflux. Although rare, pulmonary aspiration of gastrointestinal contents may occur.