Evidence based – Enteral feeding algorithm for Neurosurgery ICU/Ward

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Original Article

Author Details : Shruti Shirke*, L Anand, Rabi Narayan Sahu, Fakir Mohan, Megha Scott

Volume : 9, Issue : 2, Year : 2023

Article Page : 70-75

https://doi.org/10.18231/j.ijn.2023.014

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Abstract

Enteral feeding and Nurses: Enteral feeding is a procedure that is in practice internationally by nurses. Providing enteral feeding to the patients is an art and science of nursing that follows careful steps and principles. Nurses role is not only confined to administering enteral feed but also of educating, giving instructions to the family members, directing caregivers and significant others regarding initiating and maintaining enteral feeding, so that continuity of nutritional care is maintained even in the home setting.
Admission of patient in Neurosurgery ICU/Ward: Once the patient is admitted in neurosurgical ICU, hemodynamic stability of the patient is utmost important, as hemodynamic instability of the patient may preclude the safe initiation of EN in the critical care patients. Initial stabilization is the key for patient survival followed by maintenance therapy like drugs, mobilization, position, continuous monitoring and nutrition.
For determining the need of enteral feeding especially for neurosurgical and neurological patients three things should be given utmost importance i.e. Swallowing deficit, Unconsciousness (Level of consciousness) and Nutritional requirement. Can be easily remembered as pneumonic SUN.
Enteral tube insertion and confirming tube position: Confirming tube position is one of the critical step in effective enteral feeding practice in spite of that it has given least importance. It is recommended to confirm the tube position immediately after ryles’ tube insertion through radiologic methods which may be not feasible sometimes, therefore bedside methods can also be adopted Auscultation methods and Aspiration method are the most widely used method among all the bed side methods for confirming tube placement.
Managing high gastric residual volume: Gastric residual volume is the amount aspirated from the stomach following administration of the enteral feed. An aspirate among of less than 500ml in 4-6 hours or less than 50% of last enteral feed is safe and indicates that GIT is functioning. Most patients nicely tolerate enteral feeding via gastric tube while few patients has delayed gastric emptying and high GRVs as a result of sedation, pain medications, hypothermia, decreased movement and the effect of being critically ill. Intolerance of enteral feeding is defined as more than 500ml or more than 50% of last enteral feeding.
Conclusion: Though enteral feeding is the most popular procedure for ICU Nursing officer, but it is the most crucial in terms of deciding patient outcome. Effective enteral feeding requires through knowledge of initiation and maintenance of enteral feeding. Thus, this article propose simple algorithm to follow. Effectively delivering nutrition to the patient requires the help of dietitian and physician/surgeon to deal with its challenges that comes along with this golden feeding technique.
 

Keywords: Enteral Feeding, Critically ill, neurosurgery, ICU, Enteral feeding algorithm, Nursing Officer, Gastric residual volume, GRV

How to cite : Shirke S, Anand L, Sahu R N, Mohan F, Scott M, Evidence based – Enteral feeding algorithm for Neurosurgery ICU/Ward. IP Indian J Neurosci 2023;9(2):70-75

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