Guidelines on Artificial Nutrition Support

Malnutrition is common in patients who are admitted to hospital, and many patients lose weight during hospital admission. Malnutrition is associated with increased morbidity and mortality. Artificial nutrition support benefits nutritional status in malnourished patients, it can lead to reduced morbidity and hospital stay, and more rapid recovery from illness. • Nutritional screening of hospital admissions is recommended; patients who are malnourished, or at nutritional risk through impaired appetite or prolonged starvation, should be referred for nutritional assessment and support. Starvation for more than one week is detrimental. Nutritional support may be required within one week in patients who are unable to take adequate oral diet and who are moderately or severely malnourished, or stressed through infection surgery or disease. • Whenever possible nutritional support should be introduced before malnutrition has developed. The goals of nutritional support, prevention or management of nutritional depletion, should be clearly defined. • Nutritional support should be given by the enteral route when the intestine is accessible. Enteral feeding may be provided by nutritional supplements, tube feeding is required in patients with profound anorexia or mechanical disorders of swallowing. Patients in whom the need for tube feeding is likely to exceed 2-4 weeks should be considered for the insertion of a percutaneous endoscopic gastrostomy (PEG) tube. • Parenteral nutrition is required when the intestine is inaccessible or its function is inadequate. Where possible parenteral nutrition should be administered by the peripheral route; central parenteral nutrition is required for patients who need prolonged periods of intravenous feeding and should be undertaken in wards where the staff are familiar with this form of nutritional support. • Safe and effective nutritional support is most readily achieved by a multidisciplinary nutrition support team (NST). NSTs include a nurse, dietician, pharmacist, biochemist and clinician. The NST within each hospital develops guidelines for nutritional management and monitoring. • Most hospitals will be expected to supervise the treatment of patients who need home enteral feeding; patients receiving home parenteral nutrition are best managed in regional or supraregional centres.