Name of the Procedure:

Enteral formula, nutritionally complete, hydrolyzed proteins
(also known as amino acid and peptide chain formula, elemental diet)

Summary

This procedure involves the delivery of a specialized, nutritionally complete formula through a feeding tube directly into the stomach or small intestine. The formula contains hydrolyzed proteins (amino acids and peptide chains), fats, carbohydrates, vitamins, and minerals, and may include fiber. This method provides essential nutrients to patients who cannot consume food orally.

Purpose

Medical Conditions Addressed:

• Severe food allergies
• Gastrointestinal disorders (e.g., Crohn's disease, short bowel syndrome)
• Malabsorption syndromes
• Critical illnesses requiring nutritional support

Goals:

• Provide complete nutrition
• Maintain or regain nutritional status
• Support healing and recovery

Indications

Symptoms/Conditions:

• Inability to eat or drink normally
• Severe allergic reactions to whole proteins
• Chronic diarrhea or nutrient malabsorption
• Significant weight loss or malnutrition

Patient Criteria:

• Patients who cannot maintain proper nutrition via oral intake
• Individuals with compromised digestive systems

Preparation

Pre-Procedure Instructions:

• Patients may need to fast for a few hours before the procedure
• Review of current medications with the healthcare provider

Diagnostic Tests/Assessments:

• Nutritional assessment by a dietitian
• Blood tests to evaluate nutritional status

Procedure Description

1. Inserting the Feeding Tube: The feeding tube is placed either nasogastrically (through the nose) or surgically directly into the stomach or small intestine.
2. Formula Preparation: The enteral formula, hydrolyzed to its amino acid and peptide forms, is prepared according to the prescribed calorie needs.
3. Administration: The formula is administered via a feeding pump or gravity drip through the tube. One unit of the formula constitutes 100 calories.
4. Monitoring: Healthcare professionals monitor the patient's tolerance and adjust the feeding rate as needed.

Tools and Equipment:

• Feeding tube and placement kit
• Enteral feeding pump or gravity set
• Nutritionally complete enteral formula

Anesthesia or Sedation:

• Local anesthesia for tube insertion may be required if the tube is placed surgically.

Duration

The initial tube placement usually takes around 30 minutes to an hour. Feeding sessions can vary from a few hours to continuous 24-hour administration, depending on the patient's requirements.

Setting

• Hospital
• Outpatient clinic
• Home settings (with home healthcare support)

Personnel

• Gastroenterologist or surgeon for tube placement
• Registered dietitian for nutritional planning
• Nurses for administration and monitoring

Risks and Complications

Common Risks:

• Discomfort or irritation at the tube site
• Nausea and vomiting
• Diarrhea or constipation

Rare Complications:

• Tube dislodgement or blockage
• Infection at the insertion site
• Aspiration pneumonia

Management:

• Regular monitoring and adjustments
• Prompt medical attention for complications

Benefits

Expected Benefits:

• Improved nutritional status
• Weight stabilization or gain
• Better management of underlying medical conditions

Realization Time:

• Benefits typically realized within a few days to weeks

Recovery

Post-Procedure Care:

• Clean and care for the tube insertion site
• Monitor for signs of infection or complications

Recovery Time:

• Immediate use post-insertion
• Long-term use may require periodic adjustments

Restrictions/Follow-Up:

• Regular follow-up appointments with healthcare providers
• Continuous assessment by a dietitian

Alternatives

Other Treatments:

• Oral nutritional supplements
• Parenteral (intravenous) nutrition

Pros and Cons:

• Oral supplements may not be suitable for severe cases
• Parenteral nutrition carries greater risk of infections and complications

Patient Experience

During the Procedure:

• Discomfort from tube insertion may occur
• Anxiety about the feeding process

After the Procedure:

• Relief from hunger once feeding starts
• Possible initial discomfort as the body adjusts to the formula

Pain Management:

• Local anesthetics for insertion
• Over-the-counter pain relief if necessary
• Support from healthcare providers to ensure comfort and address concerns