Artificial nutrition

Artificial food is used when the patient's diet through the mouth is difficult or impossible. The causes may be esophageal diseases( esophageal stasis with burns or tumor compression), stomach diseases( stomach cancer), intestinal diseases( tumors, Crohn's disease, etc.).Artificial nutrition is used in preparing for surgery in weakened, depleted patients with the goal of raising vitality and the possibility of better transfer of surgical intervention. Artificial nutrition can be carried out using a probe inserted into the stomach through the mouth or nose, or gastrostomy.

You can drive nutrient solutions with enema, as well as parenterally, bypassing the digestive tract.

I. Probe food

A nurse must have a good command of the patient's nutrition through the probe, causing the patient minimal discomfort.

For this procedure it is necessary to prepare:

• sterile thin rubber probe 0.5-0.8 cm in diameter;

• Vaseline or glycerol;

• a funnel or a syringe of Janet;

• liquid food.

Sequence of actions.

1. Treat the probe with petroleum jelly or glycerol.

2. Through the lower nasal passage, insert the probe to a depth of 15-18 cm.

3. With the fingers of the left hand, determine its position in the nasopharynx and press it to the back wall of the pharynx. Without such a finger control probe can get into the trachea.

4. The head of the patient slightly tilt forward and with his right hand propel the probe to the middle third of the esophagus;if the air does not exhale during exhalation, and the patient's voice is stored, then the probe is in the esophagus.

5. Connect the free end of the probe to the funnel.

6. Slowly pour the prepared food into the funnel.

7. Then pour clean water into the funnel to rinse the probe and remove the funnel.

8. The outer end of the probe should be fixed on the patient's head so that it does not interfere with him.

The probe can not be removed during the whole period of feeding, which usually lasts 2-3 weeks.

You can use sweet tea, raw eggs, mors, mineral water without gas, broth, cream as food for probe feeding. Once through the probe you can enter no more than 600-800 ml. For this purpose, there is a special preparation ENPIT, which is a homogenized emulsion, balanced in proteins, fats, carbohydrates, vitamins and mineral salts.

II.Feeding the patient through the gastrointestinal tract

This operation( imposition of gastrostomy) is performed in case of obstruction of the esophagus and stenosis( constriction) of the pylorus. Gastrostoma in translation from Greek( gaster- "stomach", stoma - "mouth, hole") - "fistula of the stomach."

The gastrostomy tube is a rubber tube, the output of which is usually located in the region of the left rectus abdominis muscle. The method of feeding through the gastrostomy is simple: a funnel is connected to the free end of the probe, through which small amounts of liquid( 50 ml) are injected into the stomach six times a day by the heated liquid food. Gradually, the amount of food introduced is increased to 25-500 ml, and the number of feedings is reduced to four times. Sometimes the patient is allowed to chew on his own food, then it is bred in a glass with liquid and already in a diluted form poured into the funnel. With this variant of feeding, reflex excitation of gastric secretion remains.

III.Nutrition with the enema

Drip( nourishing) enemas are designed for resorptive effects on the body. Applied for the introduction into the intestines of the patient nutrient medications. Use 0.85% sodium chloride solution, 5% glucose solution, 15% amino acid solution. This method of nutrition is used when it is impossible to carry out either natural nutrition or parenteral nutrition. A drop enema is placed 20-30 minutes after the cleansing enema. For drip enema should be prepared:

• mug Esmarch( rubber, enamel or glass);

• two rubber tubes connected to a dropper;

• a thick gastric tube. The rubber tubes and probe are connected by a glass tube. On the rubber tube above the dropper a screw clamp must be fixed;

• drug solution heated to 38-40 ° C.He is poured into a mug of Esmarch, suspended on a tripod. To keep the solution cool, the mug is wrapped with a cotton swab or a heating pad;

• Vaseline.

Sequence of actions:

1. To lay the patient in a position convenient for him( it is possible on the back).

2. Open the clamp, fill the system with a solution( a solution should appear from the gastric probe) and close the clamp.

3. Introduce a Vaseline-lubricated probe into the rectum to a depth of 20-30 cm.

4. Clamp the droplet delivery rate, not faster than 60-100 per minute. During this procedure, the nurse must ensure that a constant speed is maintained and the solution remains warm.

IV.Parenteral nutrition

It is prescribed to patients with signs of obstruction of the digestive tract, with the impossibility of normal nutrition, after operations on the esophagus, stomach, intestines, etc., the depleted patient in their preparation for surgery.

During the infusion of nutrients through the subclavian vein, it is possible to develop complications such as catheter infection, cholestasis( bile stasis), bone damage, micronutrient deficiency. Therefore, parenteral nutrition should be resorted to in exceptional cases and according to strict indications. For this purpose, preparations containing products of protein hydrolysis, amino acids: hydrolysine, protein hydrolyzate of casein, fibrinosol, as well as artificial mixtures of amino acids - alvezinic, levamine, polyamine;fatty emulsions - lipofundin, indralipid, 10% glucose solution to 1 - 1.5 liters per day. In addition, it is mandatory to inject up to 1 liter of electrolyte solutions, B vitamins, ascorbic acid. The agents for parenteral administration are administered intravenously by drip. Before administration, they are heated in a water bath to a body temperature of 37 ° C.It is necessary to strictly adhere to the speed of administration of drugs: hydrolysine, protein hydrolyzate casein, fibrinosol, polyamine in the first 30 minutes injected at a rate of 10-20 drops per minute, and with good tolerability, the rate of administration is increased to 40-60 drops per minute. Polyamine in the first 30 minutes is injected at a speed of 10-20 drops per minute, and then 25-30 drops per minute. A faster injection is not advisable, since excess amino acids are not absorbed and excreted in the urine. Lipofundin S( 10% solution) is administered in the first 10-15 minutes at a rate of 15-20 drops per minute, and then gradually for 30 minutes increase the rate of administration to 60 drops per minute. All preparations are administered for 3-5 hours in an amount of 500 ml. With the rapid introduction of protein preparations, the patient may experience a feeling of heat, hyperemia of the face, difficulty breathing.