Types of Nutrition Care
Key Points for This Section
- Nutrition support gives nutrition to patients who cannot eat or digest normally.
- Nutrition support for patients who cannot eat can be given in different ways.
- Enteral Nutrition
- Parenteral Nutrition
Nutrition support gives nutrition to patients who cannot eat or digest normally.
It is best to take in food by mouth whenever possible. Some patients may not be able to take in enough food by mouth because of problems from cancer or cancer treatment. Medicine to increase appetite may be used.
Nutrition support for patients who cannot eat can be given in different ways.
A patient who is not able to take in enough food by mouth may be fed using enteral nutrition (through a tube inserted into the stomach or intestines) or parenteral nutrition (infused into the bloodstream). The nutrients are given in liquid formulas that have water, protein, fats, carbohydrates, vitamins, and/or minerals.
Nutrition support can improve a patient's quality of life during cancer treatment, but there are harms that should be considered before making the decision to use it. The patient and health care providers should discuss the harms and benefits of each type of nutrition support. (See the Nutrition in Advanced Cancer section below for more information on deciding whether to use nutrition support.)
Enteral nutrition is also called tube feeding.
Enteral nutrition is giving the patient nutrients in liquid form (formula) through a tube that is placed into the stomach or small intestine. The following types of feeding tubes may be used:
- A nasogastric tube is inserted through the nose and down the throat into the stomach or small intestine. This kind of tube is used when enteral nutrition is only needed for a few weeks.
- A gastrostomy tube is inserted into the stomach or a jejunostomy tube is inserted into the small intestine through an opening made on the outside of the abdomen. This kind of tube is usually used for long-term enteral feeding or for patients who cannot use a tube in the nose and throat.
The type of formula used is based on the specific needs of the patient. There are formulas for patients who have special health conditions, such as diabetes. Formula may be given through the tube as a constant drip (continuous feeding) or 1 to 2 cups of formula can be given 3 to 6 times a day (bolus feeding).
Enteral nutrition is sometimes used when the patient is able to eat small amounts by mouth, but cannot eat enough for health. Nutrients given through a tube feeding add the calories and nutrients needed for health.
Enteral nutrition may continue after the patient leaves the hospital.
If enteral nutrition is to be part of the patient's care after leaving the hospital, the patient and caregiver will be trained to do the nutrition support care at home.
Parenteral nutrition carries nutrients directly into the blood stream.
Parenteral nutrition is used when the patient cannot take food by mouth or by enteral feeding. Parenteral feeding does not use the stomach or intestines to digest food. Nutrients are given to the patient directly into the blood, through a catheter (thin tube) inserted into a vein. These nutrients include proteins, fats, vitamins, and minerals.
Parenteral nutrition is used only in patients who need nutrition support for five days or more.
The catheter may be placed into a vein in the chest or in the arm.
A central venous catheter is placed beneath the skin and into a large vein in the upper chest. The catheter is put in place by a surgeon. This type of catheter is used for long-term parenteral feeding.
A peripheral venous catheter is placed into a vein in the arm. A peripheral venous catheter is put in place by trained medical staff. This type of catheter is usually used for short-term parenteral feeding.
The patient is checked often for infection or bleeding at the place where the catheter enters the body.
Parenteral nutrition support may continue after the patient leaves the hospital.
If parenteral nutrition is to be part of the patient's care after leaving the hospital, the patient and caregiver will be trained to do the nutrition support care at home.
Ending parenteral nutrition support must be done under medical supervision.
Going off parenteral nutrition support needs to be done slowly and is supervised by a medical team. The parenteral feedings are decreased by small amounts over time until they can be stopped, or as the patient is changed over to enteral or oral feeding.