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Dysphagia
Coeliac diagnosis pathway (Adults)
Sengstaken/Minnesota Tube for Bleeding Varices
Eradication of Helicobacter pylori
Acute Severe Ulcerative Colitis
Acute Upper GI Bleeding (AUGIB)
Iron Deficiency Anaemia
Dyspepsia
Nutritional Support in Adults
Refeeding Syndrome
Parenteral Nutrition
Crohn’s Disease
Acute Pancreatitis
Suspected Variceal Bleeding
Lower Gastrointestinal Bleeding
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Nutritional Support in Adults
Last updated 1st September 2021
Screen Using ‘MUST’
- Screen all patients using the Malnutrition Universal Screening Tool (MUST). This is available on all wards. This gives a score which determines the care plan.
- Patients failing to meet their nutritional requirements including those who have a reduced appetite or who are experiencing unintentional weight loss of >5% of their body weight should receive some form of nutritional support. The options available include the following:
Fortified Diet
- Ensure patients menu card has the ‘Fortified’ box marked.
- Offer snacks & full fat milk to drink in-between meals.
Oral Nutritional Supplements
- A selection of these products are available if clinically indicated for the patients following assessment and recommendation by the Dietitian.
- First line products within D&G Formulary include:
Enteral Tube Feeding
- Indicated when a patient is unable to meet their nutritional requirements orally.
- Contact Dietetic Dept. on 33568 as soon as you the decision is made to start tube feeding in order that the patient can be assessed, a regime can be calculated and the system can be set up. If on evening or weekend please use the emergency starter feeding regime which is available in the ward nutrition folder and on the intranet. In addition contact the Dietetic Dept. Ext 33568 to refer the patient and leave details on the answering machine.
- Before starting a tube feed, check U&Es, Ca, PO4 and Magnesium. Any abnormalities should be corrected as indicated under ‘Refeeding Syndrome’ – Click to view section on Refeeding Syndrome.
- Enteral feeding should be carried our over 20 hours and rest for 4 hours unless otherwise indicated.
- Following initial placement of nasogastric tube, confirm position be by X-ray. Placement of tube should be checked regularly by aspiration of stomach contents and testing pH.
- Gastrostomy/PEG feeding can start 6 hours after placement of the tube provided there are no problems with the feeding site and after following this regime: nil by PEG for 2 hours post insertion, then flush PEG with 20ml sterile water every hour for 4 hours.
- Monitor biochemistry daily, treating any abnormalities as described under ‘Refeeding Syndrome’ – Click to view relevant section.
- The enteral feeding starter regime is documented on Hippo. Follow link below to Nutrition and Dietetics, Enteral Feeding Starter Regime guidelines.