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ICU GUIDELINE: ROUTES OF NUTRITION SUPPORT

ICU GUIDELINE: ROUTES OF NUTRITION SUPPORT. START. www.criticalcarenutrition.com. Able to meet needs via the oral route?. Contraindication to use of gut ? (see BLUE BOX - A). Consider TPN (Individual assessment re appropriateness required) . No. Yes. No. Yes. Enteral Nutrition.

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ICU GUIDELINE: ROUTES OF NUTRITION SUPPORT

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  1. ICU GUIDELINE: ROUTES OF NUTRITION SUPPORT START www.criticalcarenutrition.com Able to meet needsvia the oral route? Contraindication to use ofgut ? (see BLUE BOX - A) Consider TPN(Individual assessment re appropriateness required) No Yes No Yes Enteral Nutrition Oral diet BOX - A: Contraindications to use of gut:Absolute:Mechanical bowel obstruction Bowel ischemia Relative: Hemodynamic instability Small bowel ileus Bowel anastomosis Contraindication to gastric feeding (see PINK BOX - B) No Yes NG tube ND tube BOX - B: Contraindication to gastric feeding: 1) Gastric residual volumes > threshold maximum (250 ml) despite prokinetic(s). 2) Chronic/acute gastroesophageal reflux. 3) High risk pulmonary aspiration (e.g. nursed in the supine or prone position). Refer to resource entitled “ICU Guideline: Manual ND Feeding Tube Placement” for direction how to place ND tube. Pending abdominal surgery? No Yes Short term: ND tube. Place using a manual technique(see above). Place endoscopically or fluoroscopically if manual placement failed or contraindicated. Long term: Gastro-jejunostomy tube. Place tubeendoscopically or fluoroscopically. Short term EN: ND tube. Place using an intra-operative placement technique. Long term EN: Gastro-jejunostomy or jejunostomy tube. Place tube intra-operatively. Developed by: J. Greenwood, RD. Critical Care Program – Vancouver Coastal Health Authority (Update 7/4/2010). Used with permission.

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