A clinical decision algorithm that outlines the selection process for choosing the route of nutrition support in adult patients is presented in Figure 1.
1. Oral Diet
The oral route is always the preferred route for
providing nutritional intake. Many different types of oral diets are available (see Manual of Clinical
Dietetics located on each Nursing Unit). In addition, commercially prepared liquid oral
supplements can be used in conjunction with an oral diet to
promote adequate nutrient intake. Dietitians can perform a
nutrient intake analysis (calorie/protein count) to evaluate the
adequacy of daily oral nutrient intake if needed.
2. Enteral Nutrition
Tube feedings are indicated for patients who are unable
to ingest adequate nutrients normally and safely by mouth
but who have at least a partially functional GI tract.
Enteral nutrition support is preferred to parenteral
nutrition because it facilitates maintenance of intestinal structure
and function, improves immunity, and avoids
catheter-related complications associated with the use of PN. Enteral
nutrition support is significantly less expensive than parenteral nutrition.
3. Parenteral Nutrition (PN) Parenteral nutrition support is indicated in the presence of compromised nutritional status when adequate protein and calories cannot be provided by oral or other enteral routes. Parenteral nutrition includes both peripheral parenteral nutrition (PPN) and central or total parenteral nutrition (TPN).