#Time4Education

Understanding the reason why and how we use certain products and medical devices is crucial for critical patient care.

The following videos have been developed following the latest International Clinical Guidelines^1,2 and medical devices technology available to:

Give healthcare professionals clinical insights on the protein quality parameters aiming to support gastrointestinal tolerance.
Learn effective step-by-step processes of feeding tubes placement for different groups of adult patients to optimize the delivery of enteral feeding and reach appropriate nutritional targets.

In addition, you will also find highlights of our webinars on the importance of enteral nutritional management throughout the critical COVID-19 patient journey.

Transnasal feeding tubes post-pyloric & gastric feeding

Tube Feeding is indicated in patients with at least a partially functioning gastrointestinal track in whom oral intake or intake of normal feed is inadequate, unsafe or does not meet the patients’ metabolic needs³. Learn more in the video on the standard techniques of nasogastric/nasointestinal tube placement, points to consider when tube feeding is implemented and daily care guideline in adult patients and tips.

Gastrointestinal tolerance and the P4 protein blend

Gastrointestinal (Gl) tolerance during enteral nutrition (EN), often clinically identified as elevated gastric residual volumes (GRVs) or vomiting, is common in critical illness. It can result in stopping or delaying EN, which leads to reduced nutritional intake and poor clinical outcomes⁴. Learn more in the video on how to assure optimal nutritional management to reach protein and energy targets.

Protein quality P4 protein blend

Protein is a crucial macronutrient, fundamental for maintaining human biological functions. Proteins are involved in protein synthesis, preservation and function of muscle mass and are a supporting factor to many different metabolic and immunological demands^5-8. Learn more in the video on the provision of the right protein quantity and protein quality for patients⁶, especially where artificial nutrition support is the sole source of nutrition.

Gravity feeding set

Gravity feeding is intended to deliver tube feed using a drip-feeding method. This form of feeding can be used as an alternative to pump assisted feeding. However, for greater accuracy pump assisted feeding is recommended. Learn more about the instructions of use in the video.

Highlights from our Covid-19 webinar series

Due to the early removal of feeding tubes post-ICU, many patient do not reach their nutritional targets resulting in underfed patients⁹. Patients post-ICU also struggle with meeting their nutritional targets due to a missing nutritional care plan, causing a slower recovery^10,11. Learn more in the webinar highlights about the nutritional patient journey.

Clinical practice experience

In this Q&A session with Prof. Arthur R.H. van Zanten, find out the best clinical practices in enteral nutrition and feeding devices throughout the critical patient journey, such as how to start enteral nutrition, how to manage prone patients with enteral nutrition, and procedures when changing the patient’s position.

References

Bischoff SC, et al. ESPEN guideline on home enteral nutrition. Clin Nutr. 2020;39(1):5-22.
Singer P, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48-79.
Expert report & literature review- update 2018 - Enteral tube feeding pumps and sets.
Gungabissoon, et al. JPEN. 2015;39(4):441-8
Ochoa Gautier JB, Martindale RG, Rugeles SJ, et al. How Much and What Type Of Protein Should a Critically Ill Patient Receive? Nutr Clin Pract. 2017;32(1):6S-14S.
Hurt RT, McClave SA, Martindale RG, et al. Summary Points and Consensus Recommendations From the International Protein Summit. Nutr Clin Pract. 2017;32(1_suppl):142s-51s
Hussam Rostom. Basic metabolism: Proteins. Surgery. 2018;36:153-8
Hou, Y; Yln, Y; Wu, G. Dietary Essentiality Of "Nutritionally Non-Essential Amino Acids" for Animals and Humans. Exp. Biol. Med. (Maywood) 2015, 240, 997-1007.
In preparation: Slingerland-Boot R, van der Heiden I, de Vries J, van Zanten AR.
Ridley EJ, Parke RL, Davies AR, et al. What Happens to Nutrition Intake in the Post-Intensive Care Unit Hospitalization Period? An Observational Cohort Study in Critically Ill Adults. JPEN J Parenter Enteral Nutr. 2019;43(1):88-95.
Van Zanten, A.R.H., De Waele, E. & Wischmeyer, P.E. Nutrition therapy and critical illness: practical guidance for the ICU, post-ICU, and long-term convalescence phases. Crit Care 23, 368 (2019).
Wischmeyer PE. Current Opinion in Critical Care. 2016;22:279-84.
Heyland DK, Weijs PJM, Coss-Bu JA, et al. Nutrition in Clinical Practice. 2017;32:58S-71S.
McClave SA, Taylor BE, Martindale RG, et al. Journal of Parenteral and Enteral Nutrition 2016;40:159-211.

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Protein in critical illness

Loss of muscle mass and malnutrition is common among critically ill patients [12]. Protein is the most important macronutrient contributing to the conservation of lean body mass, and positively impacting both mortality and mobility [13,14].

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Medical devices

Whether for a short period in ICU or longer term from home, some people need their nutrition delivered via a tube. The pumps enabling delivery of nutrition directly into a patient's stomach, need to be both safe and accurate.

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