Insights on enteral nutrition using pump assisted feeding during the Nutricia Masterclass at ESPEN 2022

Session 1: Practical patient case studies

In this session, Prof Øivind Irtun discusses three practical case studies based on current evidence1,3; a COPD patient with colon cancer and weight loss, a patient with head trauma, fractures and contusions, and a patient with an oesophagus stricture. For these case studies, Prof Øivind discusses the advantages of Enteral Nutrition4-11 and nutritional strategies, such as pre-and post-operative nutrition12, initiation of enteral nutrition13, the administration route13, gastric or post-pyloric feeding, and whether continuous/cyclic, intermittent or bolus enteral feeding is required.

Session 2: The role of nurses when it comes to enteral nutrition

Mrs Alison Smith and Mrs Nina Cron discuss Home Enteral Nutrition (HEN). They stress the importance of giving patients the choice of how to administer HEN to make it fit around their lives, enabling them to live life fully. Further, the role of the community enteral nurse is discussed by looking at the required assessment before discharge as well as discharge training, the implementation methods of enteral nutrition1-9, the ongoing process of monitoring and evaluating after discharge, liaising with the multidisciplinary team if necessary, troubleshooting and advocacy. Also, the benefits to patients, healthcare professionals and carers of pump-assisted feeding are discussed.

Session 3: Performance and safety endpoints of enteral feeding pump

In this session, Mr. Bram Zuijderduin discusses the performance1 and safety endpoints incorporated in the new Nutricia Flocare Infinity III enteral feeding pump. During the design and development of the pump, patients who are not trained and are confronted with a new nutritional therapy are kept in mind to develop an easy and convenient to use pump, also for its use by children and elderly. The pump's advanced alarm system offers safety at all stages of the tube feeding process.

Session 4: 25 steps in 25 minutes hands-on pump training

Mrs Ingunn H. Minelle takes you through a practical pump training on the Nutricia Flocare Infinity III enteral feeding pump.

Session 1: Practical patient case studies
  1. Bischoff SC, Austin P, Boeykens K, Chourdakis M, Cuerda C, Jonkers-Schuitema C, Lichota M, Nyulasi I, Schneider SM, Stanga Z, Pironi L. ESPEN guideline on home enteral nutrition. Clinical nutrition. 2020 Jan 1;39(1):5-22.
  2. Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, Hiesmayr M, Mayer K, Montejo JC, Pichard C, Preiser JC. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical nutrition. 2019 Feb 1;38(1):48-79.
  3. Ukleja A, Gilbert K, Mogensen KM, Walker R, Ward CT, Ybarra J, Holcombe B, Task Force on Standards for Nutrition Support: Adult Hospitalized Patients, the American Society for Parenteral and Enteral Nutrition. Standards for nutrition support: adult hospitalized patients. Nutrition in Clinical Practice. 2018 Dec;33(6):906-20.
  4. Ohta K, Omura K, Hirano K, Kanehira E, Ishikawa N, Kato Y, Kawakami K, Watanabe G. The effects of an additive small amount of a low residual diet against total parenteral nutrition–induced gut mucosal barrier. The American journal of surgery. 2003 Jan 1;185(1):79-85.
  5. Buchman AL. Does enteral nutrition really prevent ischemic renal failure?. Critical care medicine. 1998 Aug 1;26(8):1461-2.
  6. Nguyen NQ, Besanko LK, Burgstad C, Bellon M, Holloway RH, Chapman M, Horowitz M, Fraser RJ. Delayed enteral feeding impairs intestinal carbohydrate absorption in critically ill patients. Critical care medicine. 2012 Jan 1;40(1):50-4.
  7. Piton G, Le Gouge A, Brulé N, Cypriani B, Lacherade J-C, Nseir S, et al. Impact of the route of nutrition on gut mucosa in ventilated adults with shock: An ancillary of the NUTRIREA-2 trial. Intensive Care Medicine. 2019;45(7):948–56. doi:10.1007/s00134-019-05649-3
  8. Ralls MW, Demehri FR, Feng Y, Ignatoski KM, Teitelbaum DH. Enteral nutrient deprivation in patients leads to a loss of intestinal epithelial barrier function. Surgery. 2015 Apr 1;157(4):732-42.
  9. Shaw D, Gohil K, Basson MD. Intestinal mucosal atrophy and adaptation. World journal of gastroenterology: WJG. 2012 Nov 11;18(44):6357.
  10. Fukatsu K. Impact of the feeding route on gut mucosal immunity. Current Opinion in Clinical Nutrition & Metabolic Care. 2014 Mar 1;17(2):164-70.
  11. Wolff NS, Hugenholtz F, Wiersinga WJ. The emerging role of the microbiota in the ICU. Critical Care. 2018 Dec;22(1):1-7.
  12. Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale RG, Waitzberg D. ESPEN practical guideline: Clinical nutrition in surgery. Clinical Nutrition. 2021 Jul 1;40(7):4745-61.
  13. Di Girolamo FG, Situlin R, Fiotti N, Biolo G. Intermittent vs. continuous enteral feeding to prevent catabolism in acutely ill adult and pediatric patients. Current Opinion in Clinical Nutrition & Metabolic Care. 2017 Sep 1;20(5):390-5
Session 2: The role of nurses when it comes to enteral nutrition
  1. Bischoff SC, Austin P, Boeykens K, Chourdakis M, Cuerda C, Jonkers-Schuitema C, Lichota M, Nyulasi I, Schneider SM, Stanga Z, Pironi L. ESPEN guideline on home enteral nutrition. Clinical nutrition. 2020 Jan 1;39(1):5-22.
  2. Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, Hiesmayr M, Mayer K, Montejo JC, Pichard C, Preiser JC. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical nutrition. 2019 Feb 1;38(1):48-79.
  3. Patel JJ, Rosenthal MD, Heyland DK. Intermittent versus continuous feeding in critically ill adults. Current Opinion in Clinical Nutrition & Metabolic Care. 2018 Mar 1;21(2):116-20.
  4. Ichimaru S. Methods of enteral nutrition administration in critically ill patients: continuous, cyclic, intermittent, and bolus feeding. Nutrition in Clinical Practice. 2018 Dec;33(6):790-5.
  5. Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, Lyman B, Metheny NA, Mueller C, Robbins S, Wessel J. ASPEN enteral nutrition practice recommendations. Journal of Parenteral and Enteral Nutrition. 2009 Mar;33(2):122-67.
  6. Bear DE, Hart N, Puthucheary Z. Continuous or intermittent feeding: pros and cons. Current opinion in critical care. 2018 Aug 1;24(4):256-61.
  7. McNelly AS, Bear DE, Connolly BA, Arbane G, Allum L, Tarbhai A, Cooper JA, Hopkins PA, Wise MP, Brealey D, Rooney K. Effect of intermittent or continuous feed on muscle wasting in critical illness: a phase 2 clinical trial. Chest. 2020 Jul 1;158(1):183-94.
  8. Bolus feeding in Adults: a practical guide. November 2017. http://nutriciahcp.auth.nutricia.com/adult/studies/Bolus_Feeding_in_Adults_A_Practical_Guide(1)/
  9. Nutrition Nurse Specialist. Avalilable from: https://www.bapen.org.uk/ofnsh/page13a.html
Session 3: Performance and safety endpoints of enteral feeding pump
  1. Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, Lyman B, Metheny NA, Mueller C, Robbins S, Wessel J. ASPEN enteral nutrition practice recommendations. Journal of Parenteral and Enteral Nutrition. 2009 Mar;33(2):122-67.

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 this delivery need to be both safe and accurate. Read more on Danone Nutricia Research website

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#Time4Education

#Time4Education is a self-paced learning video series to discover enteral tube feeding solutions. The series are based on 2 tutorial videos, one on medical devices and one the importance of intact protein feeds, followed by testimonials from different experts.

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