Cancer : Enteral and Parenteral Nutrition

by National Cancer Institute

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Enteral Nutrition

Enteral nutrition is also called tube feeding.

Enteral nutrition is food (in liquid form) given to the patient through a tube that is inserted into the stomach or the small intestine. The following types of tube feeding may be used:

A tube inserted through the nose and throat down into the stomach or small intestine. This kind of tube is usually used for short-term use.

A tube inserted into the stomach or small intestine through a stoma (an opening made on the outside of the abdomen). This kind of tube is usually chosen for long-term use or for patients who cannot tolerate a tube in the nose and throat.

If the tube is placed in the stomach, food may be given through the tube continuously or in batches several times a day. If the tube is placed in the small intestine, the food is delivered continuously. Different formulas are available. Some provide complete nutrition and others provide certain nutrients. Formulas that meet the patient's specific needs are selected. Formulas are available for patients who have other health conditions, such as diabetes.

Enteral nutrition is sometimes used when the patient is able to eat small amounts by mouth but cannot obtain enough food that way. The patient may continue to eat or drink as able, and the tube feeding provides the balance of calories and nutrients that are needed.

Enteral nutrition may be appropriate for patients whose gastrointestinal tract is still working.

Enteral nutrition continues to use the stomach and/or intestines to digest food. Enteral nutrition may be used for patients who have cancer of the head, neck, or digestive system and whose treatment with chemotherapy and radiation therapy causes side effects that limit eating or drinking.

Enteral nutrition is not appropriate for the following patients:

• Patients whose stomach and intestines are not working or have been removed.
• Patients who have a blockage in the bowel.
• Patients who have severe nausea, vomiting, and/or diarrhea.
• Patients whose platelet count is low. Platelets are blood cells that help prevent bleeding by causing blood clots to form.
• Patients who have low levels of all blood cells (white blood cells, red blood cells, and platelets).

Enteral nutrition may continue after a patient leaves the hospital.

If enteral nutrition is to be part of the patient's care after leaving the hospital, the patient and caregiver will be trained in use of the tube and pump, and in care of the patient. The home must be clean and the patient must be monitored often by the nutrition support team.

Parenteral Nutrition

Parenteral nutrition provides the patient with nutrients delivered into the blood stream.

Parenteral nutrition is used when the patient cannot take food by mouth or by enteral feeding. Parenteral feeding bypasses the normal digestive system. Nutrients are delivered to the patient directly into the blood, through a catheter (thin tube) inserted into a vein. Patients with the following problems may benefit from parenteral nutrition:

• Stomach and intestines that are not working or have been removed.
• Severe nausea, diarrhea, or vomiting.
• Severe sores in the mouth or esophagus.
• A fistula (hole) in the stomach or esophagus.
• Loss of body weight and muscle with enteral nutrition.

The catheter may be placed into a vein in the chest or in the arm.

A central venous catheter is placed beneath the skin and into a large vein in the upper chest. Placement of a central venous catheter is done by a surgeon.

A peripheral venous catheter is placed into a vein in the arm. Placement of a peripheral venous catheter is done by trained medical staff. This site may be used for short-term parenteral feeding.

The patient is checked often for infection or bleeding at the site (place) where the catheter enters the body.

Some drugs should not be given with parenteral formulas.

Many drugs and other substances do not mix safely with the formulas used for parenteral feeding. A pharmacist or doctor should be consulted before adding anything to the formula or using the catheter for another substance.

Trained medical staff should manage the use of parenteral nutrition.

The techniques and formulas involved in parenteral nutrition support are precise and require management by trained medical staff or a nutrition support team. Some of the serious complications that may occur with parenteral feeding include the following:

• Placement of the tip of the catheter into the wrong place.
• Blood clots.
• A collapsed lung.
• A high or low sugar level in the blood.
• A low potassium level in the blood.
• Elevated liver enzymes.

Parenteral nutrition support may continue after a patient leaves the hospital.

If parenteral nutrition is to be part of the patient's care after leaving the hospital, the patient and caregiver will be trained in the procedures and in care of the patient. The home must be clean and the patient must be monitored often by the nutrition support team.

Experienced medical staff should manage the patient's removal from parenteral nutrition support.

Going off parenteral nutrition support needs to be done gradually and under medical supervision. The parenteral feedings are reduced by small amounts over time as the patient is changed to enteral or oral feeding.

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