Nutrition

There are a number of dietitians who work in DCCM. In addition to their roles in DCCM they have other roles in the hospital and elsewhere, however a dietitian is usually available on most weekday mornings.

Enteral nutrition

Nutrition is an essential part of caring for a patient in the intensive care unit. The majority of the patients are able to be fed enterally, either eating or via nasogastric feeding.

The following points are useful to keep in mind:

  • You will find an algorithm regarding feeding in the bedside folder. This details starting rates and how to increase feeds in a protocolised manner.

  • Patients who are not fully fed or who have other risk factors should have stress ulcer prophylaxis charted in the form of omeprazole. Please see the SOP on Stress Ulcer Prophylaxis for further information.

  • If a concentrated (2kCal/ml) feed is used then please chart psyllium 5mls NG q8h to provide additional fibre.

  • Please ensure that current nutrition plans are noted on the transfer or discharge documentation.

  • If patients do not tolerate nasgastric feeding (generally noted by high aspirates) then prokinetics are prescribed if there are no contraindications (metoclopramide 10mg IV q6h AND erythromycin 100mg IV q6h). Alternatives include insertion of a nasojejunal tube or in rare case intravenous nutrition.

When intubated patients are planned for theatre then nasogastric feeds should be continued unless airway manipulation is required (e.g. ETT exchange, tracheostomy insertion, extubation at the end of the case). This is to help ensure adequate nutrition in the critically unwell patients. If you are unsure about this then please discuss with the SMO during rounds.

Intravenous nutrition (IVN)/Total Parenteral Nutrition (TPN)

Patients who require TPN need a dedicated central access for this.

TPN is ordered the day prior as it is made up for each individual patient in a sterile manner. Please ensure that the TPN team is aware of any new patients that are being started on TPN. Orders and changes for TPN should be completed prior to 1pm.

TPN is started at 8pm in the evening in most cases and should be charted on the fluid chart.

The TPN team can be contact via the DCCM dietitian or by contacting the Nutrition Support Team via the hospital switchboard. They are available 0800-1530 during weekdays. An on-call service is available for long weekends and statutory holidays on extension 29696. Please note that parenteral nutrition is not usually considered an emergency overnight requiring call out.

Patients who require that TPN is started after hours or on weekends may have a “shelf bag”. This is ordered on the “Adult PN Prescription (Weekend Reserve)” form - CR3139. This form is available in the Clinical Form Library on Hippo.

Additional information is available on the “Parenteral Nutrition in Adults” clinical guideline available on the Hippo website.