EN/PN Guidelines and Tips

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Tamra Recce



EN/PN Guidelines and Tips





The American Society for Parenteral and Enteral Nutrition (ASPEN and the Society for Critical Care Medicine (SCCM) have recently came together to update the nutrition guidelines for critically ill patients. These updates effect the 2009 edition. The guidelines are intended for RD’s, physicians, nurses, and pharmacists. The updates were made from current research on critically ill patients. The main focus of the updates are on adult patients expected to stay in the IC for more than 48-72 hours. The guidelines also elaborate more on different conditions including organ failure, pancreatitis, surgical patients, and management of obese patients. The guidelines are intended to assist in making decisions based on the individuality of the patient’s needs.

Some new information included in the guidelines include screening for nutrition risk with every ICU patient. The 2016 guidelines state that both the nutritional status and the disease severity be addressed. The nutritional risk screening (NRS 2002) and the Nutrition Risk in Critically Ill (NUTRIC) are both tools recommended in the new guidelines. These two tools can help standardize nutrition risk assessment in hospitals. It is mentioned that these two tools will help determine when to initiate parenteral nutrition better than the use of surrogate biochemical markers (albumin, prealbumin, and transferrin). The new guidelines also recommend that GRVs are not used to assess tolerance to EN feeds. This practice is not evidence based and has been compromising patient safety according to this article. The guidelines are also including recommendations for selecting enteral formulas. Standard plyometric formulas are endorsed. The reasoning behind this is the high cost of specialty formulas, and the conflicting data on their outcomes. This particular practice is already a commonality in many facilities. There is one exception to this recommendation, postoperative surgical ICU patients requiring EN (formulas containing fish oil and arginine have been linked with decreased hospital stays).

Overall, these new guidelines will help RD’s working in ICU to make decisions that are better for the health of their patients. It will also streamline nutrition assessment among facilities.

EN/PN Nutrition: Nutrition Support for the Critically Ill
Mandy L. Corrigan, MPH,RD, CNSC, FAND 
Sept 2016 

Comments

  1. ksu internsFebruary 1, 2017 at 6:41 PM

    The blog entries posted for the MNT/Clinical trends were varied and educational; highlighting the newest updates in the realm of dietetics. Since I am not as versed in enteral and parenteral nutrition and the recommendations and guidelines that dictate use of EN/PN, I was drawn to the blog posting entitled “EN/PN Guidelines and Tip” by TR to learn more. The journal article discussed describes the changes to EN/PN recommendations, including screening processes and tools, the use of biochemical markers for assessment, the discontinuation of gastric residual volume (GRV), and the promotion of standard plyometric formulas.

    I agree with most changes, as they are moving with the changing needs of the patients and the evolving assessment processes that are currently in use. The removal of biochemical markers, such as albumin, prealbumin, and transferrin, is necessary and should be common place, and the use of screening tools for all ICU patients will aid in identifying more critically ill patients who may benefit from EN/PN. However, I am skeptical about the discontinuation of GRV assessments and would like to learn more about how the rate of digestion will be assessed. I hope, one day, to see a follow-up to this article with a discussion of the success of these changes. Interesting article and great post!

    LH

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