Enteral and parenteral nutrition are sometimes referred to as specialized nutrition support. Specialized nutrition support refers to nutritional therapies that are administered via alternative methods other than food itself. When the body does not receive needed daily nutrients from faulty absorption or chronic poor nutrient intakes, malnutrition may develop. Malnutrition can interfere with wound healing, lessen the body’s ability to fight infection, increase recuperation time from surgery and illness, and affect ones quality of life. To counteract the ill effects of malnutrition, the initiation of specialized nutrition support is sometimes warranted.
Enteral Nutrition: A wide variety of medical conditions can cause a person to lose their appetite or their ability to ingest food for an extended period of time. A patient who is unable to eat and drink but has a functional gastrointestinal tract may be a candidate for a specialized nutrition support called enteral nutrition or tube feedings. Enteral is a term used to denote the gastrointestinal tract. With this type of feeding a tube is either inserted through the nose into the stomach or small intestine as a temporary measure, or, for long-term feeding needs, a permanent enteral access device is created directly into the stomach or small intestine. In either case, a formula containing all nutrients needed to sustain life is infused into the tubes.
Parenteral Nutrition: A diseased gastrointestinal tract may not allow food or enteral tube feeding to supply an adequate amount of nutrients for a patient to recover from illness or sustain his or he nutritional state of health. These individuals may require a highly specialized form of nutrition support known as parenteral nutrition. Parenteral refers to the delivery of a drug, fluid or, in this case, a special nutrition solution into the vein. This is done by placing a catheter into a vein and advancing the catheter through the vein until the tip of the catheter is lying close to the heart. Several conditions that can lead to severe gastrointestinal malfunction include Crohn’s disease, intestinal ischemia, and radiation enteritis. Parenteral nutrition may be used on a short-term basis to facilitate postoperative healing or long-term in patients with permanent severe malabsorption.
Home parenteral nutrition is the provision of parenteral nutrition outside of the hospital setting. Conditions that require this therapy at home include short bowel syndrome, bowel obstruction and enterocutaneous fistula. Because this form of specialized nutrition support is highly complex, a group of expert clinicians, described in more detail below, are available to evaluate and manage patients who need this therapy.
The Cleveland Clinic Nutrition Support Team, established more than 25 years ago, provides care to those needing parenteral nutrition once they leave the hospital. Our dedicated team of nutrition support specialists care for more than 200 patients a year, making us one of the largest home nutrition support services in the world. We use a comprehensive approach to evaluate and care for patients in need of this complex home therapy including:
- Case Management to identify insurance benefits and establish homecare pharmacy and nursing services
- Social Work and Psychiatric Services to identify and help with emotional and adjustment concerns
- Nutrition Support Nursing to provide specific training and education of infusion techniques, catheter care, pump operations and self-monitoring
- Nutrition Support Dietitians to perform nutrition assessments, establish individual nutrient needs and home-going formulas
- Nutrition Support Pharmacy to assure compatibility of the parenteral nutrition formula and review concurrent medications for drug-nutrient interactions
How is the Patient Monitored Once at Home?
After training is complete and a home-going nutrition support formula is established, patients are discharged with a visiting nurse who will continue to teach procedures in the home, as needed. Patients may soon become independent in all aspects of home nutrition support therapy and no longer need visiting nursing services. Regular laboratory work, intake and output records and follow-up appointments with a physician on the Nutrition Support Team are important and necessary parts of our program to avoid problems with the therapy. Dedicated home nutrition support clinicians closely coordinate the care of all patients and are available on a 24 hour/7 day per week basis to assist with immediate concerns.
To find out more information or to make an appointment, please call The Home Parenteral Nutrition Program at 216.444.6164, or toll-free 1.800.223.2273, ext 4-6164.
For more information about nutrition therapy, contact:
American Dietetic Association
120 South Riverside Plaza, Suite 2000
Chicago, IL 60606-6995
Phone: Toll-free 1.800.366.1655 or toll-free 1.800.877.1600
Fax: 312.899.4899
American College of Gastroenterology
P.O. Box 342260
Bethesda, MD 20827-2260
Phone: 301.263.9000
American Gastroenterological Association
4930 Del Ray Avenue
Bethesda, MD 20814
Phone: 301.654.2055
Fax: 301.654.5920
Email: info@gastro.org or webmaster@gastro.org
National Institutes of Diabetes & Digestive & Kidney Diseases (NIDDK)
NIH, Building 31, Room 9A04
31 Center Drive, MSC 2560
Bethesda, MD 20892-2560
American Society for Gastrointestinal Endoscopy
1520 Kensington Rd., Suite 202
Oak Brook, IL 60523
Phone: 630.573.0600
American Society for Parenteral and Enteral Nutrition
8630 Fenton St., Ste. 412
Silver Springs, MD 20910
Phone: 301.587.6315
American Celiac Society – Dietary Support Coalition
P.O. Box 23455
New Orleans, LA 70183
Phone: 504.737.3293
Fax: 504.737.4283
Email: amerceliacsoc@netscape.net
Celiac Disease Foundation
13251 Ventura Boulevard, #1
Studio City, CA 91604
Phone: 818.990.2354
Fax: 818.990.2379
Email: cdf@celiac.org
Celiac Sprue Association/USA Inc.
P.O. Box 31700
Omaha, NE 68131-0700
Phone: Toll-free 1.877.CSA.4CSA or 402.558.0600
Fax: 402.558.1347
Crohns & Colitis Foundation of America, Inc.
386 Park Avenue South, 17th Floor
New York, NY 10016-8804
Phone: Toll-free 1.800.932.2423 or 212.685.3440
Email: info@ccfa.org
Foundation for Digestive Health and Nutrition
4930 Del Ray Avenue
Bethesda, MD 20814-3015
Phone: 301.222.4002
The Oley Foundation
214 Hun Memorial, A-28
Albany Medical Center
Albany, NY 12208-3478
Toll-free 1.800.776.OLEY
