Malnutrition And Stroke

13.12.05

Why are patients at risk of malnutrition?
• Inadequate intake.
• Inability to swallow.
• Disease state.
• Malabsorption.
• Psychological problems.
• Metabolic consequences of disease state.

Nutritional support:
• Oral-fortified food/nutritional supplements if poor intake/appetite.
• Form of enteral tube via variety of routes (short term support):
-Nasogastric.
-Gastrostomy.
-Jejunostomy.
• If gut works, use it.
• Don't want to PEG before 3/4 weeks because swallowing function may return.
• Gastrostomy - artificial opening through abdominal wall to stomach to allow feeding.
• PEG feeding - effective and discreet way of feeding long-term.
• PEG insertion - low mortality (2%), 15% at 30 days - low because it's only high-risk patients.
• Tubes last 3 years.
• Methods of placement - nearly all endoscopically or radiologically guided; surgical to jejunum.
• Advantages: not surgical, so:
-No general anaesthetic.
-Less expensive.
-Quick procedure.
-Fewer complications.
-Easily removed.

Other than stroke patients:
• Neurological disorders.
• Head and neck malignancy.
• Confusional states.
• Supplementary feeding.
• Psychological problems.

Pre-insertion checks:
• No disease in stomach.
• Normal gastric emptying.
• No reflux.
• Consent.
• Clear oral cavity and oesophagus.

Contraindications:
• Ascites (very short life expectancy).
• Peritonitis.
• Inability to place by endoscope.
• Malignancy.
• Gastric ulceration.
• Previous gastric surgery.

Complications:
• Peritonitis.
• Aspiration.
• Wound infection.
• Leakage.
• Ulceration.
• Tube displacement.
• Candida colonisation.
• Blockage of tube.
• Accidental removal.

Assessment criteria:
• Assessed by team.
• Explain procedure to patient, family and carers.
• Is patient stable?
• Is PEG insertion appropriate?
• Is endoscopic incubation possible and safe?
• Is PEG placement possible and safe?
• Is tube placement ethically correct?