Enteral Regiem

Salam kawan2.
Copied from: Friendster group Board of IIUM Dietitians (BID)
By: Ahmad, our senior

Intermittent Feeding

(Please refer MNT & espen [http://www.espen.org/espenguidelines.html])

Bagaimana nk start feeding?

sebelum prescribe kita perlu tahu:
Berapa kcal/day nk bagi
Berapa g/day of protein nk bagi
Berapa ml/day of fluid nk bagi/restrict
Berapa kerap nk bagi
produk apa nk bagi
Berapa kcal/ml nk bagi

Kira energy,protein,fluid di hospital biasanya guna quick method (refer espen/MNT)

Usual practice:

1.biasanya start dgn amount yg dah tolerate masa refer (tapi disini mula dari 30cc. initiate 10-40ml/d

2.biasanya feed 5hours, rest 1hour tapi ada tempat buat feed 4hours

3. pertambahan MCT/polycose/myotein ada 2 pendapat, 1-start dgn step 1 or step 2, 2-tambah bila nk capai full volume

4. cara kira kcal/ml ada 2 pendapat. 1- ikut std preparation produk (total kcal/total volume), 2-ikut berapa air tambah (total kcal/total air tambah). I prefer pendapat 1.

5. kenaikan amount usually 10-30cc/step. Usual practice, 30cc/50cc/70cc/90cc/100cc

6. Ingatan! jgn bancuh guna air masak

7. Kira total energy, protein on last step. tapi utk edu kita kira each step.

refer to EN protocol (MNT, KKM)

9. camne nk kira berapa sc nk bagi each step? Senang jer.
Mula2 tetapkan berapa kcal/ml nk bagi. Then darab dengan berapa volume nk bagi each feeding. then bahagi kcal/sc of product. then round up to the nearest. kalau boleh jgn lebih 1kcal/ml for initiation feeding @ step 1.

e.g. 1kcal/ml (darab) 50ml (bahagi) 36kcal/sc (Nutren diabetic)
~ 1.389sc
~ 1sc

e.g. 1.5kcal/ml (darab) 50ml (bahagi) 36kcal/sc
~ 2.083sc
~ 2sc


Cth
Energy: 1800kcal/d
Protein: 80g/d
fluid: 1800cc/d
product: Nutren Diabetik (N/D) (36kcal/sc,protein 1.4/sc,~8.5g/sc)
myotein (26kcal/sc,protein 5g/sc,~6.5g/sc)

Step 1 30cc/hour, feed 5hour, rest 1 hour x4cycle/day
4sc + H20 = 150cc/cycle (nota!remember, 30x5=150cc/cycle)
(Total Energy=576kcal/d, protein=22.4g/day, fluid=600cc [30x5x4=600], 0.96kcal/ml)

Step 2 50cc/hour, feed 5hour, rest 1 hour x4cycle/day
7sc + H20 = 250cc/cycle
(Total Energy=1008kcal/d, protein=39.2g/day, fluid=1000cc, 1.okcal/ml)

Step 3 70cc/hour, feed 5hour, rest 1 hour x4cycle/day
9.5sc + H20 = 350cc/cycle
(Total Energy=1368kcal/d, protein=53.2g/day, fluid=1400cc, 0.98kcal/ml)

Step 4 90cc/hour, feed 5hour, rest 1 hour x4cycle/day
12.5sc + H20 = 450cc/cycle
(Total Energy=1800kcal/d, protein=70g/day, fluid=1800cc, 1.0kcal/ml)

Step 5 90cc/hour, feed 5hour, rest 1 hour x4cycle/day
12.5sc + 1/2 myotein + H20 = 450cc/cycle
(Total Energy=1852kcal/d, protein=80g/day, fluid=1800cc, 1.03kcal/ml)

Ada kesilapan harap maaf.
ada pape tak faham call r.

Bolus Feeding

(Please refer MNT & espen [http://www.espen.org/espenguidelines.html])

Bagaimana nk start feeding?

sebelum prescribe kita perlu tahu:
Berapa kcal/day nk bagi
Berapa g/day of protein nk bagi
Berapa ml/day of fluid nk bagi/restrict
Berapa kerap nk bagi
produk apa nk bagi
Berapa kcal/ml nk bagi

Kira energy,protein,fluid di hospital biasanya guna quick method (refer espen/MNT)

Usual practice:

1.biasanya start dgn amount yg dah tolerate masa refer (tapi disini mula dari 50cc

2.biasanya 6-8kali sehari, 3hourly. tapi disini buat 6x sahaja

3. pertambahan MCT/polycose/myotein ada 2 pendapat, 1-start dgn step 1 or step 2, 2-tambah bila nk capai full volume

4. cara kira kcal/ml ada 2 pendapat. 1- ikut std preparation produk (total kcal/total volume), 2-ikut berapa air tambah (total kcal/total air tambah). I prefer pendapat 1.

5. kenaikan amount usually 50cc/step

6. Ingatan! jgn bancuh guna air masak

7. Kira total energy, protein on last step. tapi utk edu kita kira each step.

8. camne nk kira berapa sc nk bagi each step? Senang jer.
Mula2 tetapkan berapa kcal/ml nk bagi. Then darab dengan berapa volume nk bagi each feeding. then bahagi kcal/sc of product. then round up to the nearest. kalau boleh jgn lebih 1kcal/ml for initiation feeding @ step 1.

e.g. 1kcal/ml (darab) 50ml (bahagi) 36kcal/sc (Nutren diabetic)
~ 1.389sc
~ 1sc

e.g. 1.5kcal/ml (darab) 50ml (bahagi) 36kcal/sc
~ 2.083sc
~ 2sc


Cth
Energy: 1500kcal/d
Protein: 70g/d
fluid: 1500cc/d
product: Nutren Diabetik (N/D) (36kcal/sc,protein 1.4/sc,~8.5g/sc)
myotein (26kcal/sc,protein 5g/sc,~6.5g/sc)

Step 1 50cc/3hourly 6x/d
1sc ND + H20 = 50cc/feeding
(Total Energy=216kcal/d, protein=8.4g/day, fluid=300cc [50x6=300], 0.76kcal/ml)

Step 2 100cc/3hourly 6x/d
2.5sc ND + H20 = 100cc/feeding
(Total Energy=540kcal/d, protein=21g/day, fluid=600cc, 0.9kcal/ml)

Step 3 150cc/3hourly 6x/d
4sc ND + H20 = 150cc/feeding
(Total Energy=864kcal/d, protein=33.6g/day, fluid=900cc, 0.96kcal/ml)

Step 4 200cc/3hourly 6x/d
5.5sc ND + H20 = 200cc/feeding
(Total Energy=1188kcal/d, protein=21g/day, fluid=1200cc, 0.99kcal/ml)

Step 5 250cc/3hourly 6x/d
7sc ND + H20 = 250cc/feeding
(Total Energy=1512kcal/d, protein=58.8g/day, fluid=1500cc, 1.0kcal/ml)

Step 6 250cc/3hourly 6x/d
6.5sc ND + 1/2sc myotein + H20 = 250cc/feeding
(Total Energy=1482kcal/d, protein=69.6g/day, fluid=1500cc, 0.99kcal/ml)

Ada kesilapan harap maaf.

BHT Writing Format

NOtice that there are many format in writin BHT?

Here's a good one. (it resembles how doc write in BHT).

make 2 column, left and right.

1ST COLUMN
Date/time
Anthropometry
Biochem
Drugs
Indent (pls indent _can/tin/g)

2ND COLUMN
S/B dietician/ R/V Dietician (case&progress noted)
Thank you for referal
Subjectve
current condition
patient history
complain of (c/o)
Diet recall (hospital/home)
parenteral intake
Total intake (energ, protein) from oral/EN/PN
Requirement (energ, protein)
Assessment (how many % intake/requirement)
Plan (Oral/ Oral nutritional supplement/ RTF/ Parenteral)
thank you
Sign
name
Post