Feeding Your Family Member
in the Intensive Care Unit
This handout contains information about:
 how nutrition therapy helps
 how nutrition therapy is given
 the types of nutrition therapy used
How does nutrition therapy help?
Nutrition therapy is used to give nutrition to people in the Intensive
Care Unit (ICU) because they cannot eat food normally. Our goal is
keep each patient well nourished.
Giving people the correct amount and type of nutrition:
 improves wound healing
 boosts the immune system
 reduces the risk of infection
 helps the stomach work better
 improves recovery
All patients get standard nutrition which contains protein,
carbohydrates and fats.
Some patients also need a personal mix of special nutrition such as
glutamine, high dose vitamins and fish oils.
How nutrition therapy is given
There are many ways to give liquid food:
 Enteral nutrition or enteral feeding where a tube goes into the
stomach or bowel
 Parenteral nutrition or feeding where a tube goes into the
blood
Each person’s nutrition needs are assessed daily. The best method
to give nutrition is assessed daily and may be changes throughout
the patient’s stay in ICU. The types are described in the next section.
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Enteral Nutrition
There are many ways to give enteral nutrition:
 Nasogastric tube (NGT)
 Nasojejunal tube (NJT)
 Gastrostomy tube (G-tube)
 Jejunostomy tube (J-tube)
Nasogastric or Nasojejunal tube
These are the most common type of feeding tubes used in the ICU.
A nasogastric tube is a thin tube put into the nose, down the throat
and into the stomach. It is used when feeding is needed for less than
3 weeks.
A nasojejunal tube is a thin tube put into the nose, down the throat,
past the stomach and into the first part of the bowel called the
jejunum. This tube is used:
 when the stomach cannot empty properly
 to get past a block in the small bowel
 when a condition affects the pancreas
goes into nose
stomach
nasogastric tube
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Gastrostomy tube
A gastrostomy tube goes into the stomach through an opening made
on the outside of the abdomen. This type of tube is used for people
who have long term problems with eating and swallowing.
A gastrostomy tube can be put into the abdomen by a special
procedure in the ICU.
stomach
G-tube goes in
through abdomen
Jejunostomy tube
A jejunostomy tube goes into the small bowel called the jejunum
through an opening made on the outside of the abdomen. This type
of tube is used for people who have long term problems with eating
and swallowing.
A jejunostomy tube can be put into the abdomen by a special
procedure in the ICU.
stomach
J-tube goes
in through
abdomen
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More about nutrition formulas
There are many types of formulas to choose from. The dietitian
selects the best one for your family member. This depends on the
medical condition and needs.
Most often, the formula is given over 24 hours at a slow rate.
The dietitian decides how much and how often your loved one is
given nutrition.
At first your loved one may need to have all of the nutrition through a
tube. As your loved one gets better, he or she may have some food
by mouth and have some by tube.
More about enteral feeding
Enteral feeding is only safe for people whose stomach and bowels
(intestines) are working normally. This is because the feeds follow the
normal path of digestion.
Enteral feeding is not safe if your loved one has a problem with the
stomach or bowels such as a block in the bowel.
Enteral feeding can cause problems such as gastric reflux and
aspiration:
 gastric reflux happens when the contents of the stomach,
including feeds, moves backwards into the esophagus
 aspiration happens when the contents of the stomach are
inhaled into the airway and lungs.
These types of problems can lead to problems such as pneumonia.
What is PEP uP?
PEP uP is set of guidelines used to make sure that each patient gets
the most benefit and the least side effects from his or her nutrition
plan.
These guidelines help the health care team make clear decisions
about starting, continuing and stopping enteral nutrition. They also
help ensure all patients are properly nourished.
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How are the risks of enteral feeding prevented?
Members of the health care team take steps to help reduce the risks
by:
 giving medication to help the stomach empty faster
 monitoring the volume of the stomach contents
 raising the head of the bed
 moving the feeding tube further into the intestine
Parenteral Nutrition (PN)
This type of nutrition is given by a thin tube going into a blood vessel
called a vein. This type of nutrition does not follow the normal
digestive system.
There are 2 types of parenteral nutrition:
 Central Venous Catheter (CVC) put
into a blood vessel in the neck or
chest
 Peripherally Inserted Central Catheter
(PICC) put into a blood vessel in the arm
and then into a vein in the chest
Your loved one may already have one of these types of tubes in for other
treatments.
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Your family member needs parenteral nutrition if there are problems with
the stomach or bowels such as:
 severe stomach or bowel problems
 the stomach and part of the bowel are removed
 there were nutritional problems before surgery and your loved one
could not manage enteral feeding
 there is a hole called a fistula in the stomach or esophagus
 your loved one is losing weight or not doing well with enteral
feeding
More about parenteral nutrition
The solutions used are complex and carefully made up in a sterile
room each day by a pharmacist.
Doctors and dietitians advise the pharmacist about your loved one’s
specific nutritional needs each day.
Your loved one is monitored closely while having PN.
Your loved one has blood tests done each day to check to how well
the nutrition is meeting his or her needs.
Parenteral nutrition can have side effects such as causing high blood
sugar or liver problems.
When it is time for your loved one to stop having parenteral nutrition,
the doctors and dietitian will slowly reduce the feeds over a few days.
Oral Nutrition
If your loved one is awake and can swallow safely, he or she will be
encouraged to eat small meals, high energy snacks and nourishing
drinks.
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Things can you do to help your loved one
with nutrition in the ICU
 Be prepared to answer questions about your loved one’s
nutritional status before the illness such as:
 What is his or her normal height and weight?
 Has there been any recent weight loss?
 Had your loved one been eating normally over the past week or
was there a loss of appetite?
 Ask about your loved one’s nutrition in the ICU such as:
 What is the plan for nutrition?
 Are there any special nutrients that can be used to treat the
illness such as glutamine, high dose vitamins and fish oils?
 2 to 3 days after a nutrition plan has started ask the nurse if your
loved one is getting enough nutrition:
 How is the feed being tolerated?
 Has the goal been reached?
 Should the head of the bed be elevated?
 If you are concerned about your loved one’s nutrition while in
the ICU, you may ask to see a dietitian for advice.
 If your loved one is able to eat, check with the nurse or dietitian
what foods are okay to bring in.
 You can encourage your loved one to have small amounts
often.
 If you have any questions about PEP uP, you can ask to talk with
the doctor who is in charge at <<HOSPITAL NAME>>.
 The doctor’s name is: _____________________
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My Questions and Notes:
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