Nutritional support is therapy for people who cannot get enough nourishment by eating or drinking. You may need it if you:

• Can't swallow
• Have problems with your appetite
• Are severely malnourished
• Can't absorb nutrients through your digestive system

You receive nutritional support through a needle or catheter placed in your vein or with a feeding tube, which goes into your stomach.

Nutritional support given via the alimentary canal or any route connected to the gastrointestinal system (i.e., the enteral route). This includes oral feeding, sip feeding, and tube feeding using nasogastric, gastrostomy, and jejunostomy tubes.

The insertion of a tube into the stomach, intestines, or other portion of the gastrointestinal tract to allow for the passage of food products, etc.

Surgical formation of an opening through the abdominal wall into the jejunum, usually for enteral hyperalimentation.

Giving medicines and feeding if your baby has a gastrostomy tube

• Clear the G tube or button as your health care provider showed you.
• Check for placement of the G tube or button.
• Slowly push in liquid medicine or feeding with a syringe.
• If the pharmacist says it is ok, pills and capsules may be dissolved in 10 to 20 cc of warm tap water.
• All medicines and feedings should be flushed in with 5 to 10 cc of warm tap water.
• Ask your baby’s doctor, nurse, or pharmacist how to measure the tap water.

It is important to use the specific tube adapter made by the manufacturer of your button.

• In fluid restricted babies flush medicines with ONLY 1 to 5 cc of warm tap water.
• Vent the tube after feeding to remove excess air or fluid and reduce leaking.

Protecting the G Tube or Button

• Snap t-shirts and onsies work best to prevent babies from pulling on the tube or button.
• You may also use a sticky wrap or stretchy dressing.

KEY POINTS

• Nutrition needs change at end of life.
• Patients and families decide how much nutrition and fluids will be given at the end of life.

Nutrition needs change at end of life.

For patients at the end of life, the goals of nutrition therapy are focused on relieving symptoms rather than getting enough nutrients.

Common symptoms that can occur at the end of life include the following:

• Anorexia (loss of appetite).
• Dry mouth.
• Swallowing problems.
• Nausea.
• Vomiting.

Patients who have problems swallowing may find it easier to swallow thick liquids than thin liquids.

Patients often do not feel much hunger at all and may want very little food. Sips of water, ice chips, and mouth care can decrease thirst in the last few days of life. Good communication with the healthcare team is important to understand the patient’s changes in nutrition needs.

Patients and families decide how much nutrition and fluids will be given at the end of life.

Cancer patients and their caregivers have the right to make informed decisions. The patient's religious and cultural preferences may affect their decisions. The healthcare team may work with the patient's religious and cultural leaders when making decisions. The healthcare team and a registered dietitian can explain the benefits and risks of using nutrition support for patients at the end of life. In most cases, there are more harms than benefits if the patient is not expected to live longer than a month.

Possible benefits of nutrition support for patients expected to live longer than a month include the following:

• Improved quality of life.
• Less risk of death due to malnutrition.
• Fewer physical, mental, and psychological problems.

The risks of nutrition support at the end of life include the following:

• Sepsis (bacteria or their toxins in the blood or tissues) with the use of parenteral nutrition.
• Aspiration (the accidental breathing in of food or fluid into the lungs) with the use of enteral nutrition.
• Sores and breakdown of the skin where the enteral feeding tube is inserted.
• Diarrhea with the use of enteral and parenteral nutrition.
• Complications caused by fluid overload (a condition where there is too much fluid in the blood) with the use of enteral and parenteral nutrition.