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Services

Complex Nutrition

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The importance of food to the health and wellbeing of patients is well recognised.

Malnutrition can affect people who are ill in hospital or those living in the community.

The causes of malnutrition can be for a number of reasons: poor appetite, physical disabilities, swallowing impairments, increased metabolic demands for nutrients, nutrient losses due to vomiting and diarrhoea and malabsorption.

Malnutrition is a state in which a deficiency of nutrients such as energy, protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome.

Preventing malnutrition and dehydration improves health and well-being and helps to reduce the burden on the health and social care services in treating and supporting those suffering from under nutrition and dehydration.

Malnutrition is both a cause and a consequence of ill health. Methods to improve or maintain nutritional intake are known as nutrition support. These include:

  • oral nutrition support – for example, fortified food, additional snacks and/or sip feeds
  • enteral tube feeding – the delivery of a nutritionally complete feed directly into the stomach or intestines via a tube
  • parenteral nutrition – the delivery of nutrition intravenously

The appropriate interventions using these methods of artificial nutrition can improve outcomes but decisions on the most effective and safe methods are complex.  The Complex Nutrition Team consisting of GI Consultants (Gastroenterologists) and Nutrition Specialist Clinical Nurses provide expert guidance on this.

 

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Complex Nutrition Team

The Complex Nutrition Team provides nutrition other than by the oral route.

This necessitates either the insertion of a tube into the gastrointestinal tract (enteral nutrition) or a catheter into the vein (parenteral nutrition) to provide nutrition.

The Complex Nutrition Team focuses on patients with complicated and complex nutritional problems that can occur as a result of disease, surgery, injury or eating disorder.

Our Complex Nutrition Nurses are Clinical Nurse Specialists with knowledge and experience in nutrition support. We provide nurse led specialist support and advice for adult patients requiring enteral and parental nutritional input.

We are mostly involved with patients who are unable to eat or drink normally and require special feeding tubes or intravenous (IV). We work in all areas of the Trust, as part of Multi-Disciplinary Teams (including supporting Community Services) and have close links with the Dietitians and work within Gastroenterology.

The team assesses patients who require gastrostomy insertion (special feeding tubes) or intravenous feeding (access to receive nutrition in liquid form) and manage a highly specialised method of feeding patients directly into their blood stream called parenteral nutrition.

Complex Nutrition Nurses carry out the following tasks:

  • assess patients for a variety of feeding tubes
  • provide training: teach and support patients and their families/carers to look after their own tubes if they are going home with them
  • resolve problems with feeding tubes or IV feeding lines
  • Pre & Post surgery PN​ (Parental Nutrition)
  • HPN reviews (Home Parental Nutrition)
  • Screen PEG referrals
  • Intestinal failure management
  • Working in partnership with Acute and Community Dietitians
  • Outpatient clinics
  • Clinical Nutrition Virtual Ward
  • Assessment of patients with malabsorption syndromes

We also provide advanced clinical management, education and training, information and support to clinical staff/healthcare professionals to promote best practice as well as co-ordinating the therapies required for patients receiving artificial nutrition ie teach hospital ward staff how to look after patients with feeding tubes

Patient treatment and care will take into account individual needs and preferences. Patients will have the opportunity to make informed decisions and choices throughout their care and treatment. Their needs may change and they will have the opportunity to reassess and revisit the decisions they’ve made.

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How to access the service

Referrals are made internally from our NHS clinical colleagues and can include for the following reasons:

 

  • Suspected malabsorption syndromes
  • Suspected short bowel syndrome causing malabsorption
  • Assessment to commence or discontinue Parental Nutrition (PN)
  • Suspected PN line infection
  • Patients admitted with Home Parenteral Nutrition (HPN)
  • Assessment for Percutaneous Endoscopic Gastrostomy (PEG) insertion
  • Difficulties establishing enteral nutrition
  • Enteral tube complications e.g. split/blocked tube
  • Assessment for nasal bridle retaining device for Nasogastric (NG) feeding tubes

 

Referrals

All our referrals come from clinicians who are already involved with the patient’s care.  Due to the nature of our referrals, we do not accept self referrals.

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Procedures

The Complex Nutrition Team provide specialist management of patients who require (or are likely to require) enteral or parenteral nutrition.

The Nutrition Nurses work with our Multi-Disciplinary Team colleagues to consider the best outcomes for our patients who may require artificial nutrition for a range of short and long term conditions.

We may need to test your blood to check kidney function, electrolytes and nutrient levels.  Monitoring could also involve taking your temperature regularly and checking your pulse and weight, as well as checking that your tube or catheter are working properly.

 

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Types of procedures

If you are in hospital to have an operation and you are malnourished, you may be offered different foods and drinks to improve your diet.   If you are malnourished and you are having an operation on your stomach or intestine – you may be given a liquid feed through a tube before your operation. This type of feeding is called enteral feeding and is described in more detail below.

If you can’t eat and drink normally or you are not able to take in enough nutrients, you may be offered a liquid diet through a tube into your gut. This is called enteral feeding.  Enteral feeding is when you are able to take in your nutrition support orally.

Usually a feeding tube is inserted into your nose and is passed down into your stomach. This tube is called a nasogastric tube (NG tube).  It is connected to a container of liquid feed. This feed can be given continuously or in fixed doses depending on your needs. This liquid feed should contain all of the nutrients needed by your body. If your stomach isn’t working properly the tube is passed down into your small intestine instead.

If you need enteral feeding for more than 4 weeks you may be offered a different feeding tube; this is called a gastrostomy or a PEG (percutaneous endoscopic gastrostomy) tube or a jejunostomy tube.

A PEG tube is inserted through your abdomen into your stomach and can make enteral feeding easier and more comfortable. A jejunostomy tube is inserted directly into the jejunum (which is part of your small intestine). This means the feed doesn’t go into the stomach and is given directly into the small intestine.

 

Parental Nutrition (PN) is given intravenously, directly into the bloodstream of a patient.

If you can’t be fed by a tube into your stomach or intestine you may be offered a sterile liquid feed through a tube into your blood. This is called parenteral feeding.

Parenteral nutrition is the​​​ feeding of nutritional products to a person intravenously, bypassing the usual process of eating and digestion.

A narrow tube known as a catheter is placed in a vein. This is connected to a container of sterile liquid feed. This sterile liquid feed should contain all of the nutrients needed by your body. The standard mixture of nutrients should be adjusted to suit your needs. For example, you may need additional vitamins to be added. The feed is introduced gradually. It can be given continuously or in cycles depending on your needs.

The Nutrition Nurses will check on improvements in your nutrition regularly. Once you are able to absorb nutrients and be fed by a tube into your gut, or eat normally, parenteral feeding will be stopped gradually.

As part of a Multi-Discioplinary Team (MDT) we manage all aspects of Parenteral Nutrition (PN) in the Trust. The MDT includes Gastroenterologists, Specialty Pharmacists and Specialty Dietetics.

 

An IV infusion consists of various bits of equipment joined together. The first bit is a cannula (thin, plastic tube) which is put into a vein, usually in the hand or arm. The cannula is then connected to a longer, wider tube which, in turn, is joined to a bag containing the fluid or medicine.

Magnesium Sulfate (our most common infusion) is used to treat low levels of magnesium in the blood where it is not possible for medicine to be taken orally.

 

 

If you are having enteral or parenteral feeding at home, you will be supported by a team of healthcare professionals. This team can be made up of your GP, District Nurses or other types of Homecare Nurses, Dietitians and specialists such as Speech and Language Therapists. They will work with you and your carer to make a care plan suited to your needs. This plan will cover how much feed you need, what it will be made up of, when you will receive it and how your nutrition will be monitored.

Special equipment will need to be set up in your home. You and your carer will given training on how to use it. You will be given details about delivery of the equipment, the feed and anything else you might need, including contact details for the company supplying it (Nutricia).  You will be given information on:

  • your feeding regimen
  • procedures for the feed
  • common problems and how to deal with them
  • how to use the equipment.

You will also be given telephone numbers to ring if you have any questions, as well as numbers to call in an emergency.

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Patient Information Leaflets

Percutaneous endoscopic gastrostomy (PEG)

Freka Percutaneous Endoscopic Colostomy (PEC) aftercare sheet

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Useful links

www.ageuk.org.uk

We are the UK’s eating disorder charity. Founded in 1989 as the Eating Disorders Association, our mission is to end the pain and suffering caused by eating disorders.

The Cinnamon Trust. The National Charity for older people, the terminally ill and their pets.

Bereavement help and support

It’s time to get to grips with guts

We’re the charity for the whole digestive system: the gut, liver and pancreas. Our digestive systems have been misunderstood, undervalued and underfunded for too long. We exist to change that.

We’re here to help everyone affected by cancer to live life as fully as they can, by providing physical, financial and emotional support.

Whatever the illness, wherever you are, we’re with you to the end

We bring 75 years of experience and leading research to the care we give you at home, in our hospices and over the phone. And we push for a better end of life for all by campaigning and sharing research to change the system.

We won’t give up until everyone experiencing a mental health problem gets support and respect. Find more about Mind, our work and the impact we have

Find information and services to help you manage your health.

Nutricia Homeward Enteral Nurse 

White Horse Business Park, Trowbridge, Wiltshire BA14 0XQ

Tel: 03457 623648

Talking therapies, or psychological therapies, are effective and confidential treatments delivered by fully trained and accredited NHS practitioners. They can help if you’re struggling with things like feelings of depression, excessive worry, social anxiety or post-traumatic stress disorder (PTSD).

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Tell us what you think!

Your feedback is really important to us and we would love for you to take some time to tell us what we’ve done well and how we can improve. Please use the links below to share your views

Complex Nutrition Team Patient Survey

Virtual Ward – Complex Nutrition Team Patient Survey