Artificial nutrition and nutritional support in hospital

Undernutrition is common in hospital in-patients and should be detected by routine nutritional screening on admission. Nutritional requirements can be estimated by an expert dietitian and decisions to supplement hospital diet or to supply completely artificial nutritional support should be made based on whether intake is adequate and the gut functioning. If possible, enteral nutrition is preferred and this is most commonly supplied by oral supplements or nasogastric tube feeds. More complex enteral feeding includes nasojejunal tube-feeding, percutaneous gastrostomy feeding and percutaneous jejunostomy feeding. Parenteral nutrition is not indicated unless the gut is not functioning adequately. Venous access for feeding can now be gained by several different means but in all cases meticulous care of lines is essential. Although standard parenteral nutrition bags supplied by commercial companies may be used, vitamins and trace elements must always be added in pharmacy. A multidisciplinary team is vital for the safe delivery of artificial nutritional support.