Nutritional support

Malnutrition in surgical practice is common and often undetected. It is associated with increased morbidity and mortality. Identification of patients with or at risk of malnutrition is important, and consideration of nutritional requirements should be part of the assessment of every patient on surgical ward rounds. Artificial nutritional support improves nutritional status in malnourished patients and facilitates improved clinical outcomes and potentially shorter length of hospital stay. All patients should undergo nutrition screening as a part of the admission process and expert help is available from your dietitian or nutritional support team. Enteral feeding is always preferable to parenteral nutrition if the gastrointestinal tract is available and functional. It is more physiological, safer and maintains gut barrier function. The simplest form of enteral nutrition is oral nutritional support by sip supplements. These should be used liberally. If this fails, enteral tube feeding is indicated. Enteral feeding tubes can be placed endoscopically, radiologically or surgically, although the nasal route is simplest and can be used for up to four weeks. Parenteral nutritional support can be achieved via a peripheral cannula or by central venous access depending on the available peripheral venous access and duration of planned nutritional support. Parenteral nutrition via central venous access is the most invasive and the infective complications can have serious implications. Multidisciplinary nutritional support teams are essential for safe and effective nutritional support.