全胃肠外营养 (TPN) 是一种通过静脉为人体提供营养的方法，完全绕过消化系统。当一个人由于身体状况或外科手术而无法通过消化系统获得足够的营养时，通常会使用它。 TPN 通常通过中心线或导管端口提供。可以通过外周途径使用特殊配方进行 TPN 管理。目前市场上的 PN 外设是 SmofKabiven® Peripheral 1206ml 和 1904ml 以及 Numeta G13E 300ml。
我们可以给予的最大 TPN 速率按 2ml/kg/hr 计算，通常需要 12-16 小时才能过夜，具体取决于规定的体积和卡路里。有些人可能会出现恶心/呕吐或胃部不适，这可以通过在开始 TPN 之前服用质子泵抑制剂或抗恶心注射剂等药物来预防。如果电解质失衡显示出脱水迹象，有些人可能需要额外的液体才能与 TPN 同时运行。
我们的护理团队将每周检查一次或两次血液，为您定制和优化营养治疗。我们全天候提供 24/7 服务，并将在开始日期教授有关输液泵警报和故障排除的指南。我们已经管理了数千例家庭 TPN，>99% 的患者没有大问题，并对所提供的护理感到满意。请放心，联系我们了解更多详情。 :)
通过 Port-a-Cath 获得营养
中央静脉通路是在局部麻醉下通过手臂或胸部皮肤上的小切口插入一根线，然后将线穿过静脉并进入心脏。它可以用非缝合敷料（又名 statlock）固定到位。一旦 PICC 线就位，就可以立即用于输送营养。
我们建议使用葡萄糖酸氯己定 (CHG) 浸渍敷料更换中央静脉管敷料 5-7 天。 证据研究表明，使用 CHG 敷料代替传统的粘性薄膜敷料 (IV3000) 可以降低导管相关感染的风险。可以在更换敷料的同时每周进行一次冲洗，以保持线条通畅
Nutrition in Advanced Diseases
It is common for loved ones with advanced illnesses to express their lack of desire to eat.
Reasons for loss of appetite may include:
- Changes in sense of taste or smell, making certain foods or drinks unpleasant.
- Discomfort caused by medication or treatment, such as constipation, nausea, vomiting, or bloatedness.
- The illness itself, such as cancer or organ failure, which may cause a loss of appetite.
- Pain from mouth sores, fungal infections, or dry mouth caused by radiation therapy.
- Chemical imbalances in the blood, such as high calcium levels, affecting normal bodily functions.
- Mood-related issues, such as depression, which can reduce appetite.
- Poorly controlled pain can further exacerbate low mood and reduce appetite.
- Advanced dementia can cause confusion and difficulty recognizing food, leading to refusal to eat, loss of interest in food, and holding food in the mouth instead of swallowing.
- Blockages in the body's food passage may occur due to these factors.
- Muscle weakness or lack of teeth can cause difficulties in chewing and swallowing.
Difficulty swallowing can occur due to weakened or poorly coordinated muscles involved in the swallowing process. It's essential to recognize the signs of difficulty swallowing in our loved ones, as it can increase the risk of choking on food or drink. If you notice any of the following common symptoms, it's important to inform a doctor or nurse
- Coughing during/after most meals or some may presented with clearing of throat instead of cough
- Wet "gurgling" voice after drinking and/or while resting
- Coughing up a specific type of food/drink, e.g., coughing when eating rice but not porridge
- Prolonged chewing
- Breathlessness during/after a meal
- Holding food in the mouth and not swallowing
- Complaining of a sensation of something stuck in their throat
- Eating or drinking less than usual
When an advanced illness affects nutrient processing in the body, it can result in the inability to build muscle or fat, even with a sufficient intake of food. This may cause significant weight and muscle loss to continue despite adequate food consumption.
Improving nutrition and the mealtime experience
In Singapore, food is often a way to show love and care towards our loved ones. It can be challenging to witness them losing weight despite our efforts and no longer enjoying meals that were specially prepared for them. While not all causes of appetite and weight loss are reversible, there are ways to improve their nutrition, comfort, and quality of life. One way is to understand their food preferences. Although they may have enjoyed certain types of food in the past, their preferences can change. By experimenting with different herbs, seasonings, and temperatures, we can enhance the flavor and make the meals more interesting. It's crucial to listen to our loved ones, observe their responses to food and drinks, and be receptive to their changing feedback.
Maintaining oral hygiene is essential to keep the mouth fresh and clean
- Brush and rinse the mouth daily using an ultra-soft toothbrush or an oral swab stick
- Use regular mouth rinses or a homemade mouth rinse with salt dissolved in warm water to keep the mouth fresh
- Consume flavoured ice chips or semi-frozen pineapple to maintain a fresh mouth
- Look out for mouth ulcers, sores, or patches of red or white which may indicate a fungal infection and inform the doctor or nurse if noticed
- Remove and clean dentures before and after every meal to maintain oral hygiene
- Keep a small sipper bottle of their favourite drinks by their bedside to allow frequent sips or a small spray bottle to moisten their mouth
- If unable to drink or swallow, use an oral swab stick to gently clean the mouth and apply moisturising mouth gel to keep it clean and moist
Making mealtimes enjoyable and easier for your loved one is crucial for their overall well-being.
Here are some tips to make it happen:
- Create a pleasant dining environment by using their favourite tablecloth or placemat, playing calming music or showing family photos.
- Ensure that they are seated comfortably and at a suitable height for eating.
- Consider using utensils that are easy to grip and use, such as bendable or weighted utensils.
- Serve small and frequent meals throughout the day, rather than three large meals, to avoid overwhelming your loved one.
- Offer a variety of food choices and textures that are easy to chew and swallow.
- Allow enough time for meals, and avoid rushing or forcing them to eat.
- Engage in conversation during mealtimes to make it a more social and enjoyable experience.
- Be mindful of any dietary restrictions or preferences and adjust accordingly.
- Consider consulting with a dietitian or nutritionist to ensure that your loved one is getting adequate nutrition.
- Offer positive reinforcement and encouragement to your loved one, such as praising them for eating well or trying a new food.
Assisting and pacing your loved one during mealtimes can help ensure their safety and comfort.
Here are some ways to do it:
- Sit with your loved one during meals to provide assistance as needed, such as cutting food into small pieces or opening containers.
- Allow them to eat at their own pace and avoid rushing them.
- Provide small sips of fluid between mouthfuls of food to help them clear the food int he mouth
- Offer assistance with utensils or feeding if needed.
- Monitor their chewing and swallowing to ensure that they are not experiencing any difficulty or discomfort.
- Pay attention to their body language and any signs of fatigue or discomfort.
- Allow frequent breaks during meals if needed.
- Be patient and understanding, as eating can become a challenging and tiring activity for those with difficulty swallowing or other medical conditions.
- Consult with a healthcare professional, such as a speech therapist, for further guidance on how to assist and pace your loved one during meals.
Various ways to make meals more visually appealing and interesting for your loved one.
- Incorporate a variety of colourful ingredients in a dish, such as mixing diced carrots and mashed potatoes with a side of broccoli.
- Use contrasting colours of food and crockery, such as serving porridge in a red bowl instead of a white bowl.
- Use various kitchen tools, such as ice cream scoops, muffin cups, or cookie cutters, to shape blended or minced food, making it more visually appealing and interesting.
Serve small meals or snacks throughout the day
- Encourage your loved one to decide when and what they would like to eat
- They may prefer 5 to 6 small meals a day instead of 3 large meals
- Small servings may be less intimidating and easier to tolerate
- Offer additional food if they are still hungry
- If nausea is present, serve the prescribed nausea medication at least 30 minutes before a meal, or as advised by the doctor.
Making every mouthful of food count is important to ensure that your loved one is receiving adequate nutrition.
- Add sesame oil, egg, fish or tofu to porridge to increase calorie and protein content.
- Add peanut butter or tuna biscuits to meals.
- Incorporate oral nutritional supplements to milkshakes.
- Provide high-calorie, high-protein snacks such as red or green bean soup, sesame paste, bubur cha cha, bao, and beancurd.
- Offer nourishing fluids like soy milk, full cream or flavoured milk, oral nutritional supplements, fruit smoothies, and yoghurt drinks.
- Add milk, ice cream, or honey to beverages to increase calorie and nutrient content.
Avoiding excessive fluid intake during meals is crucial for digestion and nutrient absorption.
- Fluid, especially fizzy drinks, can cause your loved one to feel full or bloated quickly.
- Unless your loved one is taking fluid meal replacements, only offer sips of fluids during meals to clear the palate.
- Allow your loved one's body to guide the amount of food and fluids to be consumed.
- Force-feeding can cause distress, physical discomfort, or pain.
- The goal of eating is to maximize enjoyment and eat as much as your loved one is able to tolerate, even if it means only a small amount for taste.
Use a suitable consistency
Food and fluid consistency can have a significant impact on the ease of swallowing. A speech therapist or nurse can help you determine the most appropriate consistency for your loved one's needs. It's crucial to consult with a healthcare professional to ensure that your loved one is receiving safe and adequate nutrition.