NST management |
The establishment of NST |
1. Establish NST, including geriatricians, dietitians, nutrition support pharmacists, nursing managers, geriatricians, and community health care workers24,29,30,36
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2c |
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2. Community and hospital to form follow-up teams to establish timely communication, operating standards, and procedures to avoid duplication of work or inconsistent information29
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1 |
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NST assessment and personalized management |
3. All the elderly with HETF should get a professional evaluation and adequate intervention, especially in case of complications or emergencies24
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5b |
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4. NST should prescribe personalized HETF according to the evaluation results24,29,32,36
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1 |
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Indicators of nutritional status, complications, and quality of life |
5. Indicators of nutritional status are mainly based on weight, body composition, and hydration status, but may also include laboratory measurements, such as serum albumin or transthyretin (prealbumin)24
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5b |
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6. Complications monitoring should include tube-related complications and respiratory and digestive tolerance24
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5b |
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7. The NutriQoL® questionnaire should be used regularly to evaluate the quality of life of the elderly during HETF24
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5b |
Training of caregivers |
Training methods should be diversified and individualized |
8. Mutual support and help between home caregivers can not only provide psychological comfort and reduce the burden but also allow them to learn from each other and share experiences29
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1 |
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9. Daily targeted health education, skill training, and workshops combined with a food model can be used for caregivers34
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2c |
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10. Education methods include oral education, graphic explanation, chatting Apps follow-up, Internet platform, etc.24
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2c |
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Training on the prevention and solution of complications |
11. Apply daily cleaning, disinfection, drying, and preservation of dietary appliances. The prepared homemade blenderized admixtures should be stored in the refrigerator at 4°C for 24 hours, and it is better to use right after preparation18
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2c |
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12. For the elderly with diarrhea, the temperature of the nutrition solution should be maintained at 38–42°C26
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5b |
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13. Elevate the head of the bed to 30–45° before feeding. After feeding, keep the original position for 30–60 minutes before laying down18,26
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2c |
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14. The diameter of the feeding tube should be at least 14Fr, and the homemade blenderized admixtures should be sieved with gauze to ensure that there are no large particles and avoid blockage18,24,25
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5b |
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15. Regularly flush the tube before and after feeding with at least 30mL of water of drinking quality in case of bolus administration or 4 hours if continuous feeding18,24,25
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5b |
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16. Call a doctor if the elderly have any of the following: tube blockage, prolapse or leakage; Signs of wound infection (if a gastrostomy tube is inserted) such as a fever of 100.4°F (38°C) or higher; Or if the place where the tube enters your body is red or swollen, feels warm to the touch, has discharge or pus, smells terrible, is very painful when touched, bleeds, or does not seem to be healing; Inability to defecate or pass gas, or have loose or hard stools; Stomach pain or cramping; Vomiting23
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5b |
Selection of nutrition formulas |
The risk of homemade blenderized admixtures is higher than that of commercial formulas |
16. The elderly without diarrhea, constipation, or special diseases should use standard commercial formulas under the guidance of NST25,28
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1c |
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To standardize the preparation process of homemade blenderized admixtures |
17. If there are special reasons to use homemade blenderized admixtures, dietitians can determine the formula, list standardized food combinations, regulate energy supply, and establish hygiene standards to prevent microbial contamination and infectious complications24,25,28
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5b |
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Semi-solid enteral nutrition can reduce the incidence of complications of gastric tube feeding |
18. Semi-solid enteral nutrition can improve the nutritional status of the elderly with gastric tube feeding and reduce the incidence of diarrhea, abdominal distension, reflux, and vomiting31
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2a |