The Caregiver Guide – Enteral and Parenteral Nutrition

Proper nutrition is essential to health and healing. But what happens when an older loved one can no longer take in enough nutrients by mouth due to illness, injury, or digestive dysfunction? That’s where enteral and parenteral nutrition come into play; two life-saving methods of delivering nutrients when oral intake is insufficient or impossible.

To understand how common and important this issue is:

• According to an article published in the National Library of Medicine (NLM), almost 438,000 U.S. patients received home enteral nutrition (tube feeding) while a little over 25,000 received home parenteral nutrition (drip feeding)0.
• Another NLM article reports that, in 2008, 15.3% of ICU patients in the US received enteral nutrition and around 6.2% received parenteral nutrition during hospital stays.

For caregivers, understanding these modalities, when they are used, how they are administered, and what to expect, can make a dramatic difference in the quality of care and confidence in supporting a loved one’s nutrition plan.

What Is Enteral Nutrition?

Enteral nutrition (EN) delivers nutrients directly into the digestive tract, typically through a tube, when a person can’t meet nutritional needs by oral intake. The tube may be placed:

• Through the nose to the stomach or small intestine
• Directly into the stomach via a small surgical opening
• Into the small intestine

Enteral nutrition uses specialized formulas that provide balanced proteins, carbohydrates, fats, vitamins, and minerals. Because it uses the gut, EN tends to preserve gastrointestinal function and reduce some complications compared to intravenous feeding.

When Is Enteral Nutrition Used?

Enteral feeding is often recommended when the digestive system still works, but oral intake is severely limited due to:

• Stroke or neurological disorders that impair chewing or swallowing
• Head or neck cancer
• Severe frailty or terminal illness
• Recovery from surgery affecting the mouth or esophagus
• Chronic neurologic disease (e.g., advanced Parkinson’s or ALS)

Enteral nutrition is generally the preferred route when the gut works because it supports normal digestive processes and gut integrity, reducing infection risks associated with intravenous feeding.

What Is Parenteral Nutrition?

Parenteral nutrition (PN) bypasses the digestive tract entirely and delivers nutrients directly into the bloodstream through an intravenous (IV) line. When all nutritional needs are met by IV, it is termed total parenteral nutrition (TPN); when it supplements other feeding, it may be called partial parenteral nutrition (PPN).

TPN includes carefully balanced mixtures of amino acids, carbohydrates, fats, electrolytes, vitamins, and trace elements, tailored to the individual’s needs.

When Is Parenteral Nutrition Used?

Parenteral nutrition is typically used when:

• The digestive tract is nonfunctional or cannot be accessed
• Severe malabsorption or bowel obstruction prevents nutrient absorption
• Critical surgical conditions prevent the use of EN
• Severe pancreatitis, short bowel syndrome, or certain severe gastrointestinal diseases occur

In ICU settings, PN may be initiated when enteral feeding is contraindicated or insufficient, especially in the first days of critical illness.

Starting Nutrition Support — What Caregivers Should Know

Assessment and Indication

Before enteral or parenteral nutrition begins, caregivers should understand:

• Why it’s needed: poor oral intake, swallowing difficulty, or digestive dysfunction
• Nutrition goals: calories, protein needs, hydration status
• Route selection: EN if gut works; PN if gut can’t be used

Healthcare teams typically include physicians, dietitians, nurses, and often a home health support team for ongoing care planning.

Training and Home Care

Many patients on nutrition support receive it at home (home enteral or home parenteral nutrition). This requires proper training on:

• Tube care and placement checks
• Pump operation for enteral feeding
• Sterile technique and catheter care for parenteral nutrition
• Signs of complications and when to call healthcare providers

Because enteral nutrition is more common in home settings, caregivers often receive instruction on formula preparation, equipment cleaning, and feeding schedules.

Monitoring and Managing Complications

Both enteral and parenteral nutrition have potential complications that caregivers should watch for:

Enteral Nutrition Risks

• Tube displacement or blockage
• Aspiration (formula entering lungs)
• Diarrhea or nausea
• Skin irritation around the tube site
• Formula intolerance or bloating

Parenteral Nutrition Risks

• Catheter-related bloodstream infections
• Liver enzyme changes or liver dysfunction
• Metabolic complications (e.g., high blood sugar)
• Electrolyte imbalances
• Fluid overload

Because of these risks, regular follow-up with healthcare professionals, including blood tests and physical assessments, is essential.

Practical Tips for Caregivers

Preparing and Administering Enteral Feeds

• Always wash hands and clean equipment
• Use pumps or gravity bags as instructed
• Keep head elevated during feedings if recommended
• Flush tubes with water to avoid blockages

Handling Parenteral Nutrition

• Ensure the catheter exit site stays clean and dry
• Watch for fever, chills, or redness around the catheter
• Follow instructions for IV line changes and pump settings
• Monitor daily fluid intake and output

Understanding and adhering to guidelines reduces the likelihood of complications and improves comfort and outcomes.

Nutrition Support and Quality of Life

Receiving nutrition support, especially when oral intake is no longer effective, can improve wound healing, strength, immunity, and overall quality of life. While these therapies are medical in nature, the caregiver’s role in ensuring their safe and effective implementation is pivotal.

Many patients who receive enteral or parenteral nutrition may also continue to take some oral nutrition if safe and feasible. Combining oral intake with supplemental support can help maintain normal life rhythms and patient morale.

Costs and Support Resources

Nutrition support can involve significant costs, including supplies, pump rental, formulas, and clinician visits. Insurance coverage varies, and caregivers should consult payers early to understand benefits.

Support organizations such as the American Society for Parenteral and Enteral Nutrition (ASPEN) provide guidelines and resources, and dietitians experienced with artificial nutrition can offer valuable education and troubleshooting.

Conclusion

Enteral and parenteral nutrition are vital tools in caring for loved ones who cannot maintain adequate nutrition by mouth. Enteral nutrition leverages the gut when possible, while parenteral nutrition provides a direct route through the bloodstream when the digestive tract cannot be used. Both require careful planning, monitoring, and caregiver involvement.

At LL Medico, we have recognized the increasing importance of supplemental nutrition, so we can now proudly offer a wide range of tube feeding products. And, for those who need to supplement inadequate oral intake due to eating difficulties, we also offer pureed foods, meal replacement shakes and drinks. Of course, while visiting our website, why not check out our principal product line, adult diapers, which we started with thirty years ago.   

If you need any advice or more details on our product range, don’t hesitate to call. Our experienced team will gladly assist. You can contact us by calling (855) 422-4556 or emailing support@llmedico.com. On weekdays between 9 am and 5 pm EST, you can also reach us through our online chat link.

As a caregiver stepping into this complex role, remember the words of Helen Keller: “Alone we can do so little; together we can do so much.” With proper knowledge, teamwork with healthcare providers, and attention to training and monitoring, you can help ensure that nutrition support not only sustains life but also enhances the comfort and dignity of the loved one you’re caring for.