Enteral nutrition via probes is indicated for patients whose gastrointestinal tract is working smoothly, but orally adequately perform the nutrients because they can not ingest food or want. Compared with parenteral nutrition enteral nutrition has the following advantages: apply Better preservation of the structure and function of the gastrointestinal tract Lower cost probably less complications, especially infections as specific indications for enteral nutrition: persistent anorexia severe protein-energy malnutrition coma or suppressed sensory perception liver failure inability for oral ingestion due to head or neck trauma metabolic stress due to severe disease (eg. as burns) Other indications for placing a feeding tube consist in the surgical preparation of the intestine of critically ill or malnourished patients, enterocutaneous in the closure fistulas, and the connection of small intestine after extensive intestinal resection (z. B. Crohn’s disease) leading to malabsorption. Procedure is the diet via a probe ? 4-6 weeks required, a soft nasogastric or nasoenteric (z. B. nasoduodenal) is normally inserted probe of silicone or polyurethane having a small diameter. Makes it difficult to injury or deformity nasal placing the probe, an oral gastric or duodenal is selected. Tube feeding for> 4-6 weeks usually requires a gastrostomy or jejunostomy to place the probe endoscopically, surgically or radiologically. The choice depends on the medical capabilities and preferred by the patient location. Probes for a jejunostomy is necessary to bring benefits to patients for whom a gastrostomy is contraindicated (z. B. after gastrectomy or bowel obstruction proximal of the jejunum). However, contrary to popular belief, these probes is, no less tracheobronchial aspiration than for PEG tubes. FNKJ probes dislocate easily and are generally used only in the hospital. Feeding tubes are surgically placed when an endoscopic and radiologic placement is not feasible technically impossible or z. As a result overlying intestine poses a danger to the patient. Open or laparoscopic surgical techniques. Formula diets to commonly used liquid food include food additives and polymeric or other tailored to the specific needs formula diets. Food additives are commercially available and include individual nutrients such as protein, fat or carbohydrates. Thus can be either a special nutrient deficiency treat isolated or fully cover the nutritional needs in combination with other formula diets. Polymeric formula diets, incl. Mixed diet and industrially, milk-based or lactose-made diets are commercially available and form a complete, balanced diet. For oral or tube feeding, they are usually food additives preferred over. For hospital patients are among the polymeric formula diets lactose most commonly used. However, formula diets are preferred milk-based as opposed to the lactose-free products. Patients who suffer from lactose intolerance, tolerate diets based on milk may, when administered as a continuous infusion slowly. For patients difficult to digest the complex proteins are to the specific needs concerted formula diets such. B. formulas containing hydrolysed proteins or amino acids sometimes used. However, this formula diets are expensive and usually unnecessary. Most patients with pancreatic insufficiency, get the enzymes, as well as patients with malabsorption can digest complex proteins. Other special recipes such high-calorie and high-protein preparations for patients whose fluid intake is restricted, or fortified with dietary fiber formula diets for patients with constipation are possibly useful. Administration during the administration of enteral nutrition and 1-2 h followed by the patient at an angle of 30-45 ° should sit upright in order to minimize the risk of nosocomial aspiration pneumonia and to the force of gravity to help to process the food. Tube feeding is repeatedly administered daily as a bolus or as a continuous infusion. The administration in bolus is physiological and is preferred in patients with diabetes. Continuous infusion is necessary when administering boluses leads to nausea. The daily amount of food in the bolus will be given in 4 to 6 individual portions either with a syringe through the probe tube or from a mounted on an infusion stand bag via gravity. After feeding the tube feeding the tube is rinsed with water in order to avoid clogging. The food input via the nasogastric or nasoduodenal probe often causes diarrhea. Therefore, small amounts of dissolved preparations are initially administered are increased depending on the tolerance of the patient. 0.5, 1 or 2, most formulations contain kcal / ml. Formulations with higher caloric concentration (less water per calorie) may result in decreased gastric emptying and thus larger Magenresiduen than when more dilute formulations with the same number of calories used. Initially, a 1 kcal / ml solution of commercially prepared can undiluted in a rate of 50 ml / h, or – if the patients have received no food for a long time – to be administered of 25 ml / h. Generally, these solutions do not provide sufficient water v. a. if there is an increased fluid loss from vomiting in diarrhea, excessive sweating or fever. Additional water is either in multiple bolus over the feeding tube or i.v. made available. After some days the input rate or solution concentration is increased so that the respective calorie and water requirement is met. A FNKJ probe requires the diet in higher dilution and smaller portions. The infusion starts, as a rule in a concentration of ? 0.5 kcal / ml and a rate of 25 ml / h. After several days of concentration and input volume be increased to finally meet the calorie and fluid requirements. is tolerated thereby usually a maximum of 0.8 kcal / ml at 125 ml / h and 2400 kcal / day. Complications are common and can be severe in intensity (see table: Complications of enteral nutrition). Complications of enteral nutrition problem consequences Comments probe related presence of the probe lesions on the nose, pharynx or esophagus sinusitis particularly large diameter probes can irritate so that it erodes the fabric. Clogging of the Sinusostien clogging of the probe lumen inadequate food intake thickened food or tablets clog the lumen of small hoses. Where appropriate, the blockage by entering a solution with pancreatic enzymes or other industrially manufactured products can be solved. Intracranial incorrect positioning of a nasal tube trauma, infection A probe may be misplaced intracranial, if the cribriform plate is broken by a heavy facial trauma. Incorrect positioning of nasal or oral feeding tubes into the tracheobronchial tree pneumonia Addressable patients cough and choke immediately. Patients with impaired consciousness have few symptoms. If this misplacement is not recognized, the probe food enters the lungs, hence pneumonia develops. Dislocation of a gastrostomy or jejunostomy probe at peritonitis A dislocated probe can come to lie intraperitoneally. If probes were placed invasive, the position correction is more difficult and more likely to lead to complications. Recipe related intolerance against one of the main nutritional components of the formulation diarrhea, gastrointestinal symptoms *, nausea, vomiting, mesenteric ischemia (occasionally) intolerance occurs in up to 20% of patients and in 50% of critically ill patients and is more common in bolus. Osmotic diarrhea Frequent, loose stools sorbitol, which is often included in the liquid preparation of active substances which are administered through the feeding tube, promotes diarrhea. Nährstoffimbalanzen In gavage develop electrolyte disturbances, hyperglycemia, fluid overload and hyperosmolarity. Body weight and blood electrolytes, glucose, magnesium and phosphorus levels should be monitored frequently (daily during the first week). Other reflux of tube feeding or difficulties with oropharyngeal secretions Aspiration Aspiration can happen even with correct probe location and elevation if patients have any of these problems. * Gastrointestinal symptoms can have other causes, including reduced compliance of the stomach by shrinkage due to lack of food intake, swelling due to the amount of food and reduced gastric emptying by dysfunction of the pylorus. Important points Enteral nutrition via probes is indicated for patients whose gastrointestinal tract is working smoothly, but orally adequately perform the nutrients because they can not ingest food or want. If tube feeding is required> 4-6 weeks, a probe should be placed endoscopically, surgically or radiologically with gastrostomy or jejunostomy. A polymeric formula diet is the most common and usually the easiest to use diet. During the administration of enteral nutrition and 1-2 h after the patient at an angle of 30-45 ° should sit upright in order to minimize the risk of nosocomial aspiration pneumonia and to help of gravity, the food. Patients receiving tube feedings must be regularly checked for complications (eg. As probe-based, formula-based, aspiration).