Nutritional support should be initiated in pts with malnutrition or in those at risk for malnutrition (e.g., conditions that preclude adequate oral feeding or pts in catabolic states, such as sepsis, burns, major surgery, or trauma).

Enteral nutrition (EN) is provided through a feeding tube placed through the nose into the stomach or beyond it into the duodenum, via a mini-surgical procedure in which a feeding tube is inserted through the abdominal wall into the stomach or beyond it into the jejunum using an endoscope, or by an open surgical approach to access the stomach or small intestine. EN is the treatment of choice when optimized voluntary nutritional support is impossible or has failed. Parenteral therapy refers to the infusion of nutrient solutions into the bloodstream via a peripherally inserted central catheter (PICC), a centrally inserted externalized catheter, or a centrally inserted tunneled catheter or subcutaneous port. When feasible, EN is the preferred route because it sustains the digestive, absorptive, and immunologic functions of the GI tract, and because it minimizes the risk of fluid and electrolyte imbalance. Parenteral nutrition (PN) is often indicated in severe pancreatitis, necrotizing enterocolitis, prolonged ileus, and distal bowel obstruction.