PICU/PCU Clinical Pathway for Initiation and Advancement of Nutrition in Children

  • Patients already on oral feeds/home feeding regimen or those with a plan to start oral feeds/home feeding regimen
  • General surgery/trauma patients
  • Patients with a known metabolic disorder
  • Intestinal rehabilitation program patients
  • Patients requiring a ketogenic diet
Ordering Provider to Initiate Pathway
No Later than 48 hours after
PICU Admission
  • Obtain Anthropometry Measurements
    per PICU Policy — View Job Aid
  • Place Nutrition Consult Order in EPIC
Barriers to Enteral Nutrition (EN)
Start Parenteral Nutrition (PN)
  • Known/Presumed Gut Ischemia
  • Persistent Hemodynamic Instability
  • Gut Graft vs. Host Disease (GVHD)
  • Malabsorptive State
    (e.g.: Short Gut)
  • Intra-abdominal Hypertension/Abdominal Compartment Syndrome
  • Intractable Emesis
  • Planned NPO Time > 72 Hours (Includes Post-surgical Patients)
 
Monitor for
Tolerance
Barriers to Initiating Enteral Nutrition (EN)
No
Yes
1. Start Enteral Feeds/Formula Selection
2. Initiate Bowel Regimen to Prevent Constipation
Consider Trophic Feeds
Yes
No
Tolerating Feeds
Yes
No
Hold Feeds
x6 hours
Advance PN per RD Recommendation to Prescribed Goal
Tolerating Feeds
Yes
No
Resume Feeds to Last Tolerated Rate
Consider Parenteral Nutrition (PN) via CVL
Conservative Advance to Prescribed Goal
Yes
No
Consider Stopping Trophic Feeds – Consider or Continue PN
Re-evaluate
Trophic Feed
Ability Daily
Posted: December 2014
Revised: May 2020
Authors: S. Irving, PhD, CRNP*; V. Srinivasan, MD*; M. Mascarenhas, MD; S. Seiple, RD; M. Nagle, RD; K. Berry, RD; K. Curry, RD; B. Blowey, PharmD; *co-leads