Trauma Nutrition — Frequent or Considerations — Clinical Pathway: ICU

Trauma Nutrition Clinical Pathway — ICU

Frequent OR Considerations

  • Delays in initiating and advancing feeds, as well as interrupting feeds for procedures contribute to inadequate calorie intake, weight loss and compromised healing
  • The table below assists with nutrition planning for children with ≥ 3 anesthetic events anticipated, precluding adequate PO intake for ≥ 3 days
  • Consider planning with IR placement of NJT with bridle within 48 hrs of admission
  • Excludes children with abdominal injuries
Invasive Airway
Jejunal (NJ, JT)
  • Review patient-specific goals with Trauma dietitian
  • Confirm Temporary Feeding Tube Position
    • Confirm NJT position with X-ray on morning of procedure
      • Goal 6 a.m. or within 12 hrs of procedure time
      • Verify procedure time with the Anesthesia Board Runner 54444
      • Re-confirm tube position with any subsequent changes in feeding tolerance
        before procedure
  • Tube position is confirmed by Trauma, Critical Care or Anesthesia attending
  • If nasojejunal tube (NJT) has migrated up to duodenum or stomach, use as nasogastric (NGT) or reinsert to jejunal position
  • NPO Time
    • Stop enteral feeds at time OR calls for the child
  • Excluded Procedures
    • Involve airway manipulation
      • Suspension laryngoscopy
      • Bronchoscopy
      • Tracheostomy
      • Replacement of endotracheal tube
        (e.g., uncuffed → cuffed)
    • Abdominal/GI
      • EGD/Colonoscopy
    • Require prone positioning
Gastric (NG, OG, GT)
  • Review patient-specific goals with Trauma dietitian
  • Cycled Feeds
    • Initiate cycled feeds within 72 hrs of admission to reach goal within 24-36 hrs
    • Begin with 20 hrs and compress to 18 hrs (or less) as tolerated
    • Intermittent feeds as clinically appropriate
  • Feeding Hours
    • Prescribed in EHR order
      • 20 hr feeds: off from 0300 - 0700
      • 18 hr feeds: off from 0100 - 0700
      • Intermittent feeds as clinically appropriate
  • Procedure Planning
    • Early a.m. discussion between trauma and/or other specialty surgical team and inpatient team to confirm plans for the day
    • PICU provider calls OR charge RN, 54444 for OR timing
  • NPO Time
    • 6 hrs before anesthesia
    • 0100 for add-on procedures
    • PICU provider calls Anesthesia Board Runner 54444 at 0700 for updated NPO time as needed
    • Note
      • Team discusses and orders IR placement of NJT with bridle within 48 hrs of admission
Natural Airway
Gastric (NG, OG, GT) or Jejunal (NJ, JT)
  • Review patient-specific goals with Trauma dietitian
  • Cycled Feeds
  • Initiate cycled feeds within 72 hrs of admission to reach goal within 24-36 hrs
  • Begin with 20 hrs and compress to 18 hrs (or less) as tolerated
  • Intermittent feeds as clinically appropriate
  • Feeding Hours
  • Times clearly prescribed in EHR order
    • 20 hr feeds: off from 0200 - 0600
    • 18 hr feeds: off from 0000 - 0600
    • Intermittent feeds as clinically appropriate
  • Procedure Planning
  • Early morning discussion between trauma and/or other specialty surgical team and inpatient team to confirm plans for the day
  • PICU provider calls OR charge RN or Anesthesia Board Runner at 54444 for OR timing at 0700
  • NPO Time
    Refer to Preparing Inpatients for Anesthesia/Sedation Pathway