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
- Utilize PICU/PCU Pathway for Initiation and Advancement of Nutrition in Children Order Set
- Obtain Anthropometry Measurements
per PICU Policy - Place Nutrition Consult Order in EPIC
Barriers to Enteral Nutrition (EN)
Start Parenteral Nutrition (PN)
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
Tolerance
Barriers to Initiating Enteral Nutrition (EN)
No
Yes
Consider Trophic Feeds
Yes
No
Tolerating Feeds
Parenteral Nutrition (PN)
via CVL
via CVL
Yes
No
Hold Feeds
x6 hours
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
Trophic Feed
Ability Daily
Posted: December 2014
Revised: December 2022
Authors: S. Irving, PhD, CRNP*; V. Srinivasan, MD*; M. Mascarenhas, MD; S. Seiple, RD; M. Nagle, RD; K. Berry, RD; N. Tabatabaei, RD; B. Blowey, PharmD; *co-leads
Revised: December 2022
Authors: S. Irving, PhD, CRNP*; V. Srinivasan, MD*; M. Mascarenhas, MD; S. Seiple, RD; M. Nagle, RD; K. Berry, RD; N. Tabatabaei, RD; B. Blowey, PharmD; *co-leads
Evidence
- Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient
- Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition
- Protein Requirements of the Critically Ill Pediatric Patient