Nutrition Support

Intermountain Medical Center's Nutrition Support Service provides specialized care for patients who can't eat on their own

Seventy percent of the people who are admitted into a hospital's intensive care unit are unable to eat, which explains the mission of Intermountain Medical Center's Nutrition Support Service.

"Proper nutrition is a key to recovery, and we have a very strong, very advanced service to deliver high-quality nutritional care to everyone we serve," says Tom White, MD, medical director of nutrition support at the hospital. "More and more evidence shows that nutrition is a therapy, which helps people get well, rather than just support, which just helps them maintain." Dr. White replaces Terry Clemmer, MD, the long-time director of the program, who helped to establish many of the protocols that have made the service so successful.

"We have a great heritage of advanced and innovative care, and we have great capabilities at Intermountain Medical Center," says Dr. White. "We have nurses and dietitians who focus solely on nutritional support. We work with all the members of a patient's care team; we use a very integrated approach and monitor our patients intensely to make sure the nutrition they're getting is helping them get better."

There are two ways to feed patients who can't eat traditional food:

• One therapy involves an infusion given through a central catheter that ends in the large vein above the heart.. That's called total parenteral nutrition, or TPN. Parenteral means through the vein. Patients who need TPN typically suffer from dysfunction of the gastro-intestinal tract, malabsorption, short bowel syndrome, intractable diarrhea or vomiting, complete bowel rest, or intolerance to tube feeding. The liquid solution given to patients using TPN includes protein, vitamins, electrolytes, trace elements, H2 antagonists, lipids, insulin, and dextrose. A dietitian, nutrition nurse, pharmacist, and nurse practitioner analyzes the amount of each dose for every patient.
• A second treatment uses a feeding tube that runs through the nose down into the gastrointestinal tract. This is called enteral therapy. Feeding patients with this kind of technology has been shown to drastically reduce infection in trauma and ICU patients.

Another specialized service: A PICC team. Intermountain Medical Center's Nutrition Support Service also includes a specialized PICC team. PICC stands for peripherally-inserted central catheter, which is an intravenous access line that can be used long-term to deliver nutrition or medications. In 2004, the PICC team at LDS Hospital made over 1,500 insertions with a 95 percent success rate, which contributes to lower rates of complication, better recoveries, and improved outcomes. At Intermountain Medical Center, the PICC team will use a portable ultrasound machine that can be used at a patient's bedside.

"Our patients benefit in several ways from this kind of advanced care," says Dr. White. "We use expert resources to teach them to manage their own nutrition, when that's appropriate, and the feedback from patients and their families has been excellent. Our specialists regularly check on them and provide moral support, which helps them clinically and emotionally. We do all we can to provide excellent care to trauma, emergency, and ICU patients, and we follow up after discharge to make sure they're thriving once they get home."