In profound brain injury the person is unable to swallow
so eating and drinking has to be done by tube.
Some go on to be able to eat and drink a little by mouth, but the chances
are all or most of their food and drink will need to be taken by tube. Fortunately this method of feeding is very
effective and once established, quite simple and practical.
Because the brain injured person is being fed
artificially by tube there is no appetite to go by and they can’t tell us when
they are hungry or full up. So it is
very important to set a target weight and then to monitor their weight on a
regular basis. This is where the
relatives are so important as they can give the dietician a good idea of what
sort of build their loved one normally is so a suitable target can be agreed
We have special scales with a big platform with ramps so
you can wheel the wheelchair on to it, that way the person can be weighed in the
chair. Once the wheelchair alone is
weighed the person’s actual weight can be calculated.
Typically just after a very serious brain injury people
lose weight so usually we are trying to get the person to gain weight and they
may need a lot of calories. As they
settle down and become more stable they often need a really low intake. So
with regular weighing and by making adjustment to the amount they are given, the
dietician can make sure the person is getting the right amount of calories to
meet, or stay within their target weight range.
There are nutritional standards for how much protein,
vitamins and minerals people need so the dietician will have to make sure a tube
fed person is getting enough of these nutrients. We are very fortunate in this country in that
there are lots of ready-made products that are designed for tube feeding so by
using the right prescription, the dietician can make sure the person is getting
enough of all the nutrients they need.
It is very important that anyone has enough to drink but
brain injured people do tend to need rather more especially in the earlier
stages. They often have infections and
the brain injury itself may make them sweat a lot so it is especially important
to make sure they have plenty of fluid.
Firstly there is the feeding tube. This goes straight into the stomach and can
be tucked away under clothing so is not necessarily visible. To put the tube in the stomach, the person
would need a minor operation in a specialist unit in hospital. Just a bit of sedative and a local
anaesthetic is needed and it takes about 20 minutes to do. The tube stays in the stomach all the time
but other tubing can be attached when the person needs food or water. Nutrition is given in liquid form to make
sure it goes through the tube OK and usually it is pumped with special equipment
designed specifically for tube feeding.
All the equipment can be put into a knapsack and hung on the back of the
wheelchair so feeding can carry on discretely anywhere if wanted.
Good nutrition and hydration underpins everyone’s health
and wellbeing so it is very fortunate that usually it is possible to make sure
that a severely brain injured person can be well fed and hydrated.