Critical care nutrition

Question 1

What should you do before feeding with a feeding tube?

How should you administer the food?

Answer 1

Aspirate tube
Warm food
Administer slowly
Flush tube with warm water

Question 2

When should you stop using a feeding tube?

Answer 2

When voluntary intake >85% BER

Question 3

Give some complications when using feeding tubes

Answer 3

Mechanical blockage
Metabolic (gastrointestinal upset, hypophosphataemia)
Tube dislodgement (peritonitis?)
Stoma infection (wound)
Tube removal by patient

Question 4

How much should you feed with a feeding tube?

Answer 4

RER (kcal):
Dog: 30 x BW + 70
Cat: 40 x BW

Nothing for first 24 hours, then 1/3 on day 1, 2/3 on day 2, 3/3 on day 3

Question 5

When should you intervene and consider feeding tubes?

Answer 5

Recent weight loss >10%
Partial/complete anorexia for >3 days
Disease causing excess catabolism

Question 6

What types of enteral nutrition are there?

Answer 6

Encourage feeding (privacy, warm food, fresh, strong-smelling)
Force feeding (syringe, careful of food aversions)
Drugs (diazepam, mirtazapine-cats)
Tube feeding

Question 7

Describe gastrotomy tube placement

Answer 7

Clip left side of stomach
Insert hypodermic needle into stomach and thread wire through
Grab wire with endoscope and pull up through mouth
Thread wire into tube, pull tube through mouth into stomach then through body wall
Remove wire

Question 8

Describe oesophagostomy tube placement

Answer 8

Placed in lateral neck (usually LHS)
Measure length of Carmalt forceps against neck
Insert forceps though mouth and push out laterally through the muscle, then incise the skin over it
Grab tube with forceps and pull until most of tube is pulled out of animal’s mouth
Reverse the tube and push it as far down oesophagus as possible
Secure tube to skin with fingertrap pattern

Question 9

Describe naso-oesophageal tube placement

Answer 9

Pour topical local anaesthetic solution into nostril
Measure tube from nose to 9-10th rib
Pass tube into nose in ventromedial direction (first push nose dorsally then flex head ventrally)
Secure tube with tape, suture tape to skin (tie first suture as close to nares as possible)
Elizabethan collar

Question 10

Enterostomy tubes are indicated when?

When are they contra-indicated?

Answer 10

Indicated: pancreatitis

Contra-indicated: diffuse intestinal disease

Question 11

Why is enteral nutrition preferred over parenteral?

Answer 11

Easier
Fewer complications
More economical
More physiological

Question 12

What are the only 3 indications for the use of parenteral feeding over enteral feeding?

Answer 12

Malabsorption syndromes, acute severe pancreatitis, severe persistent vomiting

Question 13

Gastrostomy tubes are for which length of time?

Is sedation or GA required to insert them?

Answer 13

Long term support (minimum 7 days)

GA

Question 14

Oesophagostomy tubes are for which length of time?
Is sedation or general anaesthetic required to insert them?
Where does the tube enter the oesophagus?
What are the contra-indications?

Answer 14

Medium to long term support (number of months)
GA
Laterally
CI: disease of oesophagus and below

Question 15

Naso-oesophageal tubes are for which length of time?
Which kind of food are they used for and why?
Is sedation required to insert them?
Where does the tip of the tube end?
What are the contra-indications?

Answer 15

Short to medium term (2 weeks)
Liquid foods, due to the small diameter of the tube
No
Distal oesophagus
Vomiting, no gag reflex, disease of nose or pharynx, damage to face