VETTECH U 2024 / HOUSTON, TX
LIFELINES: THE CRITICAL ROLE OF TUBE FEEDING (CONT.)
Sponsored by
SATURDAY AM • SEPTEMBER 21
KARA M. BURNS, MS, MED, LVT, VTS (NUTRITION) PRESIDENT, PET NUTRITION ALLIANCE
only 10% of the calcium required by dogs and cats, and therefore have a large inverse calcium-phosphorus ratio. Some products contain onion powder, which has resulted in Heinz body formation in cats. These products will flow through 8Fr. or larger feeding tubes and may be used on a very limited, short-term basis only when an appropriate pet food is unavailable. Human and veterinary liquid products have a better nutritional profile and thus should be used versus human baby food products. The feeding schedule is often determined by the patient's ability to tolerate food and the logistics of feeding. Feeding an amount equal to the patients RER during the first 24 hours of food re-introduction, if physically tolerated, is recommended. Feeding one-third of the RER and then increasing the amount by one-third every 24 hours is a more cautious approach to initial feeding but is not always necessary. Foods should be warmed to room temperature, but not higher than body temperature before feeding. Food boluses must be infused slowly (over approximately one minute per bolus) to allow gastric expansion. Daily food dosage should be divided into several meals according to the expected stomach capacity. Capacities for cats and dogs are 5 to 10 ml/ kg body weight during initial food reintroduction.5, 11 Maximum capacities as high as 45 to 90 ml/kg body weight have been measured in cats and dogs when fully re-alimented. Most often, meeting the patient's RER can be done in volumes far less than these maximums. Salivating, gulping, retching and even vomiting may occur when too much food has been infused or when the infusion rate is too fast. Research in people has demonstrated that the stomach does not "shrink" during a prolonged fast, but rather the stretch receptors are more sensitive and stimulated by a smaller volume when refeeding occurs. Feeding should be stopped at the first sign of retching or salivating, the meal size reduced by 50% for 24 hours and then
increased by 25% gradually. Foods provided via J-tubes must be infused slowly and often in either very small quantities or by a slow gravity drip or enteral pump with an hourly rate equal to RER/24 hours because the jejunum is volume sensitive. Remember to follow each meal with water flush to clear the feeding tube of food residue. When the patient is volume sensitive, it is important to know the minimum volume required to flush the tube. The patient's daily fluid requirement must also be met, and additional tap water may be administered through the feeding tube to meet that requirement. Liquid oral medications may also be administered easily through feeding tubes. Plugged feeding tubes can be cleared by filling the tube with water or a nonalcoholic carbonated beverage and allowing time for the food plug to dissolve. In general, end port tubes are easier to maintain than side port tubes because food tends to become trapped in the blind end of side port tubes. All tubes except orogastric and nasoesophageal tubes require standard every-other-day bandage care. SUMMARY The consequences of malnutrition in all patients, especially critically ill patients, are decreased immunocompetence, decreased tissue synthesis and repair, and altered drug metabolism. Nutritional management in patients with critical illness requires constant monitoring and careful calculations by the veterinary technician to address malnutrition. Constant vigilance and exceptional nursing care will help the patient to manage their malnutrition and facilitate healing and recovery.
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SEPTEMBER 20-22, 2024 | PROCEEDINGS | VETGIRLONTHERUN.COM
VETTECH U
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