98.Feedin tube

Question 1

methods of delivering enteral nutrition

Answer 1

1. coaxed feeding2. orogastric intubation3. NE tube4. NG tube5. pharyngostomy tube6. esophagostomy tube7. gastrostomy tube8. jejunostomy tube

Question 2

problems with coaxed feeding/forced feeding

Answer 2

–only good for 1-2 days–risk aspiration–aversion to food or handling–difficulty meeting RER–increased stress to animal–need for repeated feedings

Question 3

contraindications to NE tube

Answer 3

abN gag reflexesophageal dysmotilitycomapersistent vomitingany condition predisposing to aspiration

Question 4

checking proper tube placement for NE/NG tube

Answer 4

1. auscult for borborygmus after injecting air in tube2. check for negative pressure3. palpate two tubes4. unjust small amount saline and check for cough5. survey rads +/- contrast

Question 5

where is a pharyngostomy tube placed and why

Answer 5

caudodorsal pharynx to limit interference with epiglottis movement and laryngeal obstruction

Question 6

5 methods for esophagostomy tube placement

Answer 6

–manual unassisted transesophageal advancement–needle assisted percutaneous placement–tube assisted percutaneous placement–Eld percutaneous feeding tube placement–Esophageal feeding tube applicator

Question 7

4 placement methods of gastrostomy tubes

Answer 7

–surgical placement (L gastric body to body wall pexy–pass cath thru omentum)–percutaneous endoscopic gastrotomy tube (PEG–does NOT allow for permanent seal or gastropexy)–nonendoscopic percutaneous tube placement (semirigid orogastric tube, Eld applicator, angled metal tube)–low profile gastrostomy tube placement (long term–initial placement or 3-4 weeks after stoma healed for replacement; have antireflux valve)–endoscopic or surgical placement

Question 8

PEG tube catheters used

Answer 8

1. Pezzer mushroom tip2. Malecot mushroom tip–more flexible, can prematurely displaceuse internal flange

Question 9

T/Frisk of complications may be higher for animals with percutaneous endoscopic gastrostomy tube placement than for those with surgically placed gastrostomy tubes

Answer 9

Truecommon complications of PEG placement excessive P from external flange—skin dermatitis and peristomal infectionsalso no pexy or firm adhesion with PEG placementmay see hematemesis/melena

Question 10

methods of placing an enterostomy tube

Answer 10

–surgically( J tube or J thru G tube)–laparoscopically–low profile enterostomy tubestunnel through serosa/muscularis before penetrating mucosa aborally; secure to intestine, secure to body wall (enteropexy)

Question 11

water requirement

Answer 11

50-100 ml/kg /day

Question 12

RER

Answer 12

RER= 70 +(30 x kg)= kcal/dayORRER = 70 x (kg) to the 0.75 powerfirst day feed 1/3 of RER divided into 4-6 feedingswarm foodgive slowlyflush before and after

Question 13

recommendations for continuous feeding

Answer 13

residual volume should be aspirated q8hrif residual volume is 2x the volume previously infused in the last hour, the feeding should be discontinued for 2 hours and the rate of infusion decreased by 25%

Question 14

feeding volume recommendations

Answer 14

volume of food should NOT exceed gastric capacity which is 20-30 ml/kg in most cats and dogsstart by feeding small boluses 3-5 ml/kgbut can increase to 15 ml/kg

Question 15

methods to dislodge an obstruction in the feeding tube

Answer 15

–carbonated drinks–meat tenderizers–pancreatic enzyme solutions–pass a smaller catheter

Question 16

define refeeding syndrome

Answer 16

decr K, P, Mgnoted within 4 days of food reintroductionif P < 1.5 mg/dl may result in weakness, fluid retention, ECG changesif seen decrease feeding to 50% RER