Assisted Feeding Flashcards
when will a feeding tube be considered for a patient?
if patients aren’t able or willing to eat spontaneously
what nursing interventions can be used before placing a feeding tube?
avoid food buffets in kennels (one type at one time for a short time) avoid prescription to avoid foo aversion try different textured foods ask if the patient can be given anti-emetic medication discuss appetite stimulants TLC offer food away from the kennel analgesia (if painful) offer usual diet and favorite treats warmed food prokinetic medication is the condition worsening and can clinical signs be improved?
how long should a patient be anorexic for before a feeding tube is placed?
48 hours or more
when is a feeding tube placed?
a patient has been anorexic for 48 hours or more
if the vet anticipates the patient to be anorexic after a surgical procedure
if there is trauma to the mouth, head or neck
to administer precise oral rehydration or medicine for patients with AKI
what are the 3 types of feeding tube?
naso-oesophageal
oesophageal
percutaneous endoscopic gastrotomy tube (PEG)
what equipment is needed to place an N/O tube?
surgical stapler feeding tube of correct size syringes that fit the feeding tube local anaesthetic sterile lubricant gloves sterile water tape
what sizing is used for N/O tubes?
french gauge
what local anaesthetic is often used when fitting N/O tubes?
Proxymetacaine
how should an N/O tube be placed?
LA into nose and maybe eye
lubricate tube
push into nose quickly and medioventrally
push tube in gently until you reach the measured mark
when happy tube is correctly placed secure with tape and either superglue or staple to nose and head
where should the N/O tube be measure from and to in cats and dogs?
7th rib in cats and 8th/9th ribs in dogs up to the tip of their snout
how can you check that an N/O tube is correctly placed?
attach syringe to end and check for negative pressure
if negative pressure slowly administer 10mls of sterile water watching for signs of respiratory distress
describe how to administer an N/O tube feed
calculate required amount of food
wear non-sterile gloves
draw up the required amount of food into an appropriate syringe(s)
pre-warm food within syringes in a water bath
check for negative pressure
administer 10mls water as flush
administer food slowly (over 10-15 mins)
watch for signs of nausea or regurgitation
administer 10mls of flush after
over how long should N/O feeds be administered?
10-15mins
what should you do if you see signs of nausea or regurgitation during N/O tube feeds?
slow down or if marked stop feed and try again in half an hour
what are the main nursing considerations of a patient with an N/O tube?
keep face and muzzle clean
tempt with food before every feed
take buster collar off for walks if putting it back on is tolerated well
avoid food buffet in kennel
avoid offering any prescription diets as this can create aversion
how long can NG tubes be used for?
up to 7 days
how is an N/O tube removed?
remove staples from the patient or peel away the tape
use no-sterile gloves to pull the tube gently out of the patients nose
which conditions will contraindicate and N/O tube?
cat flu congestion rhinitis head trauma epistaxis oesophageal disease marked regurgitation persistent vomiting impaired gastric outflow patients who are comatose or have limited gag reflex due to risk of aspiration if nutritional support needed for more than 7 dyas
what are the complications of N/O tubes?
patients removing own tube
not getting negative pressure before a feed - tube displaced
infection
reluctance to eat due to irritation from tube
aspiration
large dogs requiring very large feeds due to small lumen
blockage
what equipment is needed to place and oesophageal feeding tube?
oesophageal feeding tube (correct Fr) sterile gloves non-sterile gloves curved artery forceps surgical prep equipment (clippers scrub and drape) scalpel blade bandage material
how is an oesophageal feeding tube placed?
passed into the mouth with forceps and incision made where forceps can be seen beneath the skin
passed out through the skin and then down oesophagus
suture in place
what nursing care is involved in looking after the patient with a oesophageal feeding tube?
check stoma site twice daily
tempt with food before every feed
no neck collars or slip leads
administer medication through the tube where we can to create a positive relationship with food
avoid food buffets in kennel
avoid prescription diets so that food aversion isn’t formed
how should the stoma of an oesophageal feeding tube be checked?
unwrap dressing remove primary dressing clean stoma site with 1:10 iodine assess for swelling, discharge, redness and pain check for negative pressure flush redress
when can stoma sites of oesophageal feeding tubes be checked once a day?
if discharge reduces to minimal
describe how to perform oesophageal tube feeding
wear non-sterile gloves pre-warm food within syringes in a warm water bath check for negative pressure administer 10mls of flush administer food slowly over 10-15 mins flush again with 10mls watch for any signs of regurgitation, reflux or nausea administer medication flush
how long can oesophageal feeding tubes be in place?
weeks to months
can oesophageal feeding tubes be managed at home?
yes
how should an oesophageal feeding tube be removed?
wear non sterile gloves to remove
cut the suture holding the tube to the skin and gently pull away from the patient
apply primary dressing over stoma site
what are the contraindications for oesophageal feeding tubes?
persistent vomiting
reduced / impaired gastric outflow
comatose, recumbent or dysphoric patients - aspiration risk
oesophageal disease
what are the complications of a oesophageal feeding tube?
infection
loss of negative pressure - displacement
suture failure
blockage (although harder to blovk than N/O tube)
what equipment is needed to place a percutaneous endoscopic gastrotomy tube (PEG)?
PEG tube kit of correct size endoscope endoscopic forceps suture material surgical prep equipment
what is found in a PEG kit?
guide wire
needle/catheter
PEG tube
what position must the patient be in to place a PEG tube?
righ lateral
how is a PEG tube placed?
endoscope used to shine through stomach to the skin and indicate correct location in the stomach (or surgeon uses finger to show placement via endoscope) to introduce the needle through skin into stomach
guidewire is fed through the needle and into the stomach and then out of patients mouth using endoscopic forceps
loop of PEG tube is fed through guidewire
loop at end of PEG tube is attached to mushroom tip
guide wire is pulled out of the stomach through the skin incision until the mushroom is against the stomach wall
PEG tube is secured with sutures
how long does the PEG tube need to be in place before feeding can start?
24 hours
describe how to feed through a PEG tube
wear non-sterile gloves
pre-heat food within syringes in warm water bath
aspirate contents of stomach until negative pressure
measure volume of stomach contents aspirated and then place back into stomach through PEG tube
adjust feed to include aspirated volume
administer slowly over 20-25 mins
administer any medication
flush with 10mls water
how long should it take to administer a feed through a PEG tube?
20-25 mins
what are the main nursing considerations for an animal with a PEG tube?
try to administer oral medications through the PEG tube where possible
check the stoma site twice daily
use Stockinette instead of a wrap dressing
tempt with food before every meal (if appropriate)
how long can PEG tubes remain in place for?
cannot be removed for at least 7 days
remain in place for months
why must PEG tubes be left in for at least 7 days?
allow healing to occur
how is a PEG tube removed?
cut the tube and allow it to be passed naturally in faeces
firmly pull mushroom out of the stoma site
what are the advantages of a N/O tube?
no GA required
quick to place
easy removal - no healing required
well tolerated
what are the disadvantages of a N/O tube?
short term risk of aspiration, not anchored in GI tract irritating can inhibit spontaneous eating can block due to narrow lumen time consuming feeds
what are the advantages of an oesophageal tube?
can administer larger volumes more easily
can administer medications more easily
can be managed at home with the owner
what are the disadvantages of an oesophageal tube?
GA required stoma site can become infected can dislodge if patient vomits or regurgitates aspiration risk can block time consuming feeds
what are the advantages of a PEG tube?
large lumen to administer medication
can be in situ for months and managed by owner
what are the disadvantages of a PEG tube?
GA required
must be in place for 7 days before removal so not good for short term support
cannot use it for the first 24 hours
what is the calculation used for RER?
70 x BWT^0.75) = kcal per day
what is the calculation used for RER if the patient is between 3-25kg?
(30 x BWT) + 70 = kcal
what amount of their RER should animals be fed 24 hours after tube placement?
1/3 of RER
what amount of their RER should animals be fed 48 hours after tube placement?
2/3 RER
what amount of their RER should animals be fed 72 hours after tube placement?
full RER
