Assisted feeding Flashcards
routes of assisted feeding?
enteral - via mouth - appetite stimulation - syringe feeding - tube feeding use first/main way
parenteral - IV nutrition
- when GI tract is none functional
treat underlying dehydration AND monitor weight closely
- dont want to lose weight but dont want to overload after starved
appetite stimulation?
first step is to stimulate appetite
- so want to eat
gut massages remove discharge from nose to smell food high award foods - horses = carrots/apples - dogs/cats = favourite treats - rabbits = fruit or pineapple juice mirtazapine - cats TLC to reduce stress starvation
not likely to work if dysphagic
syringe feeding?
short term solution for appetite stimulation
common for rabbits
patients must
- conscious
- able to swallow
- full functioning GI tract
- co-operative
forced feeding can cause food aversions
food aversions?
can be caused during forced feedig
- asssocciate certain foods with signs of illness or stressful events
can be persistent
offer food colds
tube feeding types?
first thing to do if dysphagic
nasogastric / naso-oesophageal tube
pharyngostomy / oesophagostomy tube
gastrostomy tube
jejunostomy
tube feeding considerations?
patient
- area of GI tract is compromised - tube choice
- contraindications
- how long need tube for - lower down = longer can leave
- anaesthetic ridk
- tolerance
- diet required - fit small tubes?
owner
- compliance - manage at home if possible?
- finance - jejunostomy very expensive
surgeon
- knowledge, skills and experience
- jejunostomy requires specialist training
practice
- 1st opinion wont do gastrostomy to jejunostomy
- advanced and not likely to have
Nasogastric / naso-oesophageal tube
inserted into nostril
passed through pharynx
lie in oesophagus not stomach
- so can’t go through cardiac sphincter of stomach
- stops aspiration of acid into oesophagus
- or creat gap in sphincter which weakens
- so acid reflux continues after removal
advantages of an NO tube?
well-tolerated - give GA drops on nose as don't like feeling generally easy to place - can be conscious - head down/flexed so less likely to damage trachea good for long term - 3-7 days can start feeding as soon as in place remove whenever patient is ready
disadvantages of NO tube?
tubes are very small in small patients
- many diets cant fit
- so require specific liquid supplements (eg recovery fluid)
can cause irritation to nose and eyes
if incorrectly placed food may enter lungs
- cause aspiration pnemonia
no useful if patient has facial/head trauma
- insertion causes sneezing = more damage
equipment for a nasogastric / naso-oesophageal tube?
local anaesthetic
tube
tape/glue/suture material/skin staple
- to secure tube to patients head
sterile water and syringe
- down tube - listen for coughs or water in lgs
- check for negative pressure - if there’s air then in trachea
buster collar (SA)/headcollar (horse)/bandage (foal)
pharyngostomy / oesophagostomy tube?
depends on location of the surgical hole
- laterally over the pharynx
- cranial oesophagus
the tube is passed through hole into the oesophagus
advantages of a pharyngostomy / oesophagostomy tube?
well-tolerated - unless dont like stuff over neck can be left for longer - 12 weeks larger tube - take thicker feed - so good for cats bypasses mouth if trauma - still used most of GIT can feed as soon as placed can remove whenever patient is ready
disadvantages of a pharyngostomy / oesophagostomy tube?
diffcult to place
requires GA
creates a wound and feeding through wound
- high risk of infection
if placed into trachea can cause aspiration pneumonia
can cause tracheal damage
equipment for a pharyngostomy / oesophagostomy tube?
general aneasthetic clipps and surgical scrub sterile gloves blade, large artery forceps and scissors mouth gag feeding tube suture material dressing and bandaging material - high risk of infection means strict wound care diagnostic imaging to confirm placement
gastrostomy (PEG) tube?
surgical placement via endoscopy
- so only small incision/wound
use a percutaneous endoscopic gatrostoy (PEG) tube
has a mushroom shaped tip on tube
- sits within stomach so cant be pulled out
requires fusion between stomach and body wall/skin
tube is passed to stomach and pulled out with endoscope until mushroom tip reaches inner wall
advantages of a gastrostomy (PEG) tube?
well tolerated
allow large feeds direct into stomach
stay for months - year
- go home with it if owner can manage
disadvantages of a gastrostomy (PEG) tube?
have to wait 24 hours before first feed and 14 days to remove
- require fusion otherwise food will leak out of stomach into abdomen
difficult to place
mushroom has to pass out ofter removed
contraindications
- something is wrong with stomach - why not eating
jejunostomy tube?
placed into small intestne
passed through a surgical hole
- to bypass upper GIT
not common
very last resort
advantages of a jejunostomy tube?
can be in place for months to a year
by passes stomach if none-functional
disadvantages of a jejunostomy tube?
requires constant feeding due to small lumen
- every 10 mins - lots of work
cant go home
have to wait 24 hours before first feed and 14 days to remove
- require fusion otherwise food will leak out of stomach into abdomen
has to be specific and expensive pre-digested food
need to open up stomach
- cant do through endoscopy
high risk of reverse peristalsis
- tube is pushed upwards from intestine to stomach
- food taken to already damaged stomach
equipment for a gastrostomy and jejunostomy?
general anaesthetic clippers and surgical srub sterile gloves tube kits suture material dressing
general tube maintenance?
check tube is still in place before feeding - negative pressure present - insert sterile water and not cough treat entry site as a surgical wound - monitor for infection - food at sight - discharge - bleeding - sutures breaking patient interference prevention monitor carefully for complications - common to get diarrhoea
what to do if tube becomes blocked?
few mls of coca cola
- slowly
unblocks everything in there
what to think about if patient is not drinking as well as eating?
replace water via tube and IV
a very dry mouth will make in uncomfortable to eat
- so wet mucous membranes
feeding using a tube?
determine volume of food required per day
determine volume of food per feed
put on gloves draw up sterile water draw up calculated volume of food position patient remove cap of feeding tube insert sterile water check patency and positional wait and monitor for coughing administer food slowly - continuous infusion systems are useful for large patients and feeds flush tube with water - doesn't need to be sterile replace cap ensure tube is clean and doesn't contain food complete hospital sheet dispose of waste appropriately
refeeding syndrome?
refeeding causes metabolic disturbances in starved patients
- more calories = rapid rise in insulin = effects electrolyte balance
when starting feeding in starved patients its important to gradually introduce food
- and monitor regularly
3 day rule for cats and dogs - 1/3 day 1 - 2/3 day 2 - 3/3 day 3 10 days in horses
regular but small feeeds
- slowly reduce to normal frequency
parental feeding?
fully (or almost fully) nono-functional GIT
an IV drip with carbs, proteins and lipis
long term complications unknown
- so short term option
must stay in hospital
very expensive
