Assisted feeding

Question 1

routes of assisted feeding?

Answer 1

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

Question 2

appetite stimulation?

Answer 2

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

Question 3

syringe feeding?

Answer 3

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

Question 4

food aversions?

Answer 4

can be caused during forced feedig
- asssocciate certain foods with signs of illness or stressful events
can be persistent
offer food colds

Question 5

tube feeding types?

Answer 5

first thing to do if dysphagic

nasogastric / naso-oesophageal tube
pharyngostomy / oesophagostomy tube
gastrostomy tube
jejunostomy

Question 6

tube feeding considerations?

Answer 6

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

Question 7

Nasogastric / naso-oesophageal tube

Answer 7

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

Question 8

advantages of an NO tube?

Answer 8

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

Question 9

disadvantages of NO tube?

Answer 9

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

Question 10

equipment for a nasogastric / naso-oesophageal tube?

Answer 10

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)

Question 11

pharyngostomy / oesophagostomy tube?

Answer 11

depends on location of the surgical hole
- laterally over the pharynx
- cranial oesophagus
the tube is passed through hole into the oesophagus

Question 12

advantages of a pharyngostomy / oesophagostomy tube?

Answer 12

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

Question 13

disadvantages of a pharyngostomy / oesophagostomy tube?

Answer 13

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

Question 14

equipment for a pharyngostomy / oesophagostomy tube?

Answer 14

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

Question 15

gastrostomy (PEG) tube?

Answer 15

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

Question 16

advantages of a gastrostomy (PEG) tube?

Answer 16

well tolerated
allow large feeds direct into stomach
stay for months - year
- go home with it if owner can manage

Question 17

disadvantages of a gastrostomy (PEG) tube?

Answer 17

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

Question 18

jejunostomy tube?

Answer 18

placed into small intestne
passed through a surgical hole
- to bypass upper GIT
not common

very last resort

Question 19

advantages of a jejunostomy tube?

Answer 19

can be in place for months to a year

by passes stomach if none-functional

Question 20

disadvantages of a jejunostomy tube?

Answer 20

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

Question 21

equipment for a gastrostomy and jejunostomy?

Answer 21

general anaesthetic 
clippers and surgical srub 
sterile gloves 
tube kits 
suture material 
dressing

Question 22

general tube maintenance?

Answer 22

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

Question 23

what to do if tube becomes blocked?

Answer 23

few mls of coca cola
- slowly
unblocks everything in there

Question 24

what to think about if patient is not drinking as well as eating?

Answer 24

replace water via tube and IV

a very dry mouth will make in uncomfortable to eat
- so wet mucous membranes

Question 25

feeding using a tube?

Answer 25

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

Question 26

refeeding syndrome?

Answer 26

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

Question 27

parental feeding?

Answer 27

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