Enteral Nutrition Flashcards
Enteral nutrition
Delivering food to gastrointestinal tract as much as possible
Parenteral nutriton
Nutrition that is placed directly into vascular circulation
* Usually just at referral level
* Total or partial parental nutrition
* Liquid made up of amino acids, glucose and lipid components
* Centrally placed catheter (multi-lumened)
* Maintain fluid therapy and fluid electrolyte analysis
Common problems with parenteral nutrition
Infection at site of catheter
Phlebitis
Hypoglycaemia
Hypertriglyceridaemia
What is assisted feeding and when is it used?
- Used when animal is unable to obtain all nutrients needed to meet daily requirement so support is needed
- Animal may be unable to eat as normal or is unable to absorb the nutrition from specific sections of GIT
What would make a good recovery diet?
○ Additional B vitamins
○ High protein
○ Moderate fat
○ Low carbohydrates
How should nutrition be administered?
Via GIT wherever possible
Administered slowly
discontinued in controlled manner (over 6-12 hours)
Why should nutrition be via GIT where possible?
Otherwise enteral villi will atrophy
Could lead to bacterial relocation
Refeeding syndrome
- Sudden drops in sodium, potassium, magnesium and nutrient losses
○ Due to sudden increase in carbohydrate in food leading to sudden increase in insulin levels
Types of tube feeding
Syringe feeding
Naso-oesophageal, naso-gastric
Oesophagostomy
Gastrostomy/PEG
Enterostomy
Types of food
Liquid or mixed diets
Specific clinical diets
Critical care diets
For parenteral - usually specific to individual patient
How do you know how much to feed?
- Calculate patients RER
○ RER = (30 X BW) + 70 - Look at food and find K/cal per ml or gram
- Roughly 10ml/kg per meal is correct
○ Maximum of 50ml/kg/feed
Giver over 8 hour day
What should you consider when decided on placing a tube?
Time-frame it is in place
Toleration
Cost
Home care
Oesophagostomy
Max 3-4 weeks
Well tolerated
Need GA so more expensive
Home care is possible with compliant owners
Can give a lot in one feed
Naso-oesophageal/Naso-gastric
3-5 days
Well tolerated
Quite cheap
Can be used at home if owner can cope
Can’t give a lot in a short space of time
Good as supplementary
Percutaneous Endoscopic
Months of potentially longer
Well tolerated
Home care with committed owners
Risks with post-op infection
Can give pretty much normal meals in liquid form
Common problems with feeding tubes
- Blockages
- Dislodging of the tube, movement
- Trauma
- Infection
- Over-granulation
Causes of problems with feeding tubes
- Forgetting to flush before and after feeding
- Coughing/sneezing/vomiting/movement
- Chewing/biting and pawing
- Poor care of the surgical site
- Movement, infection
What sort of catheter should be used for parenteral nutrition?
Central venous catheter
Placed in jugular - reduces risk of phlebitis/infection
Multiples lines for fluid therapy as well
Following repair to a simple fracture to the mandibular symphysis, Pumpkin will require 3 days of post operative nutritional support
What feeding method would you choose?
Naso-oesophageal
Pumpkin will need a feeding guide developing, she weighs 4.3kg. Work out her RER and how much to feed her if you are using RCW recovery liquid at 1.1 k/cal per 1ml liquid. Remember to think about how much per meal and how many meals per day. Show your working.
○ RER = (30xBW) + 70
○ RER = (30x4.3) + 70= 199 kcals per day
○ 1.1kcal per 1ml liquid
§ 1kcal = 0.9091 ml (180ml per day)
○ 8 hour days
○ Roughly 8 feeds per day of 22ml
