Enteral Nutrition (ASAN002/24)

Question 1

ENTERAL NUTRITION

Answer 1

Refers to providing food directly to the Gastrointestinal (GI) Tract, usually via a feeding tube.

Question 2

Tubes are named for:

Answer 2

The site at which it enters the alimentary canal.

Question 3

Factors to determine site of tube placement:

Answer 3

Anticipated length of time tube is in place.\nSize of tube\nHow well patient will tolerate the tube being placed at that site. \nAvailable tubes\nSkill of person placing tube\nStatus of patient – can they tolerate GA etc. \nType of food available for tube feeding.\nReasons for placement – eg. Sx implications vs inability to eat.

Question 4

To determine the correct type of tube, consider:

Answer 4

Site of placement\nAnticipated length of duration\nIllness / dx being treated\nDiet availability\nTube availability\nProcedure for placement; eg. PEG vs laparotomy.

Question 5

5 basic tube placement sites:

Answer 5

Naso–gastric / naso–oesophagus\nOesophagostomy\nPharyngostomy\nGastrostomy\nEnterostomy (duodenostomy or jejunostomy)

Question 6

Sites for Enteral Feeding Tubes (IMAGE)

Answer 6

https://images.cram.com/images/upload-flashcard/41/47/30/37414730_m.png

Question 7

Naso–gastric / Naso–oesophageal

Answer 7

Tube passed from external nares, through nasal cavity to distal oesophagus. \nTube size: 3.5 – 8fr (depending on patient size)\nPlacement is easy & efficient.\nEffective means to provide enteral nutrition.\nCommercial diets often required due to small size of tube. \nUseful in critically ill patients as you usually don’t need sedation &/or GA to place.

Question 8

Equipment needed for NG tube placement:

Answer 8

Local anesthetic spray\nTube – rec. size 5fr in cats (3.5fr can be too small to administer food appropriately)\n5ml syringe of water (to check tube placement)\nSuper glue (or equivalent)\nE–collar (or equivalent)

Question 9

NG tube placement:

Answer 9

Can usually be placed without sedation or GA. \nEnsure you still have drugs made up & on hand incase patient becomes unduly stressed. \nAlthough relatively easy to place, can still be wrongly placed in the trachea. \nA few mls water down the tube will elicit a cough or distress from the patient if in the trachea.\nRads can also be taken to confirm correct placement.

Question 10

Placement of NG / Naso–oesophageal tube in the cat:

Answer 10

Spray topical anaesthetic into nare of choice, tilt head upwards to allow anaesthetic to move down the nare. \nMeasure tube externally from nare to distal oesophagus (7th or 8th intercostal space). Mark tube to ensure correct placement.\nLubricate tip of tube with local anaesthetic solution. \nTube should be placed in ventrolateral aspect of nare & passed in a caudoventral direction into the nasal cavity. Tube should elicit a swallow reflex as it passes down the oropharynx into the oesophagus. \nTIP OF TUBE MUST NOT ENTER STOMACH (through lower oesophageal sphincter). May cause sphincter incompetence & reflux of hydrochloric acid into oesophagus (oesophagitis).\nInject 2 – 3mls water into tube to confirm placement. If patient coughs, remove tube and place again.

Question 11

Naso–oesophageal Tube (IMAGE)

Answer 11

https://images.cram.com/images/upload-flashcard/41/48/08/37414808_m.png

Question 12

Securing the NG/ NO tube:

Answer 12

Super glue or equivalent\nSutures to only be used if patient is sedated or under light anesthesia.\nTube is postioned over dorsal aspect of nose & head. This is less distressing to cats then placing it along their cheek & whiskers.\nMAKE SURE TUBE IS CAPPED!\nE–collars should be placed – unless patient is critically ill & vet advises against it.

Question 13

NG / NO tube Advantages:

Answer 13

Inexpensive\nNon–invasive\nQuick procedure\nEquipment readily available\nNo sedation or GA required\nNon–specialised procedure\nEasily removed\nPatient can eat & drink around tube.

Question 14

NG / NO tube Disadvantages:

Answer 14

Small tube diameter\nSpecific commercial food required\nMay not be tolerated by patient\nKinking / blockage of small tube\nNot used in patients with facial trauma\nShort term placement only\nMay cause vomiting / refulx

Question 15

Oesophagostomy Tube

Answer 15

Tube enters through left proximal part of oesophagus to the distal oesophagus.\nDoes not enter the stomach – may cause sphincter incompetence & refux casuing oesophagitis. \nFood deposited in distal oesophagus\nPreferred method of enteral feeding for patients not needing gastrotomy or enterotomy tubes (due to surgical or metabolic conditions).\nRequires light aneasthesia for placement.