the same time has advantages in some circumstances , particularly when concurrent hypovolaemia and hypoproteinaemia are present , as might be the case with horses with acute colitis or foals with EPE . The patient received three further plasma transfusions on separate days , which ran concurrently with Hartmann ' s solution supplemented with glucose during the first 5 days of hospitalisation .
Lidocaine
Lidocaine is used as a local anaesthetic and is classified as an antiarrhythmic agent ( counteracting abnormal irregularity of the heartbeat ). A CRI of lidocaine is frequently used in equine practice to control pain in horses with signs of colic . Although its clinical efficacy has not been evaluated in a large population of horses with colic , it is thought to provide analgesia , has antiinflammatory properties and has prokinetic properties to help gut motility [ 7 ] . In this case , lidocaine was used for its analgesic and anti-inflammatory properties .
Enteral nutrition and medication
The patient was inappetent during the initial period of hospitalisation , so enteral nutrition was initiated , four times a day via an NGT , which was checked for reflux each time it was placed . Twice a day , electrolytes were administered via the NGT , to correct abnormalities in the patient ' s electrolytes ; the other two times di-trioctahedral smectite ( Bio-sponge ) was given . This is commonly prescribed for horses with diarrhoea , due to its gastrointestinal protectant and anti-endotoxaemic properties [ 8 ] . On the third day of treatment the patient started to experience reflux , so enteral nutrition and medications were stopped .
The patient was offered a selection of palatable hard feeds that were high in protein to entice it to eat , along with ad libitum grass , hay and haylage ( Figure 3 ). The patient ' s appetite slowly returned after 5 days of hospitalisation . Pea protein powder was added to mashes to help to resolve the hypoproteinaemia .
Figure 3 . The patient being offered food .
Total parenteral nutrition
On day 3 of hospitalisation , TPN was started , as the patient continued to show no interest in food and started to experience reflux , so the enteral medications had to be stopped . TPN is indicated in patients that are unable to receive or tolerate enteral nutrition .
TPN provides nutritional support to prevent energy depletion , which prolongs recovery , particularly in cases of EPE [ 9 ] . TPN should be prepared aseptically and in a clean environment . A TPN solution usually contains dextrose , amino acids and lipids , and is administered via a fluid pump for accurate delivery . Regular blood glucose concentration readings should be obtained to ensure glucose levels are within normal limits .
The recipe formulated for this patient is detailed in Table 11 . Recipes can vary depending on a patient ' s age , energy requirements and disease process . When using lipids in the TPN formula , the solution ( in bags ) should be protected from light exposure until administration is complete . Strict IVC care is vital in these patients ; the dispensing sets and administration lines should be changed every 24 hours , as the components of TPN are ideal for bacterial proliferation .
Table 11 . The patient ' s TPN recipe .
Component
Nursing care ml per bag kcal per bag
Aminoven 25 % 1,000 600 Glucose 50 % 1,000 1,700 Intralipid 20 % 1,000 2,000 Potassium chloride 15 % 20 – TOTAL 3,200 4,300
Excellent nursing care is vital to the successful recovery of the patient . Cleanliness and good hygiene are essential in minimising the spread of infectious agents and are key to preventing secondary complications , as these patients are severely immunocompromised . Thrombophlebitis and irritation of the perineal skin from faecal scalding are some of the more common complications .
Stable bedding should be deep and changed regularly to aid in the prevention of decubitus ulcers and to help absorb diarrhoea and urine . If the patient is very weak and needs assistance to stand , the use of the LiftLarge animal lift would be indicated . A sling is placed around the horse while it is lying down , which enables it to be lifted with the use of a hoist . The medical ICU box in which this patient was stabled had a hoist attached to the roof , but the use of a sling was not needed .
26 Veterinary Nursing Journal