Care of feeding tubes
All clinical staff should have adequate training on the various types of feeding tubes and their individual management . The site should be re-dressed every 12 hours and checked for signs of a surgical site infection ( SSI ), such as oozing , swelling or redness – this does not apply to N-O tubes , as they do not enter a body cavity through an incision site .
Ensure staff are following aseptic procedures when using and re-dressing the chosen tube – this should include proper hand hygiene and the use of clean equipment . Alongside this , appropriate personal protective equipment ( PPE ) should be worn . This reduces the spread of bacteria and keeps the stoma / incision site free from the accidental introduction of infection . PPE should also be worn to prevent any exudate being transferred on to staff or clients and potentially causing issues with human health .
Before each feed , the tube should be checked for any visible damage or dislodgement . Following this , an empty syringe should be attached and drawn back to check for negative pressure , and 5 ml of sterile water should then be slowly introduced to assess the patency and placement of the tube . If negative pressure is not achieved then placement of the tube into the trachea would be suspected , and in this situation the positioning should be checked ; this applies to N-O and O tubes , but not PEG tubes . If concerned , a radiograph can be taken to confirm tube placement . Feeding through an incorrectly positioned tube may cause aspiration pneumonia [ 11 ] .
The feeding tube should be flushed with sterile water before and after each feed . If coughing is noted , the feed should not continue , a veterinary surgeon ( VS ) should be alerted and the tube placement should be checked . To ensure best practice , records should be kept of the amount of food given , the animal ' s tolerance of the feed , and any interventions that were made if issues arose .
The feeding tube should not be allowed to hang freely or drag on the floor . If the tube is not secured appropriately , there is an increased risk of infection from fomites or trauma due to patient interference . The use of a pet shirt or stockinette vest will reduce the likelihood of these problems occurring .
Feeding tubes are not limited to use in the veterinary practice ; they can also be used by a patient ' s owner once the patient has been discharged home . It is not recommended for cats to be outdoors unsupervised when they have a feeding tube in place , as this poses a high risk of tube dislodgement and infection . During the discharge appointment , it is important to discuss the care and safe use of the feeding tube with the owner , and provide information on the patient ' s required nutrition . A printed copy of this information will also be helpful to the client .
Use of feeding tubes
It is crucial to select an appropriate diet for the animal ' s medical and nutritional requirements , while also considering the diameter of the feeding tube . There are a variety of liquid diets available , some of which target certain conditions . They should be stored in accordance with the manufacturer ' s guidelines [ 12 ] . Open foods should be kept refrigerated and disposed of after 24 hours , due to the risk of bacterial growth [ 13 ] .
Before feeding , it is important to allow the liquid diet to reach room temperature to prevent GI intolerance and tube blockages . The patient should receive the tube feed in sternal recumbency , as this is the most natural position for an animal to eat and will assist in preventing aspiration .
The feed should be administered at 1 ml / min , giving time for the patient to swallow , confirming correct placement . Larger volumes of food may need to be administered with a syringe driver , following confirmation with a VS . The swallowing reflex would not be seen with a PEG tube as it bypasses the oesophagus .
How much food should a patient receive ? The patient ' s RER should be calculated as shown below . Dogs weighing > 2 kg and < 45 kg Daily RER ( kcal ) = [( bodyweight ( kg ) × 30 ) + 70 ] Dogs weighing < 2 kg and > 45 kg Daily RER ( kcal ) = 70 × bodyweight ( kg ) 0 . 75 Cats Daily RER ( kcal ) = bodyweight ( kg ) × 40
Once the daily RER has been calculated , divide this by the energy density ( in kcal / ml ) of the liquid diet , to calculate the overall total volume ( in ml ) required over 24 hours .
Finally , divide the total volume by the number of feeds to calculate the required volume per feed .
An example of these calculations , using a 20 kg dog that is to receive a liquid diet containing 1.5 kcal / ml , over three meals , is shown below .
Daily RER ( kcal ) = [( 20 × 30 ) + 70 ] = 670 kcal
Total volume ( ml ) required over 24 hours = 670 kcal ÷ 1.5 kcal / ml = 446.7 ml
Total volume per feed = 446.7 ml ÷ 3 meals = 148.9 ml
A VS should be continually informed of the animal ' s status , so the frequency of feeding can be determined ;
56 Veterinary Nursing Journal