Plus-Hex CLINICAL
feeding will generally commence every 4 – 8 hours [ 14 ] . During hospitalisation , the patient ' s body condition score and muscle condition score should be regularly assessed , allowing the quantity of food to be tailored to each individual ' s requirements .
Accurately calculating the daily RER allows the patient ' s requirements to be met over a 24-hour period [ 15 ] . Animals that have been anorexic for 3 days or longer are typically started on a third of their total RER to prevent refeeding syndrome , which occurs when a malnourished animal is given a large amount of food at once . This causes an imbalance in electrolytes , fluids and vitamins within the body , which can have a negative impact on the patient [ 16 ] .
If the patient is tolerating feeds well , the meals are increased by a third every 24 hours until the patient ' s total RER is met . The patient can then continue to receive its full RER through nutrition delivered via tube feeds , with its bodyweight checked daily to ensure the calculation is accurate . If the animal begins to lose or gain weight rapidly , a VS assessment would be warranted , and the feeding schedule would have to be reassessed and changed as required .
If the patient has a PEG tube , the gastric contents should be aspirated before every feed ( Figure 5 ). This is done to check the stomach is emptying and the food is moving through the GI tract . If there is more than half of the previous meal left in the stomach , the next feed should be delayed , as this could indicate a degree of gut stasis [ 10 ] .
The digestive secretions should always be re-introduced before the feed , as they are required for hydrolysis of the food . The tube should then be flushed with 5 ml of sterile water to prevent build-up of the liquid diet .
Signs of tube misplacement or SSI
Clinical signs that may indicate the misplacement of feeding tubes or SSIs can include but are not limited to :
• Coughing
• Discomfort
• Abdominal distension
• Regurgitation or vomiting
• Hypersalivation
• Pyrexia
• Swelling
• Oozing or discharge ( as seen in Figure 6 ).
If any of these are noted in a patient , the VS in charge of the case should be notified immediately .
Conclusions
It is important to consider the animal ' s condition and amenability , and the potential duration of tube placement , when deciding which feeding tube would be suitable for a patient . Monitoring the patient ' s bodyweight daily allows the feeding plan to be altered promptly , so the patient should be weighed every day to ensure it is receiving adequate nutrition for its condition . Keeping a detailed record of all tube feeds allows other staff members to know how well the patient tolerated the previous feed . Tube placement should be considered as a preventative measure rather than a last resort . The use of a feeding tube ensures the hospitalised patient gets its required nutritional intake , which aids recovery .
Figure 5 . Aspiration of the gastric contents prior to feeding . Figure 6 . SSI after placement of an oesophagostomy tube .
Volume 39 ( 6 ) • December 2024
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