Incorporating enteral nutrition into your practice - Veterinary Medicine
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Incorporating enteral nutrition into your practice
Since it's critical that ill animals receive adequate calories, if these patients aren't voluntarily consuming enough it is your responsibility to provide assistance. So read on for the why, when, what, and how of enteral nutrition.


VETERINARY MEDICINE


ONGOING MONITORING

Once an animal is discharged, body weight, BCS, and MCS should be evaluated every one or two weeks initially to ensure adequate caloric intake. The amount fed may need to be adjusted to achieve and maintain ideal body weight, BCS, and MCS. Tube monitoring should be continued at home, and bandages should be changed once a week or sooner if needed. Owners should be instructed to bring the animal in for evaluation if they have any concerns about the placement of the tube or have difficulty feeding the animal. Superficial skin infections at tube sites are not uncommon and can be treated with either topical or systemic antibiotics.

DISCONTINUING ENTERAL FEEDING

When the animal is voluntarily consuming at least 60% of its RER orally, enteral feedings can be gradually decreased. It is imperative to not remove enteral feeding tubes too early. Animals should be eating their full RER voluntarily and maintaining their body weight for at least a week before tubes are removed. If an animal is eating without assistance, the tube should be flushed with 3 to 10 ml water four times daily to maintain patency. Once tubes are removed, E and G tube sites typically heal within 24 to 48 hours by second intention.

CONCLUSION

Nutritional support can be provided to ill or injured animals in many ways. The key is to perform a thorough nutritional assessment of every animal and to initiate nutrition early. Once it is determined that a patient requires a feeding tube, its nutritional needs can be determined and the appropriate tube can be placed. Early institution of an individualized nutritional plan allows enhanced nutritional management, reduced risk of malnutrition, and ultimately, improved patient outcome.

Editors' note: Dr. Parker's nutrition communication residency is funded by P&G Pet Care.

Also read about the perks of proactive feeding in your patients and how to get clients to comply here.

Valerie J. Parker, DVM, DACVIM*
Lisa M. Freeman, DVM, PhD, DACVN
Department of Clinical Sciences
Cummings School of Veterinary Medicine
Tufts University
North Grafton, MA 01536

*Current address: Department of Veterinary Clinical Sciences
College of Veterinary Medicine
The Ohio State University
Columbus, OH 43210

REFERENCES

1. Remillard RL, Darden DE, Michel KE, et al. An investigation of the relationship between caloric intake an outcome in hospitalized dogs. Vet Ther 2001;2:301-310.

2. Chan DL, Freeman LM. Nutrition in critical illness. Vet Clin North Am Small Anim Pract 2006;36:1225-1241.

3. Wolfe RR. The underappreciated role of muscle in health and disease. Am J Clin Nutr 2006;84:475-482.

4. Evans WJ, Morley JE, Argiles J, et al. Cachexia: a new definition. Clin Nutr 2008;27:793-799.

5. Von Haehling S, Lainscak M, Springer J, et al. Cardiac cachexia: a systematic overview. Pharmacol Ther 2009;121:227-252

6. Brunetto MA, Gomes MOS, Andre MR, et al. Effects of nutritional support on hospital outcome in dogs and cats. J Vet Emerg Crit Care 2010;20:224-231.

7. Baldwin K, Bartges J, Buffington T, et al. AAHA nutritional assessment guidelines for dogs and cats. J Am Anim Hosp Assoc 2010;46:285-296.

8. Freeman L, Becvarova I, Cave N, et al. WSAVA nutritional assessment guidelines. J Small Anim Pract 2011;52:385-396.

9. Marks SL. The principles and implementation of enteral feeding. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine. 7th ed. St. Louis, Mo: Saunders, 2010;715-717.

10. Ramsey JJ. Determining energy requirements. In: Fascetti AJ, Delaney SJ, eds. Applied veterinary clinical nutrition. West Sussex, United Kingdom: Wiley-Blackwell, 2012;23-45.


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Source: VETERINARY MEDICINE,
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