Page 654 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

Enteral Nutrition 641

prospective randomized clinical evaluation of continuous Figure 26-17. Reservoirs and delivery tubes for feeding
and intermittent feeding in critically ill dogs. 47 Fifty-four solutions are available from a number of manufacturers.
dogs admitted to the critical care unit and requiring Reservoirs containing a 12- to 24-hour supply of diet
nutritional support with a nasoenteric (NE) feeding tube solution can be hung and allowed to drip in by gravity.
were enrolled. Dogs were randomized to receive either Intermittent bolus feeding requires more veterinary staff
continuous infusion (Group C) or intermittent bolus time due to the set-up and contact needed every 4 to 6
(Group I) of liquid EN. The percentage of prescribed hours for multiple feedings. Therefore we recommend
nutrition delivered (PPND) was calculated every 24 continuous feeding (constant rate infusion) using a com-
hours. The frequency of gastrointestinal (GI), mechani- mercial available syringe pump. Holahan and Abood have
cal, and technical complications was recorded and gastric found the Kangaroo 924 Enteral Feeding Pump
residual volumes (GRVs) were measured. The median (Figure 26-18) or Medfusion 2010i syringe pump
days of delivered nutrition support was 3 (range 1 to
8 days). PPND was significantly lower in Group C
(98.4%) than Group I (100%). Although there was a sta- BOX 26-7 Intermittent Bolus
tistically significant difference in the PPND between con- Feeding Instructions
tinuously and intermittently fed dogs, this difference was (to be done at each
unlikely to be of clinical significance. Likewise, there was feeding)
no statistically significant difference in GI or mechanical
complications, whereas Group C had a significantly
higher rate of technical complications (see later discus- 1. Auscultate abdomen for gut sounds. Aspirate gently
sion). GRVs did not differ significantly between Group on tube; measure and record any gastric residual fluids,
C (3.1 mL/kg) and Group I (6.3 mL/kg) and were then replace fluid through tube. If more than half the
not correlated to the incidence of vomiting or regurgita- volume previously fed is removed and the patient is
showing signs of gastrointestinal intolerance
tion. Critically ill dogs can be successfully supported with (vomiting/regurgitation), do not feed animal at this
either continuous rate infusion (CRI) or intermittent time (wait until next scheduled feeding).
bolus feeding of EN with few complications. Elevated 2. Inject 5-10 mL water through tube; if this produces
GRVs may not warrant termination of enteral feeding. coughing, the tube may be in the respiratory tract.
This study was the first published prospective clinical 3. When satisfied the animal can be fed, resume feeding
trial comparing delivery methods in dogs with NE-tubes; schedule. If necessary, place animal in sternal or right
it was also the first to evaluate gastric residual volumes lateral recumbency. Solution should be warm to room
(GRVs) in critically ill dogs. Subjects in both groups temperature and should be fed slowly. Bolus feed over
had GRVs measured and recorded every 4 hours. Median 30-60 minutes to assess the patient’s tolerance and
monitor for vomiting or aspiration.
GRVs for all dogs were 4.5 mL/kg and no significant dif-
If The Animal Vomits, Stop Feeding
ference was identified between the two delivery methods.
4. After feeding, flush the tube with 5-10 mL warm water
Additionally, no correlation was identified between the
and replace cap or cover, leaving the tube full of water.
incidences of vomiting or regurgitation and the amount
5. Observe the animal for discomfort, colic, or diarrhea
of GRVs. Results from this study have been used to estab- for the next few minutes.
lish guidelines and long-term goals in our Critical Care 6. Record each feeding and document any problems.
Unit focusing on minimizing complications and reducing 7. Nothing is to be administered via the tube, except the
technician time, while maximizing delivery of prescribed feeding solution, without the permission of the
calories. clinician.
Bolus and CRI feeding instructions are outlined in
Box 26-7 and a rescue protocol is described in

If patient vomits or regurgitates > 2 times in 24 hours

12-hour cessation of EN ordered
1 or more episodes of vomiting or regurgitation No vomiting or regurgitation in 12-hour period
Additional 12-hour cessation of EN ordered Resume feeding at last recorded caloric volume/rate

Continued vomiting or regurgitation No vomiting or regurgitation
Alternative method of nutrient delivery Resume feeding at lowest rate (1/3 RER)
Figure 26-17 Suggested Rescue Protocol for canine patients admitted to the critical care unit receiving
enteral nutrition support through nasoenteric feeding tubes. 47