Page 453 - Small Animal Clinical Nutrition 5th Edition

Enteral-Assisted Feeding 467

These products are usually accepted better than human liquid may be added to a human liquid product for a patient with a
VetBooks.ir products containing MCT oil. In most critical care veterinary high protein requirement. A vegetable oil or menhaden-fish oil
can be added to increase omega-6 and/or omega-3 fatty acids.
cases, these liquid foods are the best option currently available
Soluble fiber (e.g., psyllium husk fiber or pectin) can be added
in North America when small-diameter nasogastric and
jejunostomy feeding tubes have been placed, or when continu- to modular products, but requires greater than an 8-Fr. tube due
ous drip feedings are necessary. to the increased viscosity of the food.
Liquid milk replacer products are generally inappropriate to
feed to adult dogs and cats because they typically contain some Blended Pet Foods
lactose, have high (>300 mOsm/l) osmolarity and some are low The term blended pet foods refers to commercial products that
in caloric density (<1.0 kcal/ml), which can result in RER con- are nutritionally complete and balanced according to AAFCO
straints due to volume limitations. allowances for dogs and cats. Moist veterinary therapeutic
Module products are concentrated powdered or liquid forms foods are available with nutrient profiles that assist in the man-
of nutrients and are primarily supplemental (Table 25-10). agement of various disease conditions in dogs and cats.
These products may be added to a liquid product to increase Requirements for all other nutrients need not be calculated
the concentration of a specific nutrient. Protein, fat and carbo- when the food contains non-energy nutrients properly bal-
hydrate modules (e.g., casein powder, vegetable oil or corn anced to the caloric density of the product. When the patient
syrup) are available. For example, a modular protein product consumes the proper amount of a balanced food, all other

Figure 5. The lubricated catheter is drawn down the esophagus Figure 7. Gentle traction is used to bring the stomach and
as the suture exiting the body wall is pulled. A second “safety” abdominal wall into loose contact. A rubber flange is fitted
suture is placed through the openings in the mushroom-tip down the tube and a piece of tape attached to prevent tube
feeding tube (insert) and exits the mouth. This safety suture is slippage. The tube is not usually sutured or glued to the skin.
used to retrieve the feeding tube from the stomach if problems The safety suture is removed via the mouth (arrow) after the
occur during the placement procedure. feeding tube is secured.

Figure 6. Resistance will be encountered when the catheter tip Figure 8. PEG tubes are usually removed by traction. The
guide contacts the body wall. Steady traction and firm applica- mushroom tip will usually collapse as it pulls through the
tion of counter-pressure to the body wall will allow the guide tip abdominal wall. The resulting gastrocutaneous fistula usually
to emerge through the skin (arrow). A small skin incision (2 to 3 heals rapidly.
mm) at the point of exit may help.