Nutrition support and more
The advantages of enteral nutritional support over parenteral nutritional support are widely recognized. In humans requiring
nutritional support, enteral feeding is not only more natural but tends to be associated with fewer infective complications
and shorter hospitalizations, leading to overall decreased costs of service.
In veterinary medicine, the cost savings of enteral nutritional support over parenteral methods like TPN is obvious. However,
when there is poor tolerance of gastric feeds, reduced or poor motility or regurgitation and vomiting, IR offers an option
for distal tube placement to support feeding directly into the jejunum.
Using fluoroscopic guidance, a catheter and guidewire are used to move past the pyloris and through the duodenum into the
jejunum, where the tube is then passed.
Beal reports that jejunal access is achieved in 84 percent of patients and that nasojejunal tube placement has become the
standard of care in his service where jejunal feeding is desirable, including those animals suffering from pancreatitis, septic
peritonitis or any conditions associated with protracted vomiting or problems with gastric motility.
The value of IR, Beal tells DVM Newsmagazine, is that the approaches can lend themselves to a wide variety of treatments across many disciplines. In addition to relieving
obstructions, aiding in placement of tubes and devices and even tracheobronchial or vascular foreign-body retrieval, IR can
be used to deliver treatments more efficiently over a prolonged period.
Thrombolytic drugs and chemotherapy agents can be administered directly to the area in need, and biopsies and other tissue
samplings can be accomplished more rapidly and with less trauma to the patient.
Although IR procedures are less invasive, they do carry a level of risk. Because most procedures involve imaging technologies,
exposure to radiation for the animal and the staff must be carefully monitored. Protective precautions should be taken and
every effort made to limit the dose the patient receives.
Second, Dr. Beal notes that IR procedures are technically demanding and should be performed only by properly trained practitioners.
In untrained or inexperienced hands, significant harm or even death may result.
The Interventional Radiology Services at Michigan State and the original IR training program at the School of Veterinary Medicine
at the University of Pennsylvania in Philadelphia currently are the only two formal clinical programs that exist for this
The huge commitment in costs of imaging equipment and supplies may be a contributing factor to the limited number of programs
at this time.
"But, as students are coming through the professional curriculum, the more they see and the more they know what's available
for their patients in the future," Beal says.
Beal says he sees much enthusiasm for this specialty, not just as an offshoot of the human applications, but as its own distinct
"Dogs and cats are not people," he says. "It's not just a question of adapting human procedures to animals. It's how to optimally
develop techniques to meet the needs of dogs, cats and other animals in general.
"In an ideal world, it would be a true cooperative approach," Beal adds. "Maybe what we (veterinarians) discover can have
broader applications. Maybe physicians could look at the techniques and results of trials that are being performed on animals
and adapt them for human use. Then, everyone wins."
Wetzel is a freelance writer in Cleveland, Ohio
Beal is on the advisory board for Infiniti Medical, a distributor of IR products for veterinary medicine.