Developing a feeding plan early for your hospitalized patients can significantly increase the likelihood for recovery.
Nutrients can be supplied to the body either enterally or parenterally. Enteral (using the gastrointestinal tract) feeding
provides adequate nutrition simply and cost effectively, whether done orally or by feeding tube.
Enteral feeding usually is preferred to parenteral feeding because it is less expensive, stimulates the immune system and
avoids most metabolic complications. However, nutrients must be administered parenterally when the small intestine is inaccessible
or not functioning adequately enough to meet the patient's nutrient requirements enterally. The two methods are not mutually
exclusive. In fact, supplementing what the patient consumes voluntarily with a parenteral caloric and protein infusion is
possible in most veterinary practices.
Therefore, overall patient assessment, including evaluating a patient's ability to eat and assimilate food, is the first step
in developing a feeding plan because it dictates the route of administration. The route for providing nutritional support
then determines which type of foods may be fed.
Oral feeding
Several routes exist for enteral feeding, but the first attempt should be oral feeding unless there is a clear complicating
factor, such as facial trauma. Placing a bolus of food in the proximal portion of the mouth may stimulate the swallowing reflex
and, if the patient offers no resistance, is a good method as long as the patient receives enough food to meet its resting
energy requirement (RER).
Simple syringe feeding of a liquid product also is a good method, if tolerated. For dogs, the syringe tip is placed outside
the molar teeth and food is deposited in the cheek pouch with the head held in a normal or lowered position. For cats, the
syringe tip is placed between the four canine teeth. The patient may choose to swallow the liquid or allow it to flow out
of the mouth by gravity. Some patients refuse to swallow boluses of food, but force-feeding is not advisable because of the
increased risk of food aspiration.
Oral feeding should be discontinued if the patient does not swallow food voluntarily. Appetite stimulants may be used to induce
food consumption. However, voluntary food intake using stimulants is rarely sufficient to meet the patient's minimum caloric
intake.
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OROGASTRIC TUBES require placement at each feeding but may provide a useful option for one or two days of feeding. They can be used as long
as there is no nasal, pharyngeal or esophageal trauma or disease. Anesthesia or sedation is not required. Neonates tolerate
multiple daily oral-tube feedings better than adults. A red rubber or polyvinyl chloride tube (8 to 24 Fr.) may be used with
the tip inserted to the caudal esophagus or stomach.
An indwelling feeding tube is the method of choice if assisted feeding is necessary for more than two days. It is easier and
less stressful on the patient. Nasoesophageal, pharyngostomy, esophagostomy, gastrostomy and enterostomy are potential sites.
Tubes should be placed in the most proximal functioning portion of the GI tract by the least invasive method. The stomach,
acting as a reservoir of a meal, should be used whenever possible.
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NASOESOPHAGEAL (NE) TUBES are generally used for three to seven days, but are occasionally used longer (weeks). Polyurethane tubes (6 to 8 Fr., 90
to 100 cm), with or without weighted tip or silicone feeding tubes (3.5 to 10 Fr., 20 to 105 cm), may be passed through the
nasal cavity to the caudal esophagus or stomach.
The preferred placement of all indwelling feeding tubes originating cranial to the stomach is for the tip to be in the caudal
esophagus to minimize gastric reflux and subsequent esophagitis. An 8-Fr. tube will pass through the nasal cavity of most
dogs. A 5-Fr. tube is more comfortable for cats. NE feedings may be used in anorectic patients that do not have nasal, oral
or pharyngeal disease or trauma.
Anesthesia or tranquilization is not necessary to place an NE tube, so this route provides a feeding option for patients considered
an anesthetic risk. These tubes are most often used in the hospital, although conscientious owners can use NE tubes at home.
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