TECH164-1108 : Nutrition in Critical Care Patients

INSTRUCTOR:
Tony Johnson, DVM, DAVECC & Daniel L. Chan, DVM, DACVECC, DACVN, FHEA, MRCVS

DATES:
November 12-December 19, 2008
Real Time Sessions: Tuesdays, November 18, 25, and December 2 and 9, 2008; 11:00am-12:30pm ET (USA)

COURSE DESCRIPTION:
The Nutrition in Critical Care course will cover indications for nutritional support of canine and feline ICU patients as well as practical methods for delivery of both enteral and parenteral nutrition to critical patients; an often overlooked aspect of patient care. The technician's and clinician's role in recognizing which patients will benefit from nutritional support will be explored. Various diseases that typically require nutritional support will serve as a framework for deeper discussions and critical thinking about the pathophysiology and consequences of starvation/malnutrition and the role of nutritional support as a part of an overall treatment plan.

This course is focused toward the experienced technician and veterinarian who routinely deals with critical care cases, or has an interest in obtaining or has the VTS (ECC) and/or VTS (SAIM) designation. Participants should be versed in basics of critical care medicine and nutrition as basic knowledge of these parameters will be reviewed only. Veterinarians are welcome to take this course; we will be applying for RACE approval for both veterinarians and veterinary technicians.

Upon completion of this course participants will be able to understand and discuss

• basic pathophysiology of starvation and malnutrition as well as methods of calculating nutritional requirements for dogs and cats.
• indications and contraindications for enteral feeding and parenteral nutrition.
• methods of delivery of enteral nutrition (NE/NG tubes, esophagostomy tubes, PEG tubes, jejunostomy tubes, etc.)
• methods of delivery of partial parenteral nutrition (PPN) and total parenteral nutrition (TPN) and proper guidelines for their use.
• complications that may arise with both enteral and parenteral nutrition and their management.
• nursing care associated with nutritional support of critically ill patients.

Overall Goal: To allow the participant to be a part of the healthcare delivery team by focusing on meeting the nutritional needs of critical care patients and understanding the role of nutrition in disease and healthy states

TEXTBOOKS: There are no required texts for this course; however, the instructors recommend the following:

• Chan, D. L. (2007). Nutritional support for the critically ill patient. In A. M. Battaglia (Ed.), Small Animal Emergency and Critical Care for Veterinary Technicians (2nd ed. pp. 85-108). Saunders Elsevier. VIN Store: https://store.vin.com/custom/edit.asp?p=82432
• Chan, D. L. & Freeman, L. M. (2006). Nutrition in Critical Illness. Vet Clin No America Small Anim Pract. 36(6):1225-1241.
• Freeman, L. M. & Chan, D. L. (2006). Total parenteral nutrition. In S. P. DiBartola (Ed). Fluid, electrolyte, and Acid-Base Disorders in Small Animal Practice (3rd ed. pp584-600). Saunders Elsevier.
• Abood, S. K., McLoughlin, M. A., & Buffington, C. A. (2006). Enteral nutrition. In S. P. DiBartola (Ed). Fluid, electrolyte, and Acid-Base Disorders in Small Animal Practice (3rd ed. pp 601-620). Saunders Elsevier. VIN Store: https://store.vin.com/custom/edit.asp?p=82232

COURSE OUTLINE:

Week 1: Nutrition in disease and health
Content: Review of normal nutritional physiology basics and the deleterious effects of starvation and malnutrition on disease recovery. Formulation of the nutritional plan for your patient as well as a list of diseases that commonly require nutritional support will be covered. Pro's and con's of appetite stimulants and why force feeding is playing with fire.

Week 2: Tubes, Tubes, Tubes! Enteral nutrition.
Content: Delivery of nutrition using the GI tract. Why we put those tubes in all those places and how we select each one. Review of tube placement, maintenance and complications. The importance of keeping the GI tract healthy through the use of enteral nutrition. All this, and how a can of Coke can save the day!

Week 3: Mainline calories: Parenteral nutrition
Content: When the GI tract has to be bypassed due to illness or injury, patients require parenteral nutrition (PN). The various formulations of partial parenteral nutrition (PPN) and total parenteral nutrition (TPN) will be covered. Different methods for vascular access, complications and the hefty nursing requirements of PN will be covered.

Week 4: The whole enchilada: Nutrition in the ICU, day practice and at home
Content: The final week will cover the incorporation of nutritional support for general practices, outpatients, 24-ICUs and everything in between. For the technician and clinician practicing at all levels, there are many options for improving outcomes for your patients - you don't need a 24 hour ICU to provide nutritional support for your patients. Some resources for products and suppliers and a review of the major points from the previous sessions will be included.

LIBRARY MATERIALS: Library materials will be made available prior to the topic week so participants will have plenty of time to prepare for the real time sessions and discussion.

MESSAGE BOARD DISCUSSIONS: Message board discussions regarding the topic presented will begin on the day the course opens and continue for one week following the last real time session. These discussions will be held in the VSPN CE course area.

CE HOURS: 6

TUITION:
$117 ($105.00 early bird special if registered before October 29, 2008).
*Students currently enrolled in and taking at least 2 classes or 5 units at an AVMA accredited or CAAHT approved Veterinary Technician Program may be eligible to receive a 50% discount off the regular rate for this course (upon verification of student status). You must include the following information in the comments section of the CE enrollment form in order to be eligible for this discount: your program director's name and contact information (email/phone) and school name.

** NOTE: Enrollment will be closed when the maximum number of participants is reached or at 5pm ET the day of the first real time session.

For More Information on how our online CE courses work please read the following:

• Minimal computer requirements for participating in VSPN and VPSNCE
• How to's of online CE
• Policies and Procedures

TO REGISTER:

1. Each person must individually be a registered member of VSPN (www.vspn.org). Membership in VSPN is free.
2. To enroll in any VSPN CE course click on the ENROLL NOW link below the course title on the right side of the page at www.vspn.org/CE
3. Each enrollee must be able to receive emails from @vspn.org and @vin.com addresses. This is our major form of communication with participants. It is highly recommended that course participants use their own, personal emails rather than clinic/hospital email addresses.
4. VIN Member veterinarians SHOULD NOT register for their staff. Please have the staff member register through VSPN. Please email VSPNCE@vspn.org if you have questions.
5. VIN Member veterinarians ARE ELIGIBLE to take this course, we are requesting RACE accreditation for both veterinarians and veterinary technicians. **Please access the course enrollment through www.vspn.org/CE.

Note: "This course has been submitted for approval for 6 continuing education credits in jurisdictions which recognize AAVSB RACE approval; however participants should be aware that some boards have limitations on the number of hours accepted in certain categories and/or restrictions on certain methods of delivery of continuing education. Call VSPN CE at 1-800-700-4636 for further information." (Attendees are encouraged to check with their licensing jurisdiction(s) for information regarding recognition by their board).

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COURSE WITHDRAWAL AND REFUND POLICY: Withdrawal prior to the listed start date of a course entitles the registrant to a complete refund or a credit toward a future VSPN or VIN CE course, whichever is preferred. Withdrawal within 1 week after the listed start date (i.e. including no more than one real-time session) entitles the registrant to a credit toward any future VIN CE course. (Does not apply to courses with only one real-time session.) After the first real-time session, a registrant may withdraw due to special circumstances and receive prorated credit towards a future VIN course. These requests will be handled on an individual basis. The amount of the prorated credit will be determined based on 65% of the time remaining in the course at the time of withdrawal. It is not possible to withdraw retroactively.
Note: To ensure rapid handling of your request for withdrawal, we recommend that you call the VIN office at 1-800-700-INFO (4636).

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** For More Information on VSPN's upcoming CE Courses, check out http://www.VSPN.org/CE

Nanette R. Walker Smith, M.Ed., RVT, CVT, LVT
VSPN Content Director & CE Coordinator
VSPNCE@vspn.org
1-800-846-0028 or 1-530-297-4950, ext 187

Charlotte Waack (Charlotte@vspn.org), ext 193
Chris Upchurch (Chris@vspn.org); ext 197
VSPN CE Services
1-800-846-0028 or 1-530-297-4950

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