COVID Chronicles: 6 Feet and Lots of Tube Feeds

Talk about getting thrown right into things. We've been dietitians for less than a year and already we're involved in a global pandemic - overachievers. The news does a great job at representing the doctors and nurses treating COVID but where the dietitians at? Here's the inside scoop on what it's like working as a dietitian treating COVID. If you make it to the end you'll be rewarded with hot off the press American Society of Parenteral and Enteral Nutrition COVID specific guidelines.

Rachelle - Washington

I work at three different hospitals in Washington state, all of which have been preparing for and now treating COVID cases since March. The atmosphere in the hospitals is a little tense. When they take your temperature at the door and only let you in once you’ve shown your ID badge it’s kind of like an elite club. Except you didn’t really know the club was going to take part in a global pandemic and snacks are not provided.

Reverse Trendelenburg

A really cool learning experience that has come from the COVID craziness is how to feed a vented patient in the prone position. I didn’t even know proning was a thing and my mom is a respiratory therapist (whoops). Vented patients are turned onto their stomachs to help improve respiratory function. So, patient on a ventilator, obviously going to need a tube feed, right. But now think of that tube fed patient being flat on their stomach for the majority of the day. It would be like drinking a milkshake consistently for an entire day and then laying on your stomach with a belly full of shake - not super great. Additionally, you’re lying on your full stomach completely flat, no elevation. You can probably guess where that shake is going to end up - hint: it’s not digestion. When a patient is prone, you can only continue tube feeds if you’re able to elevate the head of the bed above the feet. This position is called the reverse Trendelenburg (I have to look up how to spell this every time). This position allows enough gravity for the tube feed to travel from the nose or mouth down into the stomach and through the GI tract. Additionally, at my facilities we've been doing trickle feeds only (10-20mL/hr) when prone so there's not as much volume in the gut when increased pressure is there.

Joyce - Vermont

As an independent contractor based out of Vermont I have a few different RD roles but I'm going to talk about my main job as the dietitian of a long term care facility. I typically work on-site twenty hours a week, assessing residents, charting, and participating in interdisciplinary team meetings.

The Remote Dietitian

I recently went 100% remote, a decision from our parent company that applied to all of our facilities in Vermont. It has been a challenge in some ways, but it also feels good knowing that the residents (and I) will be safer. I can access most of the information needed through our electronic health record system on my work laptop. The biggest difference is having to call the facility to reach nursing staff or residents to ask relevant questions that will help me decide on my nutrition care plan for each resident. The workflow is definitely different, but I'm adjusting as best as I can. I know that we're all trying our best and that we will get through it together.

What is Your Why?

Although there have been times when we feel feverish or cough once and are convinced we’ve contracted COVID (just us though?), we are so grateful to continue working and learning. The role of a healthcare worker in treating COVID is fluid and constantly evolving as we learn more and more about the virus. However, our goal and motivation as healthcare workers has not changed. We all joined this field because we wanted to help others. Maybe we didn’t think that would mean taking ten minutes to get all the proper PPE, or consoling family members who haven’t been able to enter the hospital to see their loved ones, or even supporting patients through a really scary diagnosis that we don’t know everything about. But here we are, every day going to work, writing tube feeds, calling patient rooms, and doing our best to heal.

You made it to then end! We totally get that was a lot to read; thanks for hanging in there. Your promised reward is below. The governing board for nutrition support just published (on April 1) specific guidelines for treating COVID patients in the ICU. The guidelines cover everything from timing of enteral nutrition to feeding while prone (which, bonus points, you already got a sneak peek into by reading this post). Happy reading!