The value of nutrition in healing often goes unrecognized. Any animal with significant illness and anorexia of 2-3 days duration will benefit substantially from feeding. Think about it whenever illness, injury or upcoming surgery may put them off their food. With frequent use, the following means for enteral feeding can become routine and minimally labor intensive for yourself, staff and clients.
NASOGASTRIC TUBE (ACTUALLY NASOESOPHAGEAL)—
- Often can be placed without sedation using lubricant and local anesthetic drops
- Cats: 3.5-5 F (15”) red-rubber or human infant feeding tubes
- Dogs: 5-10 F (15-42”) red-rubber tubes, human infant feeding tubes or silicone foal
- feeding tubes
Key points for application:
1. Measure to mid-thorax and mark tube
2. Instill lidocaine drops with head tilted up
3. Push nose dorsally (make a “pig-nose”) to gain access to ventral meatus
4. Lubricate tube well with K-Y jelly
5. Once in nose, flex neck to prevent intratracheal location
6. Pass tube to your mark; there should be minimal resistance if in ventral meatus
7. Secure tube tightly tucked under wing of nostril with one suture and on dorsum of nose
or side of face with second suture; attach remainder to collar
8. Cap tube
Safety maneuvers to insure proper location
- Instill 1-3 ml sterile saline…any cough?
- Instill 5-10 ml air…auscult abdomen for borborygmus?
- Radiographs if any question.
**Owners should evaluate for proper location (using saline/water) prior to each use!
PHARYNGOSTOMY TUBE—
- Used to bypass the oral cavity (oral fractures; tumor resections; hard palate repairs)
- Short-term use (days to weeks)
- Do not use if vomiting or regurgitation present
- Large bore tubes accommodate blenderized foods
ESOPHAGOSTOMY TUBE—
- Used to bypass the oral cavity (oral fractures; tumor resections; hard palate repairs)
- Do not use if vomiting or regurgitation present
- Large bore tubes accommodate blenderized foods
- Can be maintained for longer periods
- Very useful tube option; relatively easy to place and maintain
- Low morbidity if technical errors
GASTROSTOMY TUBE–
- Used to bypass the esophagus
- Can be placed percutaneously (endoscope or Eld device)
- Can be placed during celiotomy
- Can be maintained for greater than 1 year
- Low-profile devices make long-term use quite aesthetic and user-friendly
- Do not use if regurgitation or vomiting present
- Large bore tubes accommodate blenderized foods
- Higher risk than esophageal tubes
DUODENOSTOMY TUBE—
- Used to bypass stomach
- Can be placed under heavy sedation/local anesthesia
- Can be used in cases with vomiting or regurgitation
- Can be maintained for months
- Requires liquid, elemental diet
- Higher risk than esophageal tubes
JEJUNOSTOMY TUBE—
- Used to bypass the stomach
- Can be placed during celiotomy
- Can be used in cases with vomiting or regurgitation
- Can be maintained for months
- Requires liquid, elemental diet
- Higher risk than esophageal tubes
The first (or seventh!) time installing one of these tubes can be daunting. Give a call for tips/tricks/hand-holding, or we can also come on out to help you out!
Lara Rasmussen, DVM, MS
Diplomate, American College of Veterinary Surgeons