Page 642 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

Enteral Nutrition 629

BOX 26-1 List of Materials
Needed for
Nasoenteric Tube
Placement

1. Nasoenteric Feeding Tube
a. 5-8 Fr, 15-36 inches for cats/small dogs (the
authors recommend the Kendall, Curity feeding
tubes)
b. 8-10 Fr, 42 inches for dogs >20 lb (the authors
recommend the Kendall, Argyle feeding tubes with
a radiopaque sentinel line)
c. 10-12 Fr for dogs >75 lb
2. Stylet or guidewire (optional for tubes placed in large
dogs, recommend the PTFE wire 0.35 180 cm or
Figure 26-3 A kitten being feed through a nasogastric feeding the hydrophilic 0.35 260 cm straight guidewires
tube. from Merit medical)
3. Topical anesthetic (Lidocaine) to desensitize nostril
(divide dose by 3 and give each dose 5 minutes apart
When the animal swallows, advance the tube into the before tube placement)
esophagus to the depth of the premeasured mark. Using 4. Sterile, water-soluble lubricating jelly (Surgilube,
limited restraint and opening the mouth just far enough Savage Laboratories, Melville, N.Y.) or lidocaine jelly
to introduce the tube minimizes the animal’s objection to 2% (Akorn, Inc., Buffalo Grove, Ill.) to lubricate the
the procedure. Information on neonatal caloric feeding tube and lubricate the guidewire.
requirements, commercial milk replacers, and 5. Permanent marker to mark and adhesive tape to secure
instructions for feeding puppies 30 and kittens 39 from feeding tube
birth to weaning are available in written literature. 13 6. Sterile water
7. 6 mL and 12 mL syringes
NASOENTERIC FEEDING 8. Stethoscope
9. Suture material (2-0 or 3-0 Ethilon) to secure feeding
TUBES tube

Nasoenteric (nasoesophageal or nasogastric) feeding
tubes should be placed for short-term (3 to 5 days)
nutritional support in any patient that has not consumed the tube (taking care that the wire/stylet does not stick
or is not expected to consume adequate nutrition within out beyond the feeding tube). Sterile water soluble,
3 days of hospitalization. Techniques of nasoenteric tube lubricating jelly should be instilled into the feeding tube
intubation are available in written 1,14,26,27 and video lit- before introducing the stylet to facilitate easy removal of
14
erature; the materials needed for this procedure are the stylet after the tube has been passed.
listed in Box 26-1. Nasoenteric feeding tubes are made To pass a nasoenteric tube, a topical anesthetic is
in varying sizes and lengths, from a variety of materials instilled into a nostril (4 to 5 drops of 0.5% proparacaine
by different manufacturers (Box 26-2). Polyvinyl chloride hydrochloride for cats or 2% lidocaine hydrochloride for
tubes are inexpensive and work well for intragastric feed- dogs). The authors recommend repeating this step 2 to 3
ing. They may harden if left in for prolonged periods, times every 5 minutes before tube placement for adequate
however, and should be changed approximately every local analgesia. Most patients are depressed from their
3 to 4 weeks. Polyurethane or silicone tubes are more underlying disease and only require topical anesthetic.
expensive, but are resistant to gastric acid and may be Based upon a recent prospective enteral nutrition study,
used for prolonged periods. We choose the least expen- 31 of 54 (57.5%) dogs required no sedation for feeding
sive tube needed in the largest diameter and longest tube placement, 19 of 54 (35.1%) required mild sedation
length that the patient can tolerate comfortably. Large- and 4 of 54 (7.4%) dogs had feeding tubes placed postop-
diameter tubes present less resistance to solution flow, eratively while anesthetized. 47 If sedation is required, a
whereas long tubes can be placed into the stomach, reversible opioid/benzodiazepine combination is
secured to the head, and still be attached behind an recommended. Before passing the tube, measure the dis-
Elizabethan collar for easy access. tance from the nostril to the stomach (approximately the
Recommended tube sizes are listed in Box 26-1.A caudal margin of the last rib at the level of the
weasel-wire or guidewire/stylet (0.035 cm for 8 Fr or costochondral junction) and mark the tube with perma-
10 Fr feeding tubes) can be used to assist passage of nent marker. With the animal’s head held at the normal