Page 645 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

632 SPECIAL THERAPY

diameter feeding tubes (>14 Fr) permit feeding of
pureed commercial pet foods. The distal end of
esophagostomy tubes should not be placed through the
lower esophageal high-pressure zone into the stomach.
Studies have shown that such placement can cause gastro-
esophageal reflux by disrupting the integrity of this caudal
esophageal high-pressure zone. 25,63 Esophageal dysfunc-
tion, including abnormal clearing of acid within the distal
esophagus, also may occur. 61 In addition, chronic esoph-
ageal irritation by refluxed gastric acid may result in
esophageal stricture formation. Placing the distal end of
the esophagostomy feeding tube in the anterior or
midthoracic region of the esophagus prevents mechanical
disruption of the caudal esophageal high-pressure zone.
Secondary peristaltic waves move the food bolus through
Figure 26-7 Canine patient with nasogastric enteral feeding tube the remainder of the esophagus into the stomach.
in place sutured at both the nostril and cheek. The necessary materials required for this technique are
listed in Box 26-3. To place the esophagostomy tube, the
patient is anesthetized and intubated (with either a short-
acting injectable or inhalant anesthetic technique) and
placed in right lateral recumbency with the head and neck
extended. The hair is clipped from the lateral and ventral
aspects of the neck using the vertical ramus of the mandi-
ble, the base of the vertical ear canal, and the caudal edge
of the larynx as landmarks. The skin is aseptically prepared
for surgery. The mouth is held open by an oral speculum
to permit visual examination of the oral cavity and digital
palpation of the oropharynx for surgical landmarks and
structural abnormalities.
A long curved Carmalt or Mixter forcep is inserted
through the oral cavity and oropharynx into the proximal
one third of the esophagus (Figure 26-9, A). The instru-
ment is pressed laterally against the esophageal wall to
create a visible bulge in the skin along the left lateral
Figure 26-8 Dog with immune-mediated hemolytic anemia being aspect of the neck, dorsal to the jugular vein. A 1 to
feed through a nasoenteric feeding tube with an Elizabethan collar in 2 cm incision is made through the skin and subcutaneous
place to protect the feeding tube. tissues directly over the end of the forceps (Figure 26-9,
B). A number 15-scalpel blade can be used to make a
small incision in the esophageal wall at the tip of the

ESOPHAGOSTOMY FEEDING
TUBES BOX 26-3 List of Materials
Needed for
Esophagostomy tubes are specifically indicated for Esophagostomy Tube
patients requiring prolonged feedings with at-home care Placement
or bypass of the oral cavity or oropharynx due to dyspha-
gia, infection, inflammation, neoplasia, fracture, oronasal
fistula, surgical procedures, or trauma. 85,96 The diameter 1. Esophagostomy tube (>14 Fr red rubber, Silastic or
polyurethane tubing)
and length of the esophagostomy tube depends upon the
2. Injectable or inhalant anesthetic
size of the patient, type of diet, and personal preference.
3. Hair clippers
Soft red rubber urethral catheters or Silastic tubing are
4. Surgical scrub and alcohol
used commonly as esophagostomy feeding tubes; 5. Oral speculum
recommended feeding tube sizes are 12 to 16 Fr catheters 6. Curved Kelly, right angle or Carmalt forceps
for cats and dogs under 10 kg, and 12 to 20 Fr catheters 7. No. 10 (and No. 15) scalpel blades
for larger dogs (Stallion urinary catheters 6.6 mm 8. Suture material (3-0) Ethilon
137 cm (J-90s; Jorgensen Laboratories). The larger