Page 649 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

636 SPECIAL THERAPY

Suture, over-the-needle catheter,
and PEG tube exiting stomach

PEG tube
Suture
Over-the-needle
catheter PEG tube

A B

Tape retainer
External flange
Skin
Body
wall
Stomach
PEG tube
wall
C D
Figure 26-11 Technique for passing a percutaneous endoscopically guided gastrostomy tube. A, An
18-gauge needle is passed through the feeding tube just below the bevel of the catheter, and the suture is
passed through the needle and tied securely to the tube. B, The cannula and feeding tube pass through the
mouth, esophagus, and stomach, and exit through the gastric and abdominal walls. C, An external flange can
be placed around the feeding tube to prevent separation of the stomach from the abdominal wall. D, A
lightweight bandage or stockinette can be used to protect the tube exit site. (Line drawings by Dana
Schumacher.)

described above for endoscopic gastrostomy tube place- metoclopramide (1 to 2 mg/kg/day added to intrave-
ment, except that a gastrostomy tube introduction set nous fluids; 0.2 to 0.5 mg/kg orally or subcutaneously,
(see Box 26-2) is used instead of an endoscope to guide three times a day) may stimulate gastric emptying if atony
the suture from the skin, through the stomach and esoph- is present, but the effect is inconsistent. To prevent occlu-
agus, to the oral cavity (Figure 26-12). Alternative sion with food or mucus, feeding tubes are flushed with
techniques for gastric feeding tube placement were devel- water before and after each feeding, and kept securely
oped for practitioners with limited access to an endoscope capped so that water remains in the tube between
and for patients in which abdominal exploration or feedings. The materials required for placement of a
endoscopy are not indicated as part of case management, PEG tube are listed in Box 26-4.
yet controlled, postesophageal nutrition support is
indicated. The blind placement of a gastrostomy feeding NASOJEJUNAL FEEDING
tube is not indicated in patients with esophageal stricture TUBES
or other obstruction, primary gastric disease, or gastric
outflow obstruction. Placement of a feeding tube directly into a segment of the
Animals may be fed through esophagostomy or proximal small intestine, such as the descending duode-
gastrostomy tubes soon after they recover from anesthe- num or proximal jejunum, using fluoroscopic or endo-
sia. Although the stomach of normal animals serves as a scopic guidance has been advocated in small animal
feeding reservoir, prolonged anorexia may decrease gas- patients that cannot be fed more proximally. 28,32,79 Spe-
tric capacity or cause gastric atony. Initial feeding volumes cific indications for postpyloric feeding tubes may include
of 5 to 10 mL/kg of body weight per feeding pancreatitis, pancreatic surgery, hepatobiliary surgery,
(four feedings per day) usually are safe and are increased proximal GI obstruction, neoplasia or extensive gastroin-
as tolerance permits. Motility modifiers, such as testinal surgery, and a decreased level of consciousness.