Page 2223 - Cote clinical veterinary advisor dogs and cats 4th

1106 Feeding Tube Placement: Esophagostomy

• Allow donor animal to defecate naturally, and • For optimal results, the transplant should be Pearls
immediately recover stool, avoiding excessive retained in the colon for at least 45 minutes, • Owners should be warned that this is a largely
untested procedure that is not without risk.
VetBooks.ir • Blend fresh stool at a ratio of 1 part stool • Any remaining fecal shake solution may be • For animals that respond well, improvement
but longer retention is ideal.
contamination with litter, grass, or dirt.
often occurs within several days.
and 3-4 parts milk (or saline/water) using a
offered to the patient for consumption, either
blender or a spoon; the goal is to create an
partial response. Repetition once or twice
willingly drink the fecal shake prepared with
emulsion without large pieces of solid stool. as is or mixed with a tasty food. Many dogs • Transplant can be repeated if there is a
• Use a sieve (or gauze, cheese cloth) strain milk. for animals that fail to respond is reasonable,
the emulsion to remove larger particulates but if there is still no improvement, further
that might clog the enema tubing. Postprocedure transplants are unlikely to be effective.
• Draw up prepared fecal shake into syringes, Beyond keeping the patient quiet and trying • Send a fecal score chart home with the client
with size and number appropriate to to avoid allowing defecation for at least 45 and have them score and record in a log any
administer 10 mL/kg dose (e.g., for a 10-kg minutes, there is no special care required. changes in stool consistency.
dog, you might use two 60-mL syringes, • Because oxygen exposure is likely to kill
each containing 50 mL of fecal shake). Alternatives and Their Relative beneficial anaerobic microbes, use of fresh
• Sedate the patient, if desired, and posi- Merits stool (<4 hours after defecation) is best.
tion (using restraint as needed) for enema • Commercially available probiotics are
administration. In sedated patient, lateral always administered before turning to SUGGESTED READING
recumbency is used, but the procedure can fecal transplant because there is no risk of Schmitz S, et al. Understanding the canine intestinal
be done in any position. iatrogenic disease transmission with probiotic microbiota and its modification by pro-, pre- and
• Roughly measure the length of tubing administration. synbiotics—what is the evidence? Vet Med Sci
required for the enema to reach the transverse • Alternative methods of fecal transplant 2(2):71-94, 2016.
colon or even the ileum. include administration by colonoscopy AUTHOR: Matthew Haight, CVT
• Lubricate the tubing, and gently insert per directly into the ileum, administration EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
rectum. Advance slowly to the appropriate by feeding fecal shake, or administration Thompson, DVM, DABVP
position (e.g., ileocolic junction to transverse by stomach tube. Stomach acid may kill
colon). beneficial microbes, making administration
• Administer the calculated volume of the fecal by enema or colonoscopy preferred routes.
shake slowly, avoiding sudden pressure that
might trigger patient defecation.

Feeding Tube Placement: Esophagostomy Client Education Bonus Material
Online
Sheet

Difficulty level: ♦♦ • Christmas tree adapter and cap Possible Complications and
• #11 scalpel blade Common Errors to Avoid
Synonym • Needle-holding forceps, suture scissors • Make the incision small at first to keep the
Esophageal feeding tube • Long, curved hemostatic forceps (e.g., curved seal tight around the tube; you can always
Kelly, Carmalt) enlarge it if necessary.
Overview and Goal • Nonabsorbable 2-0 or 3-0 suture material • Landmarks: avoid jugular vein or close
To provide a route (days to weeks) for deliver- (e.g., nylon) proximity to the larynx. They can be avoided
ing enteral nutrition and oral medications to a • White surgical tape by advancing the tip of the curved forceps
patient unable or unwilling to eat on its own • Bandage material: sterile gauze pad, roll to the midpoint between the point of the
gauze, Esmarch-type bandage (e.g., Vetrap) shoulder and the caudal edge of the mandible
Indications and elevating the esophagus with the tip
• Nutritional support for anorexic patients Anticipated Time of the curved forceps when they are in the
• Disorders of swallowing or mastication 20-30 minutes, including preparation esophagus.
• Route of evacuation of food material in cases • Avoid clogging of tube by injecting a few
of megaesophagus (p. 642) Preparation: Important milliliters of tap water immediately after
Checkpoints every feeding or medication administration.
Contraindications • Obtain owner consent: discuss cost, risks • If the tube becomes clogged, several milliliters
• Frequent vomiting (anesthesia, bleeding, aspiration pneumonia of a carbonated, unsweetened beverage (e.g.,
• Coagulopathy [p. 793]), care of the tube and feeding at home. seltzer or club soda) can be instilled into
• Gastrointestinal (GI) obstruction • Identify landmarks. It is useful to have an the tube for several minutes to soften and
assistant hold off the external jugular vein dislodge the obstruction.
Equipment, Anesthesia to ensure the incision will be far from its
• General anesthesia or heavy sedation location. Procedure
• Clippers; materials for aseptic prep and scrub • Trim the feeding tube to the correct length, • Induce general anesthesia, and intubate the
• Mouth gag if necessary. Ideally, the tube should extend patient.
• Sterile gloves from the incision to the 7th rib, plus 6-8 cm • Place the animal in right lateral recumbency,
• Feeding tube (red rubber type), typically of tube that remains outside the patient. and apply a mouth gag.
10-Fr diameter for cats and small dogs, up The tip of the tube should be the portion • Shave and disinfect the skin on the left side
to 18 Fr for larger dogs trimmed, not the syringe end of the tube. of the neck from the angle of the jaw to the

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