Page 2224 - Cote clinical veterinary advisor dogs and cats 4th

Feeding Tube Placement: Nasoesophageal and Nasogastric 1107

point of the shoulder and from the vertebral • Turn the tip of the feeding tube back toward Alternatives and Their
column to the ventral midline. the stomach, and insert the tip of the tube Relative Merits
VetBooks.ir • Insert the curved Carmalt forceps into the or straight hemostats or your finger can help • Nasoesophageal tube (p. 1107): requires less
• Syringe force feeding: less invasive but often
back down the patient’s esophagus. Curved
• Put on sterile gloves.
more stressful and may lead to food aversion
mouth, with the tips closed and pointing up
guide the tube down the esophagus.
(away from the table), through the upper
the patient and more easily dislodged and
esophageal sphincter, and into the cervical • Plug the proximal (external) end of the tube sedation or anesthesia but more irritating to
using a Christmas tree adapter and cap.
esophagus. • Secure the tube to the skin by placing a clogged
• Advance the curved forceps until the tip white-tape butterfly and suturing it to the • PEG tube: easier to maintain long term
is halfway between the caudal edge of the skin or using a Chinese finger trap pattern. but more expensive equipment (endoscope)
mandible and the point of the shoulder. • Place a sterile dressing over the tube’s inser- needed to place it and potentially more
• Press the curved tip of the forceps into tion into the skin, and bandage the neck dangerous complications (septic peritonitis)
the lateral wall of the esophagus so that loosely with roll gauze and Esmarch-type • Larger-bore tubes of different material (e.g.,
it forms a visible tenting of the skin on bandage (e.g., Vetrap). Its purpose is to keep silicone tubing) can be used instead of red
the left lateral surface of the neck midway the site clean and prevent the tube from rubber catheters to facilitate feeding of
between the caudal edge of the mandible becoming dislodged. blenderized diets in place of liquid diets. Procedures and Techniques
and the point of the shoulder. Make sure
the tenting of the skin is well dorsal to the Postprocedure Pearls
jugular vein. Use the fingers of your right • Lateral cervical and thoracic radiographs • Esophagostomy tubes are ideal for short-term
hand (if you are right handed) to palpate the should confirm the placement of the tube. provision of enteral nutrition.
tip of the curved forceps. The confluence of The tube should not be kinked, and the tip • Tubes can be used by owners at home.
the linguofacial and maxillary veins into the should lie between the caudal edge of the • Esophagostomy tube placement is rapid, has
external jugular vein lie close to the caudal heart and the diaphragm. minimal risk of complications, and does not
edge of the mandible. These vessels must be • Feeding can begin immediately using a liquid require complex equipment.
avoided when making the stab incision into diet that flows easily down the tube. Each • The most challenging part of the tube place-
the esophagus. feeding or administration of medication ment is sliding the tip of the tube down to
• Using your extended left index finger, apply down the tube should be followed by a the caudal portion of the esophagus after
firm upward pressure to elevate the tip of the bolus of 5-10 mL of water, and immediate it has been pulled out of the mouth. The
curved forceps. This movement pushes aside capping of the tube to prevent reflux of food external portion of the tube will flip from
the external jugular vein as it tents the skin. into the tube where it might dry and cause pointing caudally to pointing cranially when
An assistant may hold off the external jugular an obstruction. the tip of the tube is successfully slid into
vein to make its location more apparent. • Most esophagostomy tubes are left in place its final position in the caudal esophagus.
• Using a scalpel blade, make a small 2-4 mm for several days or weeks. If longer-term • Technician tip: warm the liquid diet to body
wide stab incision over the tip of the forceps. use is needed, a percutaneous endoscopic temperature, and deliver with pet alert and
Continue deepening the incision until the gastrostomy (PEG) (p. 1109) tube should in sternal position over 15-30 minutes.
blade strikes the tips, allowing them to be considered. • Technician tip: to free up time for other
penetrate to the outside and be visible. • There is no minimum time that the tube treatments, the meal can be delivered by
• Using your left hand, open the tips of the must be left in place, and if it is accidentally syringe pump or frequent small doses.
forceps, and use them to grasp the tip of dislodged or needs to be removed immedi-
the feeding tube. ately after placement, there is no danger. SUGGESTED READING
• Being careful not to lose the grip on the tip • The tube may be removed without seda- Fink L, et al: Esophagostomy feeding tube placement
of the feeding tube, slowly withdraw the tion in most animals. Simply remove the in the dog and cat. J Vet Dent 31:133-138, 2014.
forceps back out of the mouth, pulling the bandage material and sutures, kink the tube, AUTHOR: Peter M. Foley, DVM, MSc, DACVIM
tip of the feeding tube through the skin, and slowly pull the tube out. This causes EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
into the esophagus, and out of the patient’s minimal to no discomfort. Thompson, DVM, DABVP
mouth. Keep pulling the tube through the • The stoma left behind after removal of the
skin until 6-8 cm of the flared, proximal tube will heal by second intention within
end of the feeding tube remain protruding 24-48 hours. It almost never needs to be
from the skin. sutured closed.

Feeding Tube Placement: Nasoesophageal and Nasogastric

Difficulty level: ♦ administration of daily caloric requirements • Suctioning of gastric fluid, gastric decompres-
and oral medications. sion, and prevention of gastric distention
(nasogastric tube only)
Overview and Goal
Enteral nutrition prevents deleterious effects Indications Contraindications
of malnourishment and can improve recovery • Short-term, inexpensive enteral feeding • Severe facial injuries involving the nares and
from disease, postsurgical healing, immune during hospitalization (<7 days) nasal turbinates
function, and decrease duration of hospitaliza- • Administration of oral liquid medication and • Severe pharyngeal, laryngeal, or esophageal
tion. Placement of a feeding tube facilitates fluids physical or functional abnormalities (e.g.,

www.ExpertConsult.com