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1108 Feeding Tube Placement: Nasoesophageal and Nasogastric

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A B C
FEEDING TUBE PLACEMENT: NASOESOPHAGEAL AND NASOGASTRIC A, Measurement of feeding tube
length. B, After instilling lidocaine into the nostrils, the clinician uses the left hand to push the nostril dorsally, and
advances the tube in a medial, then caudal direction. C, Dog after placement of nasoesophageal tube and Elizabethan
collar. The tube is glued in place and sutured (through the tape butterfly) to avoid dislodgement.

megaesophagus [p. 642], esophageal surgery • Tracheal, nasal or nasopharyngeal intubation esophagus to visually confirm correct
or perforation [p. 309], absent gag reflex) • Epistaxis placement.
• Uncontrolled vomiting (pp. 1040 and 1042) • Tube blockage with food particles, mucus, • The tube can be sutured or glued into place.
or regurgitation (p. 873) or esophageal or gastric mucosa The first point of attachment to the skin is
• Neurologic impairment • Rhinitis or dacryocystitis within a few days as close to the nares as possible. Additional
• Severe thrombocytopenia (p. 972) or of tube placement sutures or glue should be placed on the
coagulopathies • Esophageal reflux dorsum of the muzzle or on the cheek.
• Long-term feeding • Vomiting or regurgitation with expulsion of Avoid the whiskers in cats to prevent
• Aggressive patients the tube irritation.
• Aspiration pneumonia (p. 793) • Some animals do not tolerate the tubes, and
Equipment, Anesthesia an Elizabethan collar may be required.
• Placed without sedation; for very fractious Procedure
animals, sedation may be required • Manual restraint of animal, with or without Postprocedure
• Topical local anesthetic (2% [20 mg/mL] sedation • Ensure that tube does not migrate out.
lidocaine) • Elevate the nose, and with the animal’s mouth • Regularly flush tube with a volume of water
• Syringe and needle closed, instill 0.25-0.5 mL lidocaine in each equivalent to or greater than the volume
• Permanent marker or tape to mark tube nostril. Time the instillation to coincide of the tube itself to avoid blockage. This is
length with inhalation to minimize the amount of indicated especially before and immediately
• Water-based lubricating jelly anesthetic blown or sneezed out of the nares. after administering food or medications.
• Flexible feeding tube (polyvinyl, polyure- Both nostrils should be anesthetized at this • Well-liquidized food should be warmed
thane, or silicone) time to avoid delay if it becomes necessary to to body temperature and administered
• Suture material or quick-drying glue use the other nostril. The head and restraint slowly or as a constant rate infusion to
• Elizabethan collar are released while allowing lidocaine to take avoid rapid distention of the esophagus or
• Radiographic facilities effect (1-2 minutes). stomach.
• End of premeasured tube is coated with • Keep tube opening closed between feedings
Anticipated Time lubricating jelly. to avoid air buildup in the stomach.
5-10 minutes • Tube is directed ventromedially into the • Use of a prokinetic (e.g., metoclopramide)
nostril and passed by the ventral meatus. could assist with functioning of the lower
Preparation: Important Tube is advanced up to the premeasured esophageal sphincter to minimize the risk
Checkpoints mark. Slight flexion of the neck enables the of esophageal reflux.
• Select largest tube that will pass through the animal to swallow the distal end of the tube • If obstruction of the tube with food or medi-
nares. Guidelines: puppies and kittens, 3 Fr; and facilitate proper placement. cation occurs, one or more instillations of a
cats and small dogs, 5 Fr; larger cats and • Check correct placement of tube in the few milliliters of carbonated water (seltzer,
dogs, 8 Fr or bigger; giant dog breeds, 12-18 esophagus or stomach. mineral water, club soda) may dissolve the
Fr. If tube diameter is too small, feeding ○ Attempts to aspirate air from the tube obstruction. If this is not successful, the tube
solutions cannot pass through. with a syringe will create negative pressure must be replaced.
• Premeasure and mark the length of the tube. if the tube lies in the esophagus. If air is • Easily removed even within hours of
For nasoesophageal intubation, measure from easily withdrawn from the tube, it is likely placement
the nostril to the seventh intercostal space in the airway.
(ICS); for nasogastric intubation, measure ○ Injecting air through the tube creates Alternatives and Their
up to the 10th ICS. gurgling sounds on auscultation of the Relative Merits
stomach if the tube was successfully placed Alternative feeding tubes can be placed with
Possible Complications and into the stomach. minor surgery and short general anesthesia
Common Errors to Avoid ○ Capnography will detect a CO 2 curve with (e.g., percutaneous endoscopic gastrostomy
• Lidocaine intoxication in cats and possibly airway placement [PEG] tube [p. 1109], esophagostomy tube
smaller dogs (approximate toxic dosage ○ The author prefers to obtain a lateral [p. 1106]) or in conjunction with major surgical
[topical]: 4 mg/kg) radiograph of the cervical and thoracic procedures (e.g., gastrostomy and jejunostomy).

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