Page 2227 - Cote clinical veterinary advisor dogs and cats 4th

Feeding Tube Placement: Percutaneous Endoscopic Gastrostomy (PEG) 1109

Pearls • Do not check tube placement by injecting SUGGESTED READING
• There is no difference in complication rates water into the tube. Some animals are Marks SL: Nasoesophageal, esophagostomy, gas-
VetBooks.ir • In dogs, the nasal planum can be pushed cats will not cough even when the tube is In Côté E, et al, editors: Textbook of veterinary
between the two tube locations (nasoesopha-
too weak to cough, and the majority of
trostomy, and jejunal tube placement techniques.
geal or nasogastric).
intratracheal.
internal medicine, ed 8, St. Louis, 2017, Elsevier.
dorsally to ease initial insertion of the tube.
AUTHOR: Mirinda Nel van Schoor, BVSc, MMedVet
EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
Thompson, DVM, DABVP

Procedures and Techniques
Feeding Tube Placement: Percutaneous Endoscopic Gastrostomy (PEG) Client Education
Sheet

Difficulty level: ♦♦ • The animal is anesthetized and placed in
right lateral recumbency.
Overview and Goal 1
Placement of a percutaneous endoscopic gas- Possible Complications and
trostomy (PEG) tube using minimally invasive Common Errors to Avoid
techniques that provides a portal of entry into • The pulling of the PEG tube through the
the stomach for administration of food and gastric and abdominal wall can be facilitated
medications. These tubes typically can be left by carefully opening the skin around the
in place for weeks to many months. tube with a scalpel blade (opening should
only be large enough to accommodate the 4
Indications tube). 5
To enable enteral nutrition and/or medication • The disk of the PEG tube may be blocked at 3
delivery in an animal that is unable or unwilling the level of the gastroesophageal sphincter. A
to eat on its own for an extended period (e.g., firmer pull will allow the ampulla to pass this
cat with hepatic lipidosis, animal with a jaw obstacle. NOTE: It is essential to brace this
fracture) or if severe esophageal disease is present traction on the tube with counterpressure
at the level of the body wall. If pulling the
Contraindications PEG tube into place with the right hand,
• Intestinal obstruction the clinician’s left thumb and forefinger are 2
• Pancreatitis on the body wall, adjacent to the tube, and 6
• Abdominal effusion are exerting counterpressure to make sure the
• Patient cannot tolerate anesthesia disk stops at the stomach wall and does not
come out entirely.
Equipment, Anesthesia • The PEG tube must be left in place for
General anesthesia required at least 2 weeks to allow fibrous tissue to FEEDING TUBE PLACEMENT: PERCUTANE-
OUS ENDOSCOPIC GASTROSTOMY PEG kit
• Endoscope with a biopsy forceps surround the portion of the tube between (Corflo) includes a PEG tube with a tapered extremity
• Prepackaged PEG tube kit (Corflo, Cook the stomach and the abdominal wall, thereby prolonged with a wire with a loop at the end (1),
Medical PEG-24 Pull or Vygon Vet, 16-20 Fr sealing it off from the abdominal cavity. This a wire with a loop at the end (2), a needle (3), an
in diameter, according to animal size), which is important for the safe removal of the PEG L-shaped flange in two parts (4), a regular flange (5),
includes a tube with a distal pliable disk and tube and minimizes the risk of peritonitis. and adapters to close the PEG tube (6). (Used with
a tapered proximal extremity prolonged by • Accidental dislodgment of the tube before permission from Halyard Health.)
a wire with a loop at its end, a large-gauge 2 weeks requires emergent evaluation as
needle, a thin cable with loop at the end, peritonitis can result.
two flanges (one straight and one with a • Blockage of the PEG tube by dried food
90-degree angle allowing the tube to become should be avoided by rinsing the tube after • The needle is introduced through the body
parallel to the abdominal wall), and adapters each use (i.e., follow food or medications wall into the gastric lumen, aiming for the
to close the tube with water). If blockage occurs, it can be light of the endoscope.
• A sterile #11 scalpel blade addressed by repeatedly administering a few • After the needle tip is visible in the lumen
• Suture material for the skin (e.g., 2-0, 3-0 milliliters of carbonated water (seltzer, club of the stomach, the wire loop is introduced
nylon) soda, mineral water) into the tube until the through the needle into the stomach.
• Suture scissors and needle holder obstruction dissolves. • With the endoscope, the extremity of the
loop of the wire inside the stomach is grabbed
Anticipated Time Procedure using the biopsy forceps of the endoscope;
About 15-20 minutes of procedure and 30 • The endoscope is introduced into the wire, biopsy forceps, and endoscope are
minutes of anesthesia time stomach, and the extremity of the endoscope pulled outside all together through the
should be pointing toward the left side of esophagus and the mouth. NOTE: Ensure
Preparation: Important the antrum. The light at the endoscope tip that the proximal end of the wire is kept
Checkpoints should be visible through the skin. outside (e.g., clamp it with a mosquito
• Preparation of the animal: the left side of the • The stomach is then inflated with air until hemostat) to avoid the whole length of the
abdomen is shaved and aseptically scrubbed. the skin becomes tense. wire being pulled through.

www.ExpertConsult.com