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4 Feeding Tubes
Eric Monnet
Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
Enteral feeding is an important component of the treatment of critically ill patients, and for the support of patients with anorexia related to chronic conditions. Different type of feeding tubes are available to the surgeons to support the patients according to their need and underlying conditions (Armstrong et al. 1990a; Abood and Buffington 1992; Marks 1998).
Each of those feeding tubes has its advantages and disadvantages. The choice of feeding tube is based on the underlying disease, the goal of the enteral nutrition, and the length of time the tube will be needed. Combination of tubes is also possible. It is not rare to combine a gastrostomy tube with a jejunostomy tube to support a patient in the short term and the long term. The jejunostomy tube will be used in the short term to support the patient in the recovery phase of the surgery, especially if the patient is vomiting, while the gastrostomy tube will be used in the long term to support the patient if still anorexic.
Enteral feeding is also very important to support the integrity of the gastrointestinal tract. The enterocytes are getting their nutrient directly from the metabolite present in the lumen of the gastrointestinal tract.
4.1 Nasoesophageal and Nasogastric Tubes
Nasogastric or nasoesophageal feeding tubes can be used in dogs and cats. Since the tubes are of a small diameter they can be advanced in the stomach without increasing the risk of gastric reflux and esophagitis (Crowe 1986; Armstrong et al. 1990a; Abood and Buffington 1991; Yu et al. 2013; Herring 2016).
4.1.1 Indications
Nasoesophageal and nasogastric tubes are mostly used for the short‐term support of a patient. It is an interesting tube for a patient that may not tolerate general anesthesia since it can be placed with only local anesthesia.
It can be used to feed a patient with a liquid diet since the tubes are of a small diameter. This tube is more efficient for small dogs and cats than for large‐breed dogs, since only liquid can be used.
It can also be used to keep the stomach decompressed or empty to prevent gastroesophageal reflux, regurgitation, and/or vomiting (Crowe 1986).
Nasoesophageal tubes are contraindicated if the patient has esophageal motility disorders. Nasogastric tubes are contraindicated for patients with esophageal strictures.
Feeding with these tubes should not be attempted if the patient is vomiting or lateral recumbent because it will increase the risk of aspiration pneumonia. However, a nasogastric tube can still be used to keep the stomach decompressed as mentioned above.
4.1.2 Materials and Equipment
Feeding tube of small diameter is required. Size 5 or 6 Fr is commonly used in dogs and cats. Polyurethane or silicone tubes are used. The tube needs to be long enough to reach the stomach. Weighted tubes can be used to facilitate their migration in the stomach (Figure 4.1). Because of the size of the tube only liquid diet can be used.
Local anesthetic mixed with a lubricant is needed to facilitate the placement of the tube. Usually 1 ml of 0.5% bupivacaine can be mixed with 1 ml of water‐soluble lubricant.
General anesthesia is not required to place a nasoesophageal or nasogastric tube. Heavy sedation might be required.
4.1.3 Surgical