Ch 98 Feeding tubes Flashcards
Types of indwelling tubes
- nasoesophageal,
- pharyngostomy,
- esophagostomy,
- gastrostomy, and
- enterostomy.
Nasoesophageal intubation is the only procedure that does not require general anesthesia. Enteral nutrition is generally considered to be safer, easier, more physiologic, and less expensive than parenteral nutrition.
Nasoesophageal Tubes
Indications
- too debilitated to undergo anesthesia
- only short-term nutritional suppor
- gastric decompression
- tubes across the lower esophageal sphincter increase the risk for regurgitation and gastroesophageal and reflux esophagitis; however, a recent study did not identify this
Contraindications
- abnormal gag reflex,
- esophageal dysfunction, coma, or other condition that increases the risk for aspiration.
- vomiting
necessitates use of commercial liquid diets rather than blenderized pet foods
tube placement can be verified by injecting 5 to 10 mL of air through the tube and auscultating for borborygmus.
Complications
- epistaxis, dacryocystitis, rhinitis, sneezing, and premature tube removal.
- Aspiration pneumonia may occur if the end of the tube is displaced into the pharynx
local anesthetic on the nasal mucosa
Esophagostomy Tubes
Indications
- long-term feeding of anorectic animals
- disease or trauma of the oral cavity or pharynx
Contraindications
- esophageal disorders (esophageal stricture, megaesophagus, vascular ring anomalies, esophagitis, esophageal neoplasia)
- after esophageal surgery.
Unlike gastrostomy and enterostomy tubes, there is no concern for peritonitis
Large tubes allow the use of blenderized diets
can be removed at any time after placement.
Percutaneous Feeding Tube Applicator
complications
- stomal infection or abscessation,
- tube kinking,
- tube obstruction
- tube displacement caused by vomiting
- oesophageal perforation + leakage
- worng placement into trachea
desired location in the midthoracic or distal esophagus.
Gastrostomy Tubes
Indications
- anorexia or inability to eat.
- oral cavity, pharynx, and esophagus must be bypassed because of injury, disease, or obstruction
- after pharyngeal or esophageal surgery when the presence of a feeding tube could interfere with healing.
Contraindications
- primary gastric disease
- persistent vomiting
left in place for months and are well tolerated by most animals
surgically or by percutaneous method
mushroom-tipped (e.g., Malecot or Pezzer) catheters (14 to 28 Fr) are preferred over Foley catheters because the Foley balloon tip deteriorates with exposure to gastric contents over time
should not be removed until adhesions have formed > 7-10 days
removal
- cut the catheter at skin level, allowing the tip and flange to fall into the stomach and pass in the feces
- risk in small animals
- can be retreived endoscopically
- gastrocutaneous fistula seals within 24 hours, and the stoma usually heals rapidly by second intention
complications
- vomiting, diarrhea, regurgitation, gastroesophageal reflux (too much volume, too close to pylorus
- aspiration pneumonia
- failure of adhesion formation, resulting in leakage of stomach contents > peritonitis
- peristomal inflammation or infection
- tube obstruction
G -tube Surgical Placement
- stomach can be secured to the abdominal wall with sutures rather than relying on later adhesion formation.
- A full-thickness purse-string suture
- midline or paracostal approach
Percutaneous Endoscopic Gastrostomy Tube Placement
PEG
- does not allow sutured gastropexy to ensure an early and permanent seal between the stomach and abdominal wall
- simplicity, speed, and safety
- CI: ascites, obesity
- Gastric distention causes the stomach wall to contact the left abdominal wall
- endoscope light may be seen > stab incision
- catheter introduce suture from outside > stomach
- Pezzer or Malecot mushroom-tipped catheter (14 to 24 Fr) is preferred.
- tip modified to make flange > flared end of the mushroom-tipped catheter is cut off, 2-cm segment of remaining tube
- cannula and mushroom-tipped catheter are pulled through the mouth
- endoscope is reintroduced to verify proper positioning
- external flange is placed on the catheter to help maintain apposition
complications
- higher than for those with surgically placed
- excessive pressure from an external flange placed too tightly against the skin ( granulation tissue, cellulitis, infection, moist dermatitis, pressure necrosis, and gastric leakage)
- Inadvertent perforation of abdominal organs
- Subcutaneous emphysema
Nonendoscopic Percutaneous Tube Placement
- use some device that allows one end of suture material to be passed from the abdominal wall through the stomach and to exit through the mouth.
- end of the tube is positioned several centimeters caudal to the last rib
- ELD applicator
complications
- accurate tube placement may be more difficult
- through the visceral surface of the stomach and deep leaf of the omentum > risk trauma other organs
Low-Profile Gastrostomy Tubes
- may be used for long-term feeding
- device length is based on abdominal and gastric wall thickness
- used as a replacement for a surgically or percutaneously placed mushroom-tipped catheter (inserted through the gastrocutaneous fistula in an awake animal)
- can also be placed via percutaneous endoscopic gastrostomy or by surgical placement.
- antireflux valve and are capped between feedings
- increased patient comfort and fewer problems with dislodgmen
Enterostomy Tubes
Indications
- bypass disease of the stomach and proximal duodenum
- in any animals undergoing abdominal surgery
- associated with less risk for gastroesophageal reflux (coma, abscent gag)
Contraindications
- any intestinal obstructions distal to the enterostomy site
small catheter diameter necessitates feeding a liquid diet.
continuous infusion feeding rather than a bolus > remain hospitalized
- open surgery, laparoscopically assisted placement, or advancement through a gastrostomy tube
- duodenum or proximal jejunum
- advanced aborally 20 to 40 cm
- mattress or purse-string suture can be placed around the tube
- intestinal wall is sutured to the abdominal wall
- Needle-Assisted Technique for Tubes Without Catheter Adaptors
- left in place for a minimum of 7 days before removal
Gastroenterostomy Tube
- After the percutaneous endoscopic gastrostomy tube is in place, an enteral feeding tube is passed through the percutaneous endoscopic gastrostomy tube
- improved stomal healing, a reduced risk for peritonitis from premature dislodgment, and the ability to use a larger diameter tube
nasojejunal tube
- placed with endoscopic guidance or using fluoroscopy
- receive enteral nutrition for less than 1 week. After several days, nasojejunal tubes can cause rhinitis, esophagitis, esophageal reflux, and dacrocystitis
complications
- diarrhea, vomiting, and abdominal discomfort.
- leakage at the enterostomy site > peritonitis
Tube Feeding
- 50 to 100 mL of water per kilogram of body weight per day to maintain hydration
RER kcal/d= 70 x (BWkg) ^ 0.75
Outcomes, including death, in dogs with pneumothorax following nasogastric feeding tube misplacement
in the tracheobronchial tree: 13 cases (2017–2022)
Odunayo 2023
14 dogs out of 4,777 (0.3%) developed pneumothorax as an adverse effect
Nine out of 13 dogs developed evidence of respiratory compromise after the NG tube was placed. Eleven dogs required thoracocentesis
Five dogs suffered cardiopulmonary arrest
5 dogs died or were euthanized because of the pneumothorax.
Biomechanical comparison of two percutaneous gastropexy techniques for securing percutaneous endoscopic gastrostomy tubes in canine cadavers
Bishop 2019
T-fastener or U-stitch gastropexy may decrease the risk of early dislodgement of a PEG tube in dogs
PEG tube is placed, it acts as a temporary gastropexy to maintain the gastric serosa and parietal peritoneum in apposition until adhesions develop to form a permanent gastropexy.7 The gastropexy site is under tension owing to caudolateral retraction of the gastric wall during tube placemen
T/U percutaneous suture
Complication rates associated with nasoesophageal versus nasogastric feeding tube placement in dogs
and cats: a randomised controlled
trial
Camacho and Humm 2024
prospectively randomised
tube was misplaced into the respiratory tract in three (3.1%) cases. No technique for checking placement was completely concordant with radiography but the presence of negative pressure at the thoracic inlet during placement was consistent with the presence of the tube in the oesophagus in 86.2% cases, while capnography can be considered to confirm tracheal placement. The overall rate of complications during tube placement was 25.8%,
no significant difference in the new-onset regurgitation/vomiting rate, or complications while the tube was in situ between the nasoesophageal and nasogastric groups.
Oesophagostomy tube complications
in azotaemic dogs: 139 cases (2015 to
2019)
Tube-related complications were reported in 74 of 139 dogs (53%). Minor complications were
reported in 66 of 74 (89%) and major complications in eight of 74 (11%).
Retrospective study of complications
associated with surgically-placed
gastrostomy tubes in 43 dogs with
septic peritonitis
K. Elmenhorst 2020
Fifteen dogs had a Foley gastrostomy tube placed and 28 had a de Pezzer gastrostomy tube placed.
There were no major complications relating to the gastrostomy tube; minor complications
occurred in 11 (26%) patients.
Gastrostomy feeding tubes provide a safe way to provide enteral nutrition to dogs
with septic peritonitis; they are associated with a low complication rate in these patients.
