Chapter 98 Feeding Tubes Flashcards
Name 6 broad types of feeding tube.
- Orogastric tube
- NO/NG tube
- Pharyngostomy tube
- Oesophagostomy tube
- Gastrostomy
- Enterostomy
Name 3 methods of checking appropriate NG tube placement
- Instill 5-10 ml air and listen for borborygmy
- Insill 3-5 ml sterile water and check for coughing
- Radiographs
- (Capnography)
What 2 veins need to be avoided with pharyngostomy tube placement?
Linguofacial and maxillary.
List 4 methods of o-tube placement
- Manual (unassisted) transoesophageal advancement
- Needle assisted percutaneous placement
- Tube assisted percutaneous placement
- Percutaneous feeding tube applicator (ELD applicator)
Re o-tubes - what has been associated with reduced incidence of oesophageal injury and reflux oesophagitis ?
Mid-oesophageal placement
What type of tube is contraindicated for G-tube and why?
Foley
gastric acid –> deterioration and deflation of baloon
Name 3 methods of g tube placement
- Surgically
- PEG (percutaneous endoscopic)
- Non-endoscopic percutaneous tube placement
What additonoal step is recommended in PEG/non-endoscopic percutaneous tube placement?
Placement of internal +- external flange
If low profile gastrostomy tube being used to repace G tube - what time delay is recommended to allow secure gastrocutaneous fistula formation
3-4 weeks
What procedure is being shown here?
Tube-assisted percutaneous nonendoscopic gastrostomy.
What procedure is being shown here?
Percutaneous nonendoscopic gastrostomy with an ELD device.
List 3 methods of non-endoscopic percutaneous G tube placement
- Semi-rigid orogastric tube
- Metal tube with 45 degree angled, flared end
- ELD applicator
Comment re fit of low-profile gastrostomy tube vs pre-exisiting g tube
Low profile should be snug fit so sl larger (2-4 Fr) than pre-existing tube
What additional procedural step resulted in more consistent placement of g tube through parietal gastric surface in non-endoscopically placed G tubes?
Insufflation of stomach before lateralization of stomach
What is a benefit or enterostomt tube vs gastrostomy?
Lower risk of gastroesophageal reflux so good if aspiration pneumonia risk
List 5 techniques for enterostomy tube placement
- Standard surgical technique
- Needle-assisted
- Gastroenterostomy
- Duodenostomy through limited approach
- Nasojejunal (fluoro or endoscopically)
List 3 purported advantages of gastroenterostomy tube vs enterostomy
What tube specific features may be have fewer problems with tube migration?
- Improved stomal healing
- Reduced risk of peritonitis from premature dislodgement
- Ability to use larger tube
- Allows gastric decompression
Tungsten weighted or inflatable bulb tips
What factor has been associated with higher incidence of catheter kinking andintestinal perforation in enterostomy tubes?
Use of stiff polyvinyl catheters
What is daily water requirement?
50-100 ml/kg/day
What if formula for RER
70 x(BW)0.75
What is gastric capacity of most dogs/cats
22-30 ml/kg
Briefly explain the pathophysiology of refeeding syndrome
What electrolye abnormalities charaterise refeeding syndrome?
What c/s
- Depletion of intracellular cations (even if plasma levels normal)
- When feeding resumes cations rapidlty shift into cells.
Characterised by hypokalaemia, low magnesium, low phosphate (an anion) (+ low calcium)
C/s: Weakness, fluid retention, ECG abnormalities, dyspnoea, vomiting, diarrhoea, ileus, renal dysfunction
