Chapter 98 Feeding Tubes

Question 1

Name 6 broad types of feeding tube.

Answer 1

• Orogastric tube
• NO/NG tube
• Pharyngostomy tube
• Oesophagostomy tube
• Gastrostomy
• Enterostomy

Question 2

Name 3 methods of checking appropriate NG tube placement

Answer 2

• Instill 5-10 ml air and listen for borborygmy
• Insill 3-5 ml sterile water and check for coughing
• Radiographs
• (Capnography)

Question 3

What 2 veins need to be avoided with pharyngostomy tube placement?

Answer 3

Linguofacial and maxillary.

Question 4

List 4 methods of o-tube placement

Answer 4

• Manual (unassisted) transoesophageal advancement
• Needle assisted percutaneous placement
• Tube assisted percutaneous placement
• Percutaneous feeding tube applicator (ELD applicator)

Question 5

Re o-tubes - what has been associated with reduced incidence of oesophageal injury and reflux oesophagitis ?

Answer 5

Mid-oesophageal placement

Question 6

What type of tube is contraindicated for G-tube and why?

Answer 6

Foley

gastric acid –> deterioration and deflation of baloon

Question 7

Name 3 methods of g tube placement

Answer 7

1. Surgically
2. PEG (percutaneous endoscopic)
3. Non-endoscopic percutaneous tube placement

Question 8

What additonoal step is recommended in PEG/non-endoscopic percutaneous tube placement?

Answer 8

Placement of internal +- external flange

Question 9

If low profile gastrostomy tube being used to repace G tube - what time delay is recommended to allow secure gastrocutaneous fistula formation

Answer 9

3-4 weeks

Question 10

What procedure is being shown here?

Answer 10

Tube-assisted percutaneous nonendoscopic gastrostomy.

Question 11

What procedure is being shown here?

Answer 11

Percutaneous nonendoscopic gastrostomy with an ELD device.

Question 12

List 3 methods of non-endoscopic percutaneous G tube placement

Answer 12

1. Semi-rigid orogastric tube
2. Metal tube with 45 degree angled, flared end
3. ELD applicator

Question 13

Comment re fit of low-profile gastrostomy tube vs pre-exisiting g tube

Answer 13

Low profile should be snug fit so sl larger (2-4 Fr) than pre-existing tube

Question 14

What additional procedural step resulted in more consistent placement of g tube through parietal gastric surface in non-endoscopically placed G tubes?

Answer 14

Insufflation of stomach before lateralization of stomach

Question 15

What is a benefit or enterostomt tube vs gastrostomy?

Answer 15

Lower risk of gastroesophageal reflux so good if aspiration pneumonia risk

Question 16

List 5 techniques for enterostomy tube placement

Answer 16

1. Standard surgical technique
2. Needle-assisted
3. Gastroenterostomy
4. Duodenostomy through limited approach
5. Nasojejunal (fluoro or endoscopically)

Question 17

List 3 purported advantages of gastroenterostomy tube vs enterostomy

What tube specific features may be have fewer problems with tube migration?

Answer 17

1. Improved stomal healing
2. Reduced risk of peritonitis from premature dislodgement
3. Ability to use larger tube
4. Allows gastric decompression

Tungsten weighted or inflatable bulb tips

Question 18

What factor has been associated with higher incidence of catheter kinking andintestinal perforation in enterostomy tubes?

Answer 18

Use of stiff polyvinyl catheters

Question 19

What is daily water requirement?

Answer 19

50-100 ml/kg/day

Question 20

What if formula for RER

Answer 20

70 x(BW)^0.75

Question 21

What is gastric capacity of most dogs/cats

Answer 21

22-30 ml/kg

Question 22

Briefly explain the pathophysiology of refeeding syndrome

What electrolye abnormalities charaterise refeeding syndrome?

What c/s

Answer 22

• 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