Gastric Intubation

Question 1

types of feeding tubes

Answer 1

nasoesophageal/nasogastric, esophagostomy, gastrostomy, orogastric (not used outside of neonates for nutrients)

Question 2

nasoesophageal/nasogastric uses

Answer 2

administer meds and contrast mediums, administer food and water, short term use (no longer than 2 weeks)

Question 3

nasoesophageal/nasogastric complications

Answer 3

administration of contents into respiratory tract, esophageal trauma, gastric irritation

Question 4

nasoesophageal/nasogastric pros

Answer 4

can be removed within hours of placement, well tolerated, patient can eat with tube in place

Question 5

nasoesophageal/nasogastric supplies

Answer 5

sedation for patient, gloves, 6-12 mL syringe, stethoscope, feeding tube, lubricant, proparicaine (anesthetize nostril you are putting feeding tube into and corresponding eye), 3-0 nylon suture, 1/2-1” porous tape, needle drivers

Question 6

nasoesophageal/nasogastric tube sizing

Answer 6

cat= 5 french x 91cm
dog 2-15kg= 5 french x 91cm
dog >15kg= 8 french x 91cm

Question 7

nasoesophageal/nasogastric placement

Answer 7

1. anesthetize nostril and corresponding eye
2. start at nasal planum then measure to NE: 7th-8th intercostal space (or point where elbow meets body after bringing elbow up against body), NG: last rib
3. advance tube and aim medial ventral

Question 8

what are the 4 ways to confirm the placement of a nasoesophageal or nasogastric tube?

Answer 8

1. apply suction to the tube (if you get gastric juices in syringe then you are in the right place)
2. inject a small bolus of air (listen for borborygmus)
3. inject a small bolus of sterile saline (if there’s a cough you are in the trachea)
4. radiographs (gold standard method) (end of NE tube should be above or right after heart, NG should be 1-2in into the stomach)

Question 9

securing nasoesophageal/nasogastric tube

Answer 9

1. simple surgeon’s knot to secure to lateral aspect of nose (alar fold)
2. chinese finger trap suture along tube to help prevent it from easily being pulled out
3. apply butterfly tape and simple surgeon’s knot to secure to face (dogs: lateral side of face, cats: dorsal on top of head because they don’t like things touching their whiskers)
4. always put on an e-collar!!

Question 10

esophagostomy tube uses

Answer 10

anorexic patients with disorders of the oral cavity or pharynx, functional GIT distal to esophagus

Question 11

esophagostomy tube pros

Answer 11

well tolerated, easy for clients to use and feed, can eat and drink with tube in place, can be removed anytime after placement

Question 12

placing an esophagostomy tube

Answer 12

anesthetize patient
DVM usually places between ramus of mandible and thoracic inlet

Question 13

esophagostomy tube feeding and care

Answer 13

check tube is clear
food administered should be close to body temperature
slowly deliver food and follow up with tepid water chaser (~ 6mL)
can administer liquid meds through tube if needed
clean stoma daily and change dressings as needed

Question 14

gastrostomy tubes

Answer 14

aka percutaneous endoscopic gastrostomy tubes or PEG tube
place on left side of body (literally the side of their body)
use for patients who need a tube in place for months

Question 15

why should a gastrostomy tube be placed on the left side?

Answer 15

that’s where the body of the stomach is and body of the stomach is the best place for the tube to be

Question 16

orogastric tube uses

Answer 16

lavage stomach, decompress GDV, toxin ingestion, administer barium

Question 17

orogastric tube complications

Answer 17

aspiration, esophageal trauma, gastric irritation, gastric perforation

Question 18

orogastric tube supplies

Answer 18

tubes: 12 french rubber urethral catheter for puppies/kittens, 18 french rubber urethral catheter for adults up to 40lbs, foal stomach tube for dogs >40lbs
also need speculum, 2” vetrap, marker for measurement, lubricating jelly, syringe with 5mL sterile saline, syringe or funnel for material to administer

Question 19

orogastric tube placement

Answer 19

measure oral opening to last rib