Small animal surgery tubes and drains (derm)

Question 1

What are two appetite stimulants (to help avoid needing tubes)

Answer 1

Capromorelin
Mitrazapine (more effective in cats than dogs)
Cyproheptadine

Question 2

How much of the GI tract should we try and use when placing a feeding tube

Answer 2

As much as possible

Question 3

How to know how much food to give via feeding tube

Answer 3

Calculate resting energy requirements [30xBW + 70]kcal/day
Then weight daily and add more if losing weight

Question 4

Which patients are most likely to not get enough food if just giving resting energy requirements

Answer 4

Those with wounds and daily dressing changes; high ernergy requiremetns + may be being starved for repeated sedation for dressing changes

Question 5

Which feeding tube is better tolerated in cats so mostly used in them

Answer 5

Naso-oesophageal tubes

Question 6

Advantages and disadvantages of NO tube

Answer 6

Don’t need a GA
Quick and simple

BUT easily displaced by patient, needs buster collar, can only be left in for <1 week, can’t be used to give medication

Question 7

How to place a NO tube

Answer 7

Place local anaesthethic in nostrils
Pre-measure tube to rip 9
Lube up tube and feed tube in ventromedially
Observe for swallowing once it reached pharynx then feed down to marker level

Question 8

How to verify correct placement of an NO tube

Answer 8

1) Put empty syringe and apply negative pressure
 Should get a little bit of ait (from in tube) THEN get vacuum as in oes
 If lots of air suggests in trachea instead or back out mouth

2) inject some water which should be well tolerated i.e don’t get lots of coughing

[3) can radiograph if not sure]

Question 9

Advantages/disadvantages of oesophagostomy tubes

Answer 9

Can use for long-term feeding including home care, simple to place, can use large tubes for blended food and medication, can remove early

BUT requires GA to place, not suitable for oesophageal disease, can get leakage into peri-oes tissues, can get stomal infection, may not be suitable if vomiting, hard in obese patients

Question 10

What kind of patients is it a good idea to place an O tube

Answer 10

Where GI tract healthy so not expecting vomiting
If not sure whether they will eat; can remove tube if they do eat

Question 11

How is an O tube placed

Answer 11

Under GA in sterile way
- Premeaasure tube from neck entry to 7th/8th rub
Involved non sterile assistent placing haemostats into mouth, pushing up to make tend; then you cut this, stretch skin over forceps and cut fown; puch forceps through and grab tube from outside neck

Pull in out through mouth, the turn it around and push down oesophagus

Question 12

How to check O tube is in and how to keep it in place

Answer 12

Use radiography
Suture using two finger trap sutures

Question 13

Advantages/disadvantages with gastrostomy tubes

Answer 13

Good for long term feeding, does not interfere with voluntary intake, can do home care, good in paralysing conditions, can empty stomach e.g in peritonitis

BUT requires GA< risk of peritonitis, cannot remove before 7-10 days due to risk of of content leaking out stomach wall and causing peritonitis before good adhesion formed

Question 14

Protocol before feeding an animal through a tube

Answer 14

Ensure animal awake and upright
Have food at room temp
Draw back on tube using empty syringe; do not proceed if getting more than 10 ml air back or any food
Slowly inject 5-10ml tap water, if any coughing or distress must stop immediately

THEN if okay give food over 10-20 mins
Inject 5ml water at end

Question 15

What is the only tube removal that canno be done conscious

Answer 15

G tube in cats

Question 16

What must we remember about positioning of drain

Answer 16

Drain exit must be separate from the sutured wound site to prevent wound dehiscence

Question 17

How do penrose drains work

Answer 17

Gravitational and capillary flow action
So CANNOT put on dorsum

Question 18

When do we remove penrose drains

Answer 18

When fluid production is significantly reduced i.e 3-5 days

Question 19

When are active suction drains used

Answer 19

large cancer surgery defects, infected wounds, where there is a seroma or one is anticipated

Question 20

What is different about positioning of active suction drains vs penrose

Answer 20

Can place active suction drains anywhere since don’t need to use gravity

Question 21

When do we remove active suction drain

Answer 21

once fluid production has reached <2-4ml/kg/day

Question 22

What must we remember about where fenestrations in active suction drains lie

Answer 22

All must be within surgical site otherwise air can be sucked in

Question 23

When can we start to use active suction drains once places

Answer 23

6-8 hours after; need to leave time for fibrin seal at wound site so that -ve pressure can be maintained

Question 24

Advantages of active suction drains vs penrose

Answer 24

• Closed system
• Works independently of gravity
• Volume of fluid can be recorded
• Less risk of ascending infection
• No skin scald risk
• Repeat cytology possible

But expensive