Feeding tubes

image of Feeding tubes
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Nutrition is a vital aspect of the medical management of many, if not all, patients with gastrointestinal (GI) disease and for all pets with critical illness or severe trauma. When any animal has an illness that results in significant weight loss, inability to eat or special feeding needs, nutritional support through alternative feeding methods is often critical to successful medical management. This chapter is an overview of the approach to proper utilization and placement of feeding tubes in dogs and cats, including both endoscopic and non-endoscopic methods for placement of feeding tubes. In addition, selection of appropriate foods, feeding frequency and feeding volume will be reviewed. In general, providing enteral nutrition for dogs and cats is approached similarly, but where there are differences, they will be discussed.

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27.1 Multiple sizes and types of feeding tube available for use in dogs and cats.
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27.4 Canine head (anatomical model) used to illustrate proper placement of a naso-oesophageal feeding tube in the ventral meatus.
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27.5 Patient in right lateral recumbency, with the neck prepared for placement of an oesophagostomy tube.
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27.6 (a) Introducer with needle and ‘peel-away’ catheters. (b) Patient undergoing insertion of van Noort oesphagostomy tube. (Courtesy of Ronald von Noort)
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27.7 Curved Carmalt forceps inserted into the oesophagus and used to make an incision at the site of the oesophagostomy tube placement. These forceps are also used to grasp the tube to pull it into the oesophagus during placement.
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27.8 Advancing the oesophagostomy tube down the oesophagus.
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27.9 Securing the oesophagostomy tube with a purse-string stay suture and a Chinese finger trap (overlapping) suture to prevent sliding.
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27.10 A Pezzer urological catheter used for gastrostomy tube feeding.
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27.11 Example of a commercially available gastrostomy tube kit.
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27.12 Patient in right lateral recumbency and prepared for placement of PEG tube.
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27.13 Using an over-the-needle catheter to enter the inflated stomach. Once the catheter is in the stomach and well visualized by the endoscopist, the needle is removed and the string to be used to pull the tube through is introduced.
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27.14 Visualization of the string passing through the catheter in the stomach wall, which is then grasped by grasping forceps passed through the endoscope. (Courtesy of James Simpson)
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27.15 Illustration showing the suture securely attached to the feeding tube, with the feeding tube attached to a pipette tip or other small plastic introducer, which allows the tube to be pulled through the hole in the stomach and body wall.
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27.16 Following the tube as it is pulled back down the oesophagus into the stomach and ready to be pulled through the wall. (Courtesy of Edward Hall)
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27.17 The tube is pulled carefully, but with steady pressure, through the incision in the wall. If too much resistance is encountered, the incision should be widened slightly but using caution not to make the hole too large.
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27.18 An external flange is often used to help maintain contact between the stomach and the body wall.
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27.19 An ELD device showing (a) the entire device and (b) the extended knife for puncturing the body wall and the hole in the end used to hold the suture in place as it is returned into the stomach.
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