G-tube, E-tube, or neither? (Proceedings) - Veterinary Healthcare
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G-tube, E-tube, or neither? (Proceedings)


CVC IN SAN DIEGO PROCEEDINGS


Objectives

  • Describe the most commonly-used enteral feeding tubes
  • Discuss scenarios in which enteral feeding is indicated and/or essential
  • Briefly outline the basic methods for placing nasogastric/nasoesophageal tubes (NG/NE-tubes), esophagostomy tubes (E-tubes), Percutaneous endoscopic gastrostomy tubes (PEG-tubes) and endoscopically-placed jejunostomy tubes (PEG-J tubes)
  • Provide comparison of enteral feeding devices relative to cost, ease of placement, ease of use and complications

Key Points

  • The anorectic cat, regardless of the underlying cause, should be managed aggressively
  • Diseases or conditions in which enteral feeding should be considered include pancreatitis, cholangiohepatitis, hepatic lipidosis, oral disease (fractures, oral tumors, stomatitis), renal disease, critically ill patients, patients receiving chemotherapy
  • The method of enteral feeding should be determined by the specifics of the case, the patient's anesthetic risk, the length of time anticipated for nutritional support, the availability of specialized equipment/expertise and cost.

Background

The cardinal rule of feeding a malnourished or anorectic patient is "use the gut if at all possible." This is a tricky proposition in cats who seem more prone to anorexia than dogs as a result of stress (at home or in hospital), finicky eating behaviors and dietary preferences, and the important role of odor and texture in feline appetite. When these factors are added to an ill cat experiencing nausea, vomiting, diarrhea, malaise, pain or lethargy, it becomes a challenge to keep these patients at an appropriate plane of nutrition. Yet studies have shown that nutrition plays a key role in the full recovery of critically-ill patients. Enteral feeding techniques preserve the mucosal barrier, prevent villus atrophy, help maintain the immunologic function of the GI tract, and can allow owners to treat their pets at home.

Types of feeding tubes

Nasoesophageal tubes (NE tubes)

Require no anesthesia except local lidocaine or proparacaine. These tubes are most appropriate for short-term nutrition in cases where animals are simply anorexic, but not vomiting. The size of the tube limits the type of diet to liquid forms. Radiographs of the chest will confirm that the tube has not been advanced through the lower esophageal sphincter (LES) as this can cause discomfort, esophageal reflux and/or vomiting in the cat, thereby increasing the risk of aspiration. Care must be taken to insure that the tube has not been threaded inadvertently into the trachea prior to administering the diet. A small amount of sterile saline can be injected into the tube and if a cough is elicited, it is safest to replace the tube. The lack of a cough does not completely rule out tracheal placement and therefore is another good reason for post-procedure radiographs. Despite being sutured in place, some cats manage to pull the tube or can vomiting the tube into the mouth where they can chew and swallow the pieces. While an E-collar can be used to prevent this, such measures can be additional stressors that decrease the likelihood the cat will begin to eat on its own.

Esophagostomy tubes (E-tube)

Require a short general anesthesia, but can be placed easily and without the need for special equipment or expertise. A larger bore tube, such as a 16 – 18 French red rubber feeding tube allows for the use of blended diets. As with the nasoesophageal tube, placement should not extend into the stomach past the LES. The red rubber tubes do not usually have a radiodense strip within them but can still be visualized on plain radiographs or with the infusion of contrast material. Vomiting patients are not ideal candidates for E-tubes because the same potential for aspiration exists as with the NE-tube. The owner can easily care for the tube at home and must be instructed to clean the stoma site daily. One retrospective study identified stomal infections/abscesses as the most common complication. Others included swelling of the head from tight bandaging and vomiting the tube into the oral cavity.


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Source: CVC IN SAN DIEGO PROCEEDINGS,
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