Esophagostomy feeding tube placement in Cats (Felis) | Vetlexicon
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Esophagostomy feeding tube placement

ISSN 2398-2950

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Introduction

  • Placing an esophagostomy tube provides a route for feeding which avoids the oral cavity.
  • This is useful in animals with oral disease or those unable or unwilling to eat for other reasons.

Uses

  • Allows complete nutrition of debilitated animals or those who have sustained head/jaw trauma.

Advantages

  • Well-tolerated, easy to site, cheap.
  • Endoscopy not required for positioning.
  • Patient can drink/eat with tube in situ.
  • Fewer complications than with pharyngostomy tubes; unlike gastrostomy tubes Gastrostomy: percutaneous tube (endoscopic), early removal (accidental or deliberate) does not lead to problems.
  • Esophagostomy tubes can be left in situ for prolonged periods.

Disadvantages

Alternative techniques

Requirements

Materials required

Minimum equipment

  • Small curved hemostat.

Ideal equipment

  • Flexible silicone esophagostomy tube.
  • Pipe introducer.
  • Peelaway catheter with needle introducer.

Minimum consumables

  • Size 10F red rubber or PVC tube.
  • Scalpel blade.
  • Suture material to fix tube in place.

Preparation

Site preparation

  • Right lateral recumbency (esophagus is to left of midline, therefore easier to position tube on left side, though either side is possible).
  • Standard skin preparation of left lateral cervical area.

Restraint

Technique

Approach

Step 1 - Prepare tube

  • Measure tube from entry side to 7th-8th intercostal space and mark.
    Catheter tip should lie within the mid- to distal esophagus; avoid the lower esophageal sphincter or gastric positioning.

Core procedure

Step 1 - Site the tube

  • Curved hemostat Surgical instruments: hemostats - OShaughnessy  Surgical instruments: hemostats - Roberts inserted through mouth and into esophagus.
  • Angle tip laterally, tent skin and palpate tip externally in the neck region.
    Avoid the jugular vein.
  • Small scalpel incision in skin over hemostat tip.
  • Deliver hemostat tip through incision.
  • Grasp distal end of measured tube and retract through stoma and up into mouth.
  • Redirect the distal end down the esophagus.
  • Insert to pre-measured level to ensure correct tip placement.
    Ensure no buckling or twisting occurs in the mouth/pharynx.

Step 2 - Alternative technique

  • Place pipe introducer in mouth and advance into esophagus to a point midway down neck.
  • Push flange laterally to tent skin.
  • Insert peelaway sheath catheter through skin and esophageal wall over opening of introducer and advance up the pipe.
  • Check catheter is firmly seated in pipe introducer tube and remove catheter introducer needle.
  • Premeasure and mark esophagostomy tube from point of insertion to last rib.
  • Lubricate tube and insert towards mouth through catheter into pipe introducer tube up to mark.
  • Remove peelaway sheath by pulling on tabs.
  • Hold catheter and advance introducer rod into esophagus or stomach.
  • Withdraw rod.

Step 3 - Secure tube

  • Secure proximal end to skin using a Chinese finger trap (or similar) suture of 3/0 polypropylene (Prolene).
  • Apply swab with antibacterial ointment Therapeutics: antimicrobial drug over the tube site.
  • Bandage lightly only. Change this daily.
  • Exit the free end behind the head for convenience.
  • Cap the tube.

Exit

Step 1 - Remove the tube

  • Release suture and pull gently on the tube.
  • Allow the stoma to granulate; it is possible not to suture wound.

Aftercare

Immediate Aftercare

Wound Protection

  • In some cases an Elizabethan collar may need to be fitted to prevent interference with tube .

Potential complications

  • Few complications are reported with this technique:
    • Peristomal inflammation/abscess: conservative management.
    • Ensure securing bandage is not too tight.

Outcomes

Complications

  • Vomiting may displace tube into oral cavity.
  • Stricture/esophagitis have not been reported as problems.
    If the tube is advanced too far and placed through lower esophageal sphincter, reflux esophagitis could be seen.

Prognosis

  • Depends on reason for tube placement.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Yam P & Cave C (2003) Enteral nutrition: options and feeding protocols. In Pract 25 (3), 118-129 PubMed.
  • von Werthrern C J & Wess G (2001) A new technique for insertion of esophagostomy tubes in cats. JAAHA 37 (2), 140-4 PubMed.
  • Leving P B, Smallwood L J & Buback J L (1997) Esophagostomy tubes as a method of nutritional management in cats - a retrospective study. JAAHA 33 (5), 405-410 PubMed.