Care and Use of Feeding Tubes (E-Tube Care)

Feeding tubes are used to facilitate feeding of dogs and cats that refuse to eat on their own or that have a specific need for feeding directly into the esophagus, stomach, or intestine.

What kind of feeding tubes are used?

There are many different types of feeding tubes, all of which have an external (outside the body) feeding port connected to a tube that ends in the gastrointestinal tract. Esophagostomy tubes enter the esophagus and terminate in the lower portion of the esophagus, whereas gastrostomy tubes enter the left abdominal wall directly into the stomach. PEG tubes (percutaneous endoscopic gastrostomy) are gastrostomy tubes that have been placed using endoscopy. Low profile gastrostomy tubes are often used for long term feeding of dogs and cats, and are short gastrostomy tubes that have an external feeding port that fits flush with the skin. Feeding tubes are usually secured to the body with sutures, bandages, or elastic stockinette material. An Elizabethan collar (or E-collar) is usually placed around your pet’s neck to prevent it from removing the tube.

How to Feed?

1. Prepare and warm the food to room temperature before feeding
2. Unscrew or remove the cap at the end of the tube, place an empty syringe on the end, and open the clamp on the tube.
3. Aspirate (pull the plunger out a bit) the tube with an empty syringe to check for residual food left in the stomach from the previous feeding. Replace any of the food pulled out. If more than half of the last feeding is pulled out of the stomach, skip this feeding.
4. Give all medications before feeding, then feed the designated amount of food via the syringes. Each time you change syringes on the end of the tube, close off the clamp to make sure food does not leak out of the end of the tube. Give the food slowly over 10 to 15 minutes, so that your pet can adapt to their stomach filling up. If your pet begins to salivate or seems uncomfortable, feed more slowly. If the signs worsen, or there is some vomiting during the feeding, stop feeding.
5. Once all of the food or medications are administered, flush the tube with 5-10 mL water (depending on the size of the tube). This will help prevent the tube from clogging. Every time you administer anything through the tube other than water, you must flush the tube with a water rinse.
6. Close the tube clamp, screw or replace the plug back on to the feeding adapter, and place the tube back under the mesh netting.

GASTROSTOMY TUBE (Stomach Tube)

1. The feeding tube exits from the inside of your pet’s stomach to the outside body wall on the left side. There are several parts to the feeding tube. The long tube that extends out is the actual tube that the food will pass through.
2. At the body wall, there is a cross piece (or “stent”) that is the same color as the long feeding tube. This piece is there to help keep the tube in place and to prevent it from slipping in or out of the stomach. There is a dark pen line drawn around the outside of this small piece of tubing. It is important that you look and make sure you see this line every day. If the line disappears, this may mean that the feeding tube has slipped too far into the stomach and could be a problem. Please call the hospital immediately if this occurs.
3. Adjacent to the crosspiece of tubing, there is a cable tie wrapped around the tube. This cable tie helps make sure that the tube does not slip. These should be firmly attached. You should not be able to move them up and down. The tube should also be sutured to the skin about halfway up the tube, which helps stabilize the tube.
4. Above the white circles of plastic is a clamp. This should be closed (or clamped) off at all times unless you are in the process of feeding through the tube. This clamp helps keep the food from backing out or leaking out of the stomach.
5. There is a feeding adapter at the end of the tube held in place by another cable tie. The feeding syringe will attach to the end of the tube when you open the plugs that are attached to the adapter. These plugs can be removed just prior to feeding. The type of syringe used will determine which plug site will need to be opened.
6. Near the entrance of the tube through the left side there may be a gauze sponge that has an antibiotic ointment underneath it. This ointment will help keep the tube site from becoming infected. Your veterinarian may have you change this gauze sponge on a scheduled basis.
7. Most dogs and cats with a feeding tube have a white mesh netting around their body that keeps the tube in place. It is important the tube stays underneath this netting to keep it from getting caught in a floor heater, in a door, etc. which could possibly pull the tube out. You can remove the netting temporarily, as needed, to keep it clean. They can be hand washed and reused. You can also purchase replacement netting, or design your own holding material (a T-shirt, stockings, etc.).

ESOPHAGOSTOMY TUBE

1. 1. Your pet’s esophagostomy tube is a red rubber catheter that is placed in the esophagus and exits through the skin. To secure the tube, suture is placed around the tube in an “X” pattern and is sutured to the skin. The tube should not move in and out of the placement site. If the tube appears loose or is moving freely in and out of the skin, do not feed and notify your veterinary hospital.
2. At the top of the tube a feeding adapter is usually placed and secured with a white cable tie. The feeding adapter has two different sized ports with plugs attached to the ports. The larger port is usually used for feeding. The feeding syringe can be attached to the end of the feeding adapter after removing the plug. In some cases, a feeding adapter will not be included and you will be attaching the feeding syringe directly to the esophagostomy tube.
3. At the placement site (against the skin), there should be a gauze square with an antiseptic ointment placed around the esophagostomy tube. The ointment will help prevent the placement site from becoming infected. There will also be a gauze bandage applied around your pet’s neck. This keeps the placement site clean and stabilizes the tube. Your pet’s veterinarian may have you clean the placement site and change these bandages on a regular basis.

TUBE CARE

Change the gauze sponge at the entry site of the tube as instructed by your veterinarian. Each day, inspect the entry of the tube site in the skin for abnormalities such as tenderness, redness, discharge or foul odor. If any of these symptoms are noted, please contact your doctor as soon as possible. Clean the area underneath the tubing that is next to the body with some antiseptic scrub daily. Try to keep the entire tube as clean as possible and make sure that food and debris do not build up on the tube, especially around the area that is next to the skin and body wall.

CLOGGED FEEDING TUBES

Check to make sure the tube clamp is open. If you are feeding food through the tube, it may be too thick and have caused a clog in the tube. Try to flush the tube with water. If the feeding tube flushes well, check to see if the clog is actually at the tip of the syringe that you are currently feeding with. Try to aspirate back after trying to flush with water. This often unblocks the tube. If this doesn’t work try to massage the outside of the tube before or while you are flushing the tube. If you cannot unclog the tube with firm, but not excessive pressure, leave the tube filled with the water and close off the tube as you normally would do. Leave the water in place for 20 minutes. Again, try to flush the tube. If the tube is still clogged, instill a carbonated beverage into the tube (2-5 mls) and leave in place for 20 minutes and then attempt to flush again with water. If this does not unclog the tube, close off the tube again and call your pet’s veterinarian as soon as possible. If a clog is noted at night, do not attempt further feedings through the tube.

WHEN TO CALL THE HOSPITAL

1. The tube position has changed or the tube is no longer secure or falls out any time. Call immediately.
2. If the entry site into the stomach or esophagus is irritated, painful, or a discharge is present from the entry site.
3. The tube cracks, or its attachments (feeding port, external stent) become detached.
4. Your pet coughs or develops breathing problems. Call immediately.
5. Your pet vomits, develops fever, or becomes lethargic.
6. The tube clogs and you are unable to unclog it after following the directions above.

FEEDING INSTRUCTIONS

In a mixer, blend ____ (mL or cups) of ________________________ (type of food) with ____ (mL or cups) of water until the consistency is smooth. Food can be blended and stored in the refrigerator for up to 3 days. The food should be warmed to room temperature either by using a microwave or by warming it in boiling water. Feed __________mL of the food mixture slowly over 10 to 15 minutes

____________ times daily. After each feeding is complete, flush the tube with ________ mL of water. The tube must be flushed at least twice daily with as least 10 mL of water even if it is being used only once a day or not at all. This will help prevent the tube from clogging.