A number of options exist for enteral feeding tubes. Factors to consider when choosing the most appropriate tube include the animal's nutritional status, its ability to tolerate anesthesia, the length of time the animal is expected to require nutritional support, the function of the animal's gastrointestinal tract (and using as much of the gastrointestinal tract as possible), available hospital facilities, the cost, and your comfort level with different techniques for tube placement. Detailed information on placing these feeding tubes is described elsewhere.1-3
Nasoesophageal and nasogastric tubes
Nasoesophageal (NE) and nasogastric (NG) tubes are typically 3.5- to 8-Fr feeding tubes (red rubber, silicone, or polyurethane). Light sedation may be required; however, applying a local topical anesthetic agent (e.g. ophthalmic proparacaine hydrochloride) to the nares is usually sufficient for tube placement in most animals.
Potential reasons to avoid placing an NE or NG tube include severe thrombocyctopenia, underlying coagulopathy (epistaxis may occur), or dyspnea since one nostril will be occluded. NE and NG tubes require a liquid diet and are best used for short-term (< five days) nutritional support.
Esophagostomy (E) tubes are typically > 14-Fr feeding tubes (red rubber, silicone, or polyurethane). Red rubber tubes are less expensive than tubes made of other material but do not last as long and may be less comfortable for the patient. However, anecdotally, tubes made of other material can be harder to place and may be more likely to displace if the animal vomits. For large dogs (> 55.1 lb [25 kg]), long E tubes are available commercially, or stallion urinary catheters can be used.
E tubes may be maintained for weeks to months if necessary and are good choices for long-term nutritional support. Liquid enteral diets, critical care diets, or canned food that has been liquefied by using a blender can be fed through an E tube. Choosing an appropriate diet will depend on the patient's underlying medical condition.
E tubes are contraindicated if esophageal disease is present (e.g. megaesophagus, stricture).
For large dogs, a gastropexy may be performed to reduce the tension placed on the tube. For animals that require extended nutritional support, a low-profile gastrostomy device may be placed to reduce the amount of external tubing present and, thus, the risk of inadvertent removal.
Potential contraindications for the placement of a G tube include underlying gastric disease, ascites, hypoalbuminemia, or risk for poor adhesion formation (e.g. animals receiving immunosuppressive medication). To prevent pressure necrosis of the skin, care should be taken not to place too much tension on the skin with the external flange of the G tubes.
Indications for jejunostomy (J) tubes include the need to bypass the stomach, pancreas, or proximal duodenum (e.g. severe pancreatitis). J tubes are typically 3.5- to 8-Fr feeding tubes (red rubber, silicone, or polyurethane) that require surgical placement in most cases. New techniques have been described for the endoscopic and fluoroscopic guidance of nasojejunal5,6 and gastrojejunostomy7 tubes; however, placing these tubes is more technically difficult, and further studies are warranted to investigate their clinical relevance. J tubes require a liquid enteral diet and are usually reserved for hospitalized patients since continuous-rate infusion should be used for feedings because of the lack of a reservoir function of the small intestine (vs. the stomach).
1. Holahan ML, Abood SK, McLoughlin MA, et al. Enteral nutrition. In: Dibartola SP, ed. Fluid, electrolyte, and acid-base disorders in small animal practice. 4th ed. St. Louis, Mo: Elsevier, 2012;623-646.
2. Larsen JA. Enteral nutrition and tube feeding. In: Fascetti AJ, Delaney SJ, eds. Applied veterinary clinical nutrition. West Sussex, United Kingdom: Wiley-Blackwell, 2012;329-352.
3. Marks SL. Nasoesophageal, esophagostomy, gastrostomy, and jejunal tube placement techniques. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine. 7th ed. St. Louis, Mo: Saunders, 2010;333-340.
4. Ireland LM, Hohenhaus AE, Broussard JD, et al. A comparison of owner management and complications in 67 cats with esophagostomy and percutaneous endoscopic gastrostomy feeding tubes. J Am Anim Hosp Assoc 2003;39:241-246.
5. Beal MW, Brown AJ. Clinical experience utilizing a novel fluoroscopic technique for wire-guided nasojejunal tube placement in the dog: 26 cases (2006–2010). J Vet Emerg Crit Care 2011;21:151-157.
6. Pápa K, Psáder R, Sterczer Á, et al. Endoscopically guided nasojejunal tube placement in dogs for short-term postduodenal feeding. J Vet Emerg Crit Care 2009;19:554-563.
7. Jergens AE, Morrison JA, Miles KG, et al. Percutaneous endoscopic gastrojejunostomy tube placement in healthy dogs and cats. J Vet Intern Med 2007;21:18-24.