Managing PEG Tubes and Feeding Tubes
Theresa M. Ortega and Marcella F. Harb-HauserFeeding tubes allow continued feeding of an animal when it has a mouth, jaw, throat, esophageal, stomach, liver, kidney, or pancreatic disorder that causes loss of appetite or prevents normal eating swallowing, or digestion. There are several different types of feeding tubes, all of which have an external feeding port connected to a tube that ends in the gastrointestinal tract, Nasoesophageal, nasogastric, and nasojejunal tubes enter one of the nostrils, pass through the nose and throat, and end in the esophagus, stomach, or small intestine (jejunum), respectively. Pharyngostomy tubes enter the throat (pharynx) and esophagostomy tubes enter the esophagus; both end in the esophagus. Gastrostomy tubes enter the left abdominal wall directly into the stomach. "PEG" tubes (percutaneous endoscopic gastrostomy tubes) are gastrostomy tubes that have been placed using endoscopy. "Button" tubes are short gastrostomy tubes that have only an external feeding port at the entrance into the body wall and no external feeding tube. Jejunostomy tubes enter the abdominal wall and end in the small intestine (jejunum). Feeding tubes are secured to the body with sutures, bandages, tube stents, or elastic stockinette or fishnet material. An Elizabethan collar (or "E-collar") is sometimes placed around your pet's neck to prevent it from removing the tube.
HOW TO FEED (FOLLOW THIS ORDER)
Prepare and warm the food and medications as directed by your veterinarian. Attach an empty syringe to the external feeding port. Release or open any external tube clamps (some gastrostomy tubes have a clamp that should be closed between changing syringes and between meals). Aspirate the tube with an empty syringe to check for residual food or fluid left over from the previous feeding. Return any of the aspirated food or fluid back into the tube. If more than 20% of the volume of the previous feeding is aspirated, skip this feeding.
With nasal tubes, administer about 3 mL of water and watch for signs of coughing or breathing problems; if either of these occurs, do not give any medication or any food. If liquid medications are to be given at the time of meal feeding, attach the medication syringe to the feeding port and administer all the medications before feeding. Attach a food syringe to the feeding port and administer the food slowly over 10 to 15 minutes so that your cat can adapt to an enlarging stomach. If your cat begins to drool or seems uncomfortable, feed more slowly. (If these signs worsen or your pet vomits during the feeding, stop feeding.) Flush the tube with 5 to 10 mL of water (at room or body temperature). This will help prevent tube clogging. Every time you finish administering medication or food through the tube, you must flush the tube with water. Close any tube clamps (if present). Detach the empty water syringe and close the external feeding port.
NASOESOPHAGEAL OR NASOGASTRIC TUBES
When feeding, check the tube position and security on the face and nose. Also check for irritation of the face and nose (redness, swelling, hair loss, nasal discharge, or sneezing). Gently remove any debris from the nostril and tube using a warm, moist cotton ball, gauze, or cloth.
PHARYNGOSTOMY, GASTROSTOMY, AND JEJUNOSTOMY TUBESCheck the tube position daily by locating the external mark placed on the tube by your veterinarian. Also check the insertion site for redness, swelling, discharge, or pain. It is normal for a thin rim of pink or red tissue to grow outward to the skin of the insertion site. Clean the insertion site with an antiseptic solution recommended by your veterinarian, and clean debris on the tube with a warm, moist cotton ball, gauze, or cloth. After cleaning, place antiseptic ointment and gauze over the insertion site. You should report the development of excessive, foul-smelling material to the veterinarian immediately to circumvent complications from the development of purulent cellulitisAll of these activities should be performed daily.
CLOGGED FEEDING TUBES
Check for kinks in the external tube and make sure the tube clamp is open (if present). Massage the external tube to loosen any material in the tube. Flush and aspirate the tube with water. If it flushes but food cannot be administered, check the tip of the feeding syringe; the syringe tip (versus the tube) may be obstructed. If water flushing does not relieve the obstruction, leave water in the tube, and attempt to flush again in 20 minutes.
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. The insertion site or sutured skin is excessively irritated, swollen, painful, or infected.Call immediately 3. The development of excessive, foul-smelling material. Call immediately
4. The tube cracks or rips, or its attachments (feeding port , external stent) become detached.Call immediately
5. Your pet coughs or develops breathing problems. Call immediately.6. Your cat vomits, develops a fever, or becomes more lethargic. Call immediately
7. The tube clogs (even if you can clear it). Your veterinarian may wish to change the feeding formulation.
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