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MILA Nasogastric Feeding Tube Placement

Nasoesophageal and nasal gastric feeding tubes are placed for feeding of liquid diets or decompression. Contraindications include severe thrombocytopenia and head trauma where elevated intracranial pressure is not desired. Several drops of local anesthetic either 2% lidocaine or topical proparacaine are inserted into the nostril. The animal is sedated if required. Placement of the first suture is absolutely key to the animal not being able to remove the catheter. A 20 gauge hypodermic needle is inserted at the edge of the alar groove between the furred and non furred areas. Monofilament suture material will be passed back through the needle to secure the tube. With a suture in this location, the animal is unlikely to be able to sneeze or physically manipulate the tube in order to remove it. Hypodermic needle is used instead of the suture needle as this is less traumatic. Nasoesophageal tubes are measured to the seventh and ninth intercostal space. Ideally this is counted, if not, an imaginary line can be drawn directly dorsally from the xiphoid process. Nasoesophageal tubes are used for decompression of patients with Mega esophagus or for feeding into the esophagus. Nasogastric tubes are measured from the nearest to the widest part of the last rib. This should always be done by drawing an imaginary line straight dorsally from the widest part of that last rib, in order to ensure that the tube is in sufficiently. This tube will be use for decompression and feeding. The planum of the nose is pushed dorsally and the tube is inserted at almost a 90 degree angle in a ventral medial direction into the ventral meatus. Once in the meatus the nose is relaxed and the tube is inserted to the pre measured level The inner stylet which provides some rigidity and allows easy placement is then removed A single overhand throw is placed against the skin. This can be pre placed if desired. Once this overhand throw has been made the sutures then passed around the tube and secured in place. This sandwich of tube in between two layers of suture will increase the friction and again prevent loosening of the tube from the nostril. As this suture is tightened the tube will insert along the alar groove which again improves security. Suture ends are tied long enough to allow easy removal at the time that the tube is no longer needed. The hypodermic needle is then passed through the skin along the bridge of the nose and an additional sutures placed to secure the tube. This suture is not tied in an overhand loop, but is merely passed around the tube. These subsequent sutures that will be placed our purity designed to make sure that the tube does not fall in front of the animal’s face. A final suture is also passed over the dorsum of the skull again to keep the two from falling in front of the animal’s face. Hypodermic needles again are used in all situations, as they are much less uncomfortable for the animal than using the swaged end needles. Suture ends should be cut long enough to facilitate easy removal. If desired the tube can be sutured along the side of the face, instead of in between the eyes. This is not tolerated well in the cats because of their whiskers These videos are to be used as guides only and not intended to replace clinic protocol.

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