Jim A.

Taylor
DVM, Diplomate ACVS-SA

The 2015 Veterinary Forum

October 18th, 2015

www.VSCVets.com Facebook.com/AnimalSurgeons
Overview
1. Indications
2. Technique
3. Maintenance - handout
4. Feeding guidelines - handout
5. Potential complications
Indications:
1. Hyporexia / Anorexia
2. Metabolic disease
3. Structural oropharyngeal disease

Contraindications:
1. Persistent vomiting
2. Inflammatory & dysmotility disorders
3. Strictures or neoplasia
Advantages:
1. Minimal cost / equipment required
2. Ease of placement
3. Patient tolerance
4. Large bore tubes allow larger foodstuffs
5. Ease of feeding / maintenance
6. Patient able to eat / drink around the tube
7. Tube removal anytime after placement
8. No laryngeal / pharyngeal interference
Disadvantages:
1. Requires general anesthesia for placement
2. E-collar (initially)
3. Bandage
4. Clogging
5. Premature removal
6. Challenging in obese / large patients
 Required
Instrumentation
1. Surgical gloves
2. Curved Kelly, Needle holder, Mayo scissor
3. Feeding tube
1. Jorvet e-tube
2. Red rubber, X-mas tree, Male adapter, wire
4. 2-0 non-absorbable suture (Ethilon, Prolene)
5. Triple antibiotic ointment
6. Bandage
1. Jorvet Kitty Kollar / Kanine Kollar
2. 2 bandage material
 Feeding Tubes
Jorvet Red rubber
 Bandages
Jorvet - Kitty Kollar 2 bandage
 Technique
1. General anesthesia, endotracheal
intubation
2. Large bore tube selection (14-20 Fr)
3. Can be placed on either side
4. Lateral recumbency
5. Lateral cervical region clipped / prepped
 Technique
1. Cut the end of the tube to remove the
blind end portion and decrease the chance
of clogging
2. Transverse cut vs. 45 angle
3. Soft rounded edges
4. Pre-measure tube
1. Wing of atlas to 8th rib
2. Mark with Sharpie
Technique
 Technique
1. Place a closed curved Kelly forcep through
the oropharynx and upper esophagus with
the tip laterally oriented, dorsal to jugular
vein, caudal to hyoid.
 Technique
1. Tilt the forceps laterally thinning the skin over
the tip of the forcep and cut directly
through to the forcep with a #15 blade.
 Technique
1. Advance the forcep through the esophagus
and skin, grasp the tip of the e-tube and
withdraw through the oral cavity.
 Technique
1. Re-direct the tube back through the mouth
and upper esophagus, turning the corner
and advancing the tube caudally to the
level previously marked.
 Technique
1. Obtain a lateral cervical/thoracic
radiograph to confirm correct placement.
 Bandages
Jorvet - Kitty Kollar 2 bandage
 Feeding Guidelines
1. RER Resting Energy Requirement
2. Initial gastric capacity is 5-10 ml/kg.
3. Normal gastric capacity is 45-90 ml/kg.
4. Day 1 Feed ~ 25-30% RER
5. Gradual increases of 25-30% per day for 3-5
days. Reduces risk of refeeding syndrome.
1. Dramatic decreases in phosphate, magnesium,
potassium.
2. Potentially fatal pulmonary, cardiovascular,
neurologic & neuromuscular abnormalities.
 Bolus Feeding

1. Daily volume of food, added water, and water

used to flush the tube is divided into 4-6
feedings according to the expected stomach
capacity and volume being fed.
2. Flush the tube with 10-20 ml warm water prior to
and after each feeding.
 Potential Complications

1. Tube obstruction
2. Overly tight bandage head swelling
3. Peristomal dermatitis
4. Stomal infection/abscessation
5. Premature removal
6. Vomiting, patient bites tube, gastric foreign
body
 Potential Complications

Tube Obstruction
1. Usually by food/medications
2. Commonly in blind ended tubes reason for
cutting the end off, preferably @ 45 angle.
3. Flush warm water in/out with gentle
pressure/suction
4. Carbonated water or pancreatic enzyme slurry
can be used and allowed to sit for 1 hour
5. Guidewire for physical deobstruction
 Potential Complications

1. All stoma sites should be allowed to heal by second

intention
2. Immediate replacement through the original stoma
is possible and can be easily achieved if the stoma
has been present long enough to form scar tissue
3. Esophageal leakage can be observed through
esophageal tears if multiple attempts at
placement have been made
4. Peristomal dermatitis resolves with tube removal &
local wound care.
5. Hemorrhage during placement is possible if placed
too ventrally toward the jugular vein
 Potential Complications

1. Patients rarely vomit the tube allowing

protrusion through the oral cavity
2. Can be bitten off and remaining portion acting
as a gastric foreign body
3. Tube should be immediately removed +/-
replaced if observed
 Questions?

Thank You!
Vienna / Leesburg / Winchester / Woodbridge

Contact us at VSC@VSCVets.com

www.VSCVets.com Facebook.com/AnimalSurgeons