Surgery and Radiology Section

Naso gastric intubation in horses

NESO GASTRIC INTUBATION IN HORSES

• It is used to administer the  medication, fluids (or) nutrients directly into the stomach. Selection of tube of proper diameter is the first step in nasogastric intubation.
• Restraint is extremely important during nasogastric intubation.
• In a stall  both restraint and intubation should be done from the same side to decrease the possibility of injury to every one involved.
• Generally a lip twitch is sufficient to restrain, If this is inadequate, tranquilization may be indicated.

Steps

• The tube should be washed in a bucketful of clean warm water to make it pliable before intubation.
• A water soluble lubricant such as water (or) K-Y jelly should be applicable to facilitate  passage of the tube.
• The tube may be inserted into either right or left nostril.
• If standing on the left side of the horse, loop the tube over the left arm and place the palm of the right hand over the bridge of the horse's nose, with the thumb inserted into the nostrils.( left hand if standing on the right side making certain the fingers do not occlude the opposite nostrils)
• When holding the horse in this manner, the tube can be easily directed into the ventral meatus of the nasal cavity.
• In an average horse, the tube should proceed to about 12 inches caudal before it stops at the dorsal pharyngeal wall.When the tube stops at the pharynx, gentle movement to and fro should be made to stimulate the swallowing reflex.
• The respiration can be heard (or) felt through the nasogastric tube.
• When the tube enters in trachea horse may cough.
• Rotating (or) blowing into the tube may also cause the animal to swallow.
• When the horse swallows the tube should be the advanced 4-6 inches.
• Once the tube is in oesophagus, passage of the tube may be enhanced by gently blowing into the tube to dilate the muscular wall of the oesophagus as the tube is advanced.
• Passing of the tube into the oesophagus can be visualized over the left side of the neck near the jugular furrow.
• Gurgling sounds are heard in most of the horses and are often accompanied by a distinct gastric odour when the tube enters into the stomach.
• When the tube is in the stomach, the liquid medication may be administered with a stomach pump, close string (or) funnel.
• After medication, give 250-500 ml of water, then gently blow through the tube to force most of the liquids into the stomach.
• Before withdrawing the tube, cap/close the end with your thumb (or) kink the tube to prevent leaking one of remaining material in the tube.
• The head should be held very still/ without any movement as the tube is removed so as to prevent the end of the tube from striking the turbinates and causing haemorrhage.
• One complication that may result from nasogastric intubation, no matter how carefully performed, is epistaxis.
• The patient should be kept quite until haemorrhage caeses(usually within 10-20 minutes)