Veterinary Clinical Medicine-I (General and Systemic)

GASTROSTOMY FEEDING TUBE 

• Gastrostomy feeding tubes may be placed surgically through a small laparotomy incision or at time of abdominal surgery, or non-surgically using an endoscope (percutaneous endoscopic gastrostomy tube) or non-endoscopically (blind placement using an ELD PGFTA, the gastrostomy introducer (Cooke Veterinary Products), or using a stomach tube).
• Advantages of a gastrostomy tube are that they can be used in animals with esophageal or higher disease, a large bore feeding tube (16 to 24 French) can be used so pet food gruels may be administered, they can be used for extended periods of time (months to years), and there is no mechanical inhibition of voluntary food consumption.
• A gastrostomy tube placement device can be prepared by purchasing a length of vinyl or stainless steel tubing from a hardware store. The length of the tubing is determined by measuring the distance from the nasal planum to the iliac crease and adding 15 cm. The outer diameter of the tube ranges from 1.2 cm (patients weighing <12kg) to 2.5 cm for dogs weighing >25kg. The distal tip of a stainless steel tube can be flared and deflected 45^o to the long axis of the tube to help displace the lateral body wall. The lubricated tube is passed through the mouth and into the stomach.
• The tube is advanced until the end of the tube displaces the stomach laterally. Positioning the animal with its head over the edge of the table and lowering the proximal end of the tube will facilitate identifying the tube tip through the body wall. A percutaneous needle is introduced into the lumen of the tube while the assistant firmly holds the distal tip of the tube between two fingers.
• A skin nick is made over the end of the tube and a 14G over-the-needle catheter is advanced into the lumen of the tube. Proper positioning of the catheter is confirmed by moving the hub from side to side and feeling the catheter tip strike the inside of the tube.
• A guide wire prepared from a banjo string or cerclage wire is threaded through the catheter, into the tube, and out of the mouth of the patient. The tube and catheter are removed and the wire is attached to a gastrostomy tube, which is secured. The tube is then pulled into the stomach and through the abdominal wall by placing tension on the wire at the abdominal wall exit site.
• Gastrostomy tubes can also be placed by using commercially available devices (the ELD PGFTA or the Cooke gastrostomy introducer). The ELD PGFTA is the only device that utilizes an internal trocar, whereas the Cooke gastrostomy introducer contains a wire that is threaded through an introduction needle. Dogs and cats tend to tolerate gastrostomy feeding tubes well.
• In addition, a low profile gastrostomy feeding tube device may be used for extended periods of time. Complications with use of gastrostomy feeding tubes include vomiting with risk of aspiration pneumonia (often associated with administering cold food or food too quickly), dislodgement of the tube which may result in peritonitis or cellulitis, peristomal infections, and difficulties in maintaining bandages on dogs and cats.
• Additionally, penetration of the spleen, stomach, or omentum may occur if the stomach is not insufflated with air prior to positioning the tube against the lateral abdominal wall. When managing a gastrostomy feeding tube, it is important for the ostomy site to be observed and cleaned daily. Contraindications to using the blind techniques include severe obesity, ascites, and esophageal disease.