Managing PEG Tubes and Feeding Tubes

Feeding tubes allow continued feeding of an animal when it has amouth, jaw, throat, esophageal, stomach, liver, kidney, orpancreatic disorder that causes loss of appetite or preventsnormal eating swallowing, or digestion. There are severaldifferent types of feeding tubes, all of which have an externalfeeding port connected to a tube that ends in thegastrointestinal tract. Nasoesophageal, nasogastric, and nasojejunal tubes enter one ofthe nostrils, pass through the nose and throat, and end in theesophagus, stomach, or small intestine (jejunum), respectively.Pharyngostomy tubes enter the throat (pharynx) and esophagostomytubes enter the esophagus; both end in the esophagus.Gastrostomy tubes enter the left abdominal wall directly intothe stomach. "PEG" tubes (percutaneous endoscopic gastrostomytubes) are gastrostomy tubes that have been placed usingendoscopy. "Button" tubes are short gastrostomy tubes that haveonly an external feeding port at the entrance into the body walland no external feeding tube. Jejunostomy tubes enter theabdominal 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. AnElizabethan collar (or "E-collar") is sometimes placed aroundyour 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 yourveterinarian. Attach an empty syringe to the external feedingport. Release or open any external tube clamps (some gastrostomytubes have a clamp that should be closed between changingsyringes and between meals). Aspirate the tube with an emptysyringe to check for residual food or fluid left over from theprevious feeding. Return any of the aspirated food or fluid backinto the tube. If more than 20% of the volume of the previousfeeding is aspirated, skip this feeding.With nasal tubes, administer about 3 mL of water and watch forsigns of coughing or breathing problems; if either of theseoccurs, do not give any medication or any food. If liquidmedications are to be given at the time of meal feeding, attachthe medication syringe to the feeding port and administer allthe medications before feeding. Attach a food syringe to thefeeding port and administer the food slowly over 10 to 15minutes so that your cat can adapt to an enlarging stomach. Ifyour cat begins to drool or seems uncomfortable, feed moreslowly. (If these signs worsen or your pet vomits during thefeeding, stop feeding.) Flush the tube with 5 to 10 mL of water (at room or bodytemperature). This will help prevent tube clogging. Every timeyou finish administering medication or food through the tube,you must flush the tube with water. Close any tube clamps (ifpresent). Detach the empty water syringe and close the externalfeeding port.NASOESOPHAGEAL OR NASOGASTRIC TUBESWhen feeding, check the tube position and security on the faceand 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 markplaced on the tube by your veterinarian. Also check theinsertion site for redness, swelling, discharge, or pain. It isnormal for a thin rim of pink or red tissue to grow outward tothe skin of the insertion site. Clean the insertion site with anantiseptic solution recommended by your veterinarian, and cleandebris on the tube with a warm, moist cotton ball, gauze, orcloth. After cleaning, place antiseptic ointment and gauze overthe insertion site. You should report the development ofexcessive, foul-smelling material to the veterinarianimmediately to circumvent complications from the development ofpurulent cellulitisAll of these activities should be performeddaily.CLOGGED FEEDING TUBESCheck for kinks in the external tube and make sure the tubeclamp is open (if present). Massage the external tube to loosenany material in the tube. Flush and aspirate the tube withwater. If it flushes but food cannot be administered, check thetip of the feeding syringe; the syringe tip (versus the tube)may be obstructed. If water flushing does not relieve theobstruction, leave water in the tube, and attempt to flush againin 20 minutes. WHEN TO CALL THE HOSPITAL1. The tube position has changed or the tube is no longer secureor falls out any time. Call immediately.2. The insertion site or sutured skin is excessively irritated,swollen, painful, or infected. Call immediately3. The development of excessive, foul-smelling material. Callimmediately4. The tube cracks or rips, or its attachments (feeding port,external stent) become detached. Call immediately5. Your pet coughs or develops breathing problems. Callimmediately.6. Your cat vomits, develops a fever, or becomes more lethargic.Call immediately7. The tube clogs (even if you can clear it). Your veterinarianmay wish to change the feeding formulation.FEEDING INSTRUCTIONSIn a mixer, blend _______ (mL or cups) of ______________________(type of food) with _______ (mL or cups) of water until theconsistency is smooth. Food can be blended and stored in therefrigerator for up to 3 days. Feed _______ (mL) of the foodmixture slowly over 5 to 10 minutes, _______ times daily. Aftereach feeding, flush the tube with _______ mL of water.The above is general veterinary information. Do not beginany course of treatment without consulting your regularveterinarian. All animals should be examined at least once every12 months.