{"id":35883,"date":"2025-06-20T18:17:21","date_gmt":"2025-06-20T18:17:21","guid":{"rendered":"https:\/\/todaysveterinarypractice.com\/?p=35883"},"modified":"2025-06-20T18:17:21","modified_gmt":"2025-06-20T18:17:21","slug":"minimizing-small-animal-esophageal-feeding-tube-complications","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/minimizing-small-animal-esophageal-feeding-tube-complications\/","title":{"rendered":"Minimizing Small Animal Esophageal Feeding Tube Complications"},"content":{"rendered":"<p><div class=\"su-spacer\" style=\"height:10px\"><\/div><div class=\"su-note\"  style=\"border-color:#d8d8d8;border-radius:3px;-moz-border-radius:3px;-webkit-border-radius:3px;\"><div class=\"su-note-inner su-u-clearfix su-u-trim\" style=\"background-color:#f2f2f2;border-color:#ffffff;color:#333333;border-radius:3px;-moz-border-radius:3px;-webkit-border-radius:3px;\"><strong>Abstract<\/strong><\/p>\n<p class=\"p1\">Challenges associated with assisted feeding are common and can be associated with the esophageal tube (e.g., tube obstruction, tube dislodgement, high-viscosity slurries) or patient complications (e.g., stoma infection, underfeeding). Many complications can be prevented by using a few straightforward techniques.<\/p>\n<p class=\"p1\"><strong>Take-Home Points<\/strong><\/p>\n<ul>\n<li class=\"p1\">Preventing tube obstructions is key.<\/li>\n<li class=\"p1\">Proper daily stoma care is critical for preventing complications.<\/li>\n<li class=\"p1\">For tube dislodgement, timely intervention is critical.<\/li>\n<\/ul>\n<p><\/div><\/div><\/p>\n<p class=\"p1\"><span class=\"s1\">Esophageal feeding tubes (e-tubes) are assisted-feeding devices that enable targeted delivery of nutrients, calories, medications, and fluids. Challenges associated with e-tubes faced by the veterinary team include ensuring proper placement, preventing dislodgement, providing stoma care, troubleshooting clogged tubes, and achieving an ideal diet slurry for ease of administration. Although complications can occur, the authors recommend the following protocols to help minimize issues and improve assisted-feeding outcomes.<\/span><\/p>\n<h2 class=\"p2\"><span class=\"s1\">Esophageal Feeding Tube <\/span>Placement<\/h2>\n<p class=\"p1\"><span class=\"s1\">E-tubes can be easily placed in patients of varying sizes through a relatively straightforward surgical procedure that typically results in minimal postoperative pain and brief hospitalization. Supplies suggested for e-tube placement are listed in <\/span><span class=\"s2\"><b>BOX 1 <\/b><\/span><span class=\"s1\">and helpful tips for tube placement in medium to large dogs in <\/span><span class=\"s2\"><b>BOX 2<\/b><\/span><span class=\"s1\">.<\/span><\/p>\n<p><div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:3px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:1px;border-top-right-radius:1px\">BOX 1 Supplies Needed for Esophageal Feeding Tube (E-Tube) Placement and Slurry Preparation\/Administration<\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:1px;border-bottom-right-radius:1px\"><strong>E-tube placement<\/strong><\/p>\n<ul>\n<li>E-tube (Note: Mila brand comes with an anchoring device [suture wing])\n<ul>\n<li>14 Fr for patients weighing &lt;\u20092 kg (4.4 lb)<\/li>\n<li>18 Fr or larger for patients weighing &gt;\u20092 kg (4.4 lb)<\/li>\n<\/ul>\n<\/li>\n<li>Mouth gag (Smart Gag Set; Bella Veterinary Medical Solutions, <a href=\"http:\/\/bellavms.com\" target=\"_blank\" rel=\"noopener\">bellavms.com<\/a>)<\/li>\n<li>Tunneling device (ETUN14, ETUN18, or BE18MI; Mila, <a href=\"http:\/\/milainternational.com\" target=\"_blank\" rel=\"noopener\">milainternational.com<\/a>)<\/li>\n<li>#11 scalpel blade<\/li>\n<li>Surgical instruments (needle driver, suture scissors, +\/- thumb forceps)<\/li>\n<li>0 Prolene suture (Ethicon, <a href=\"http:\/\/ethicon.com\" target=\"_blank\" rel=\"noopener\">ethicon.com<\/a>; very robust to withstand sharp toenails)<\/li>\n<li>+\/- Sandbag to bend the neck (for medium or large dogs)<\/li>\n<li>Tissue glue<\/li>\n<li>Permanent marker<\/li>\n<li>Collar\/neckband designed for e-tube protection<\/li>\n<\/ul>\n<p><strong>Slurry preparation and administration<\/strong><\/p>\n<ul>\n<li>Silicone o-ring catheter syringes (Miracle Oring Syringe, <a href=\"http:\/\/miraclenipple.com\" target=\"_blank\" rel=\"noopener\">miraclenipple.com<\/a>)<\/li>\n<li>Pitcher-style blender<\/li>\n<li>Gram scale (if feeding dry food slurry)<\/div><\/div><\/li>\n<\/ul>\n<div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:3px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:1px;border-top-right-radius:1px\">BOX 2 Helpful Tips for Esophageal Feeding Tube Placement in Medium to Large Dogs<\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:1px;border-bottom-right-radius:1px\">\n<ul>\n<li>Before beginning the procedure, confirm placement of the mouth gag as the assistant may need to reach into the oral cavity to stabilize the tunneler during placement.<\/li>\n<li>Position a long sandbag or a rolled towel beneath the neck to elevate the esophagus closer to the skin, facilitating palpation and incision over the tunneling device.<\/li>\n<li>Use a tunneler designed for balloon dilation for esophageal strictures <strong>(BOX 1)<\/strong> to aid with palpation and incision as the tip is larger and the device is easier to stabilize during the incision process.<\/div><\/div><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">With proper stoma hygiene and regular care, e-tubes can remain in place indefinitely when medically indicated. In addition, removal is typically uncomplicated; after the sutures are cut, the tube can be removed. The stoma heals very quickly, usually within 1 to 2 days. Although e-tube placement requires that the patient be under general anesthesia, the procedure takes relatively little time, which helps minimize risks associated with general anesthesia. However, standard anesthetic precautions and monitoring remain essential. At the time of initial tube placement, do not empirically prescribe perioperative antibiotics.<\/span><\/p>\n<h3 class=\"p3\"><span class=\"s3\"><b>Step 1.<\/b><\/span> Placing the E-Tube<\/h3>\n<ol>\n<li class=\"p4\">Position the anesthetized and intubated patient in right lateral recumbency.<\/li>\n<li class=\"p4\">Clip a wide area and aseptically prepare the skin.<\/li>\n<li class=\"p4\">Insert the tube and tunneling device (<span class=\"s4\"><b>VIDEO 1<\/b><\/span>).\n<ol>\n<li class=\"p5\">Connect the proximal end of the tube to the tunneling device. Ensure that the mouth gag remains in place during oral cavity passage (to prevent overextension of the mandibular joint).<\/li>\n<li class=\"p5\">Pass the distal tube end and tunneling device orally until the tube meets resistance at the lower esophageal sphincter.<\/li>\n<li class=\"p6\">Use a laryngoscope to confirm proper esophageal placement.<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<div class=\"su-youtube su-u-responsive-media-yes\"><iframe width=\"600\" height=\"400\" src=\"https:\/\/www.youtube.com\/embed\/lOvZZ5eA3hs?\" frameborder=\"0\" allowfullscreen allow=\"autoplay; encrypted-media; picture-in-picture\" title=\"Esophageal Feeding Tube Placement in a Cat\"><\/iframe><\/div>\n<h3 class=\"p3\"><span class=\"s3\"><b>Step 2.<\/b><\/span> Tunneling<\/h3>\n<ol>\n<li class=\"p4\">Elevate the esophagostomy tunneler tip until it tents the skin approximately two-thirds of the distance from the ear to the shoulder (<span class=\"s4\"><b>FIGURE 1<\/b><\/span>).\n<p><div id=\"attachment_35889\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig1.png\"><img fetchpriority=\"high\" decoding=\"async\" aria-describedby=\"caption-attachment-35889\" class=\" wp-image-35889\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig1.png\" alt=\"\" width=\"350\" height=\"398\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig1.png 792w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig1-264x300.png 264w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig1-768x874.png 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-35889\" class=\"wp-caption-text\">FIGURE 1. The esophagostomy tunneler placed orally and tenting the skin.<\/p><\/div><\/li>\n<li class=\"p4\">Position the tunneler dorsal to the jugular vein to help clear the pharynx and upper esophageal sphincter.<\/li>\n<li class=\"p4\">Dissect over the tunneler tip with a #11 scalpel blade until it emerges through the skin.<\/li>\n<li class=\"p7\">Pull the tunneler completely through with the attached tube until the tube angle shifts toward the ear (<span class=\"s4\"><b>FIGURE 2<\/b><\/span>). Ensure the e-tube does not wrap around the endotracheal tube while pulling.\n<p><div id=\"attachment_35890\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig2.png\"><img decoding=\"async\" aria-describedby=\"caption-attachment-35890\" class=\" wp-image-35890\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig2.png\" alt=\"\" width=\"350\" height=\"354\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig2.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig2-297x300.png 297w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig2-768x777.png 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-35890\" class=\"wp-caption-text\">FIGURE 2. The esophageal feeding tube pulled through the stoma.<\/p><\/div><\/li>\n<\/ol>\n<h3 class=\"p3\"><span class=\"s3\"><b>Step 3.<\/b><\/span> Confirming E-Tube Position<\/h3>\n<ol>\n<li class=\"p4\">Verify e-tube position in the esophagus and not in the airway through either of the following options.\n<ol>\n<li class=\"p5\">Radiographic confirmation that the distal tube tip is within the esophagus at the 7th to 9th intercostal space (<span class=\"s4\"><b>FIGURE 3<\/b><\/span>).\n<p><div id=\"attachment_35891\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig3.png\"><img decoding=\"async\" aria-describedby=\"caption-attachment-35891\" class=\" wp-image-35891\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig3.png\" alt=\"\" width=\"350\" height=\"192\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig3.png 1080w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig3-300x165.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig3-1024x562.png 1024w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig3-768x422.png 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-35891\" class=\"wp-caption-text\">FIGURE 3. Radiographic confirmation of appropriate placement of the esophageal feeding tube in the esophagus extending to the 7th\u20139th intercostal spaces.<\/p><\/div><\/li>\n<li class=\"p6\">Endoscopic visualization of the distal tube tip where the heartbeat is visible (just below the heart base) (<span class=\"s4\"><b>FIGURE 4<\/b><\/span>).\n<p><div id=\"attachment_35892\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig4.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-35892\" class=\" wp-image-35892\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig4.png\" alt=\"\" width=\"350\" height=\"349\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig4.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig4-300x300.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig4-150x150.png 150w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig4-768x764.png 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-35892\" class=\"wp-caption-text\">FIGURE 4. Confirmation of appropriate esophageal feeding tube placement via endoscopic visualization. The distal end of the tube is placed at the level of the heartbeat.<\/p><\/div><\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<h3 class=\"p3\"><span class=\"s3\"><b>Step 4.<\/b><\/span> Securing the E-Tube<\/h3>\n<ol>\n<li class=\"p4\">Mark the tube at skin level with a permanent marker.<\/li>\n<li class=\"p4\">Position suture wings 1 to 2 centimeters from the mark.<\/li>\n<li class=\"p4\">Anchor the wings to the tube with 0 Prolene suture (Ethicon, <a href=\"http:\/\/ethicon.com\" target=\"_blank\" rel=\"noopener\"><span class=\"s2\">ethicon.com<\/span><\/a>).<\/li>\n<li class=\"p4\">Suture the wings to the skin.<\/li>\n<li class=\"p4\">Apply tissue glue to the seam of the tube.<\/li>\n<li class=\"p7\">Create a stacked finger trap pattern with glue above the suture wing to prevent the tube from sliding (<span class=\"s4\"><b>FIGURE 5<\/b><\/span>).\n<p><div id=\"attachment_35893\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig5.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-35893\" class=\" wp-image-35893\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig5.png\" alt=\"\" width=\"350\" height=\"427\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig5.png 720w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig5-246x300.png 246w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-35893\" class=\"wp-caption-text\">FIGURE 5. The esophageal feeding tube is secured to the anchoring device and the device is secured to the skin as described in the text. The stacked finger trap above the anchoring device prevents the tube from slipping through the anchoring device.<\/p><\/div><\/li>\n<\/ol>\n<h3 class=\"p3\"><span class=\"s3\"><b>Step 5.<\/b><\/span> Completing the Process<\/h3>\n<ol>\n<li class=\"p4\">Trim the e-tube to the appropriate length to accommodate the anchoring device.<\/li>\n<li class=\"p4\">Attach a neck band or appropriately sized Kitty Kollar (<a href=\"http:\/\/kittykollar.com\" target=\"_blank\" rel=\"noopener\"><span class=\"s2\">kittykollar.com<\/span><\/a>) to prevent inadvertent dislodgement.<\/li>\n<li class=\"p4\">Place the administration cap on the e-tube.<\/li>\n<li class=\"p7\">Secure the final positioning with a collar or neck band (<span class=\"s4\"><b>FIGURE 6<\/b><\/span>).\n<p><div id=\"attachment_35894\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig6.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-35894\" class=\" wp-image-35894\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig6.png\" alt=\"\" width=\"350\" height=\"380\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig6.png 792w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig6-277x300.png 277w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig6-768x833.png 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-35894\" class=\"wp-caption-text\">FIGURE 6. The esophageal feeding tube (e-tube) should be cut to the length that allows it to be secured under the e-tube protection device. A wrap or appropriately sized Kitty Kollar (<a href=\"http:\/\/kittykollar.com\" target=\"_blank\" rel=\"noopener\">kittykollar.com<\/a>) can be placed around the patient\u2019s neck and used to further protect the tube.<\/p><\/div><\/li>\n<\/ol>\n<h2 class=\"p2\"><span class=\"s1\">Esophageal Feeding Tube <\/span>Maintenance<\/h2>\n<p class=\"p1\"><span class=\"s1\">For preventing complications at the e-tube site, proper daily care is critical (<\/span><span class=\"s2\"><b>BOX 3<\/b><\/span><span class=\"s1\">). The stoma must be protected from abscess formation (e.g., resulting from food accumulation or an improperly secured e-tube). Immediate cleaning of any contamination is recommended. A 5-minute application of dilute bleach provides antiseptic and anti-inflammatory benefits.<sup>1<\/sup> The dilute bleach solution is prepared by mixing \u00bc\u00a0teaspoon bleach with \u00bd cup tap or bottled water to make a 0.008% solution. Gauze or a cotton pad is dampened with the solution and applied to the stoma site for 5 minutes twice daily to minimize the risk for infection and control inflammation. Bleach degrades rapidly because of 5 factors: 1) dilution of hypochlorite concentration, 2) high solution temperature, 3) acidic solution pH, 4) concentration of impurities that catalyze decomposition, and 5) light exposure.<sup>2<\/sup> Therefore, the solution should be prepared immediately before application to ensure its effectiveness. In the authors\u2019 experience, this protocol has resulted in markedly decreased infections at their institutions. For at-home care, clients can be advised to wear gloves and apply the solution to the pet in a well-ventilated area.<\/span><\/p>\n<p><div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:3px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:1px;border-top-right-radius:1px\">BOX 3 Supplies Needed to Remedy Esophageal Feeding Tube (E-Tube) Complications<\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:1px;border-bottom-right-radius:1px\"><strong>E-tube replacement<\/strong><\/p>\n<ul>\n<li>Stiff guidewires (0.025-in or 0.035-in) and either of the following catheter options:\n<ul>\n<li>5-Fr, 8-Fr, 10-Fr or 12-Fr red rubber<\/li>\n<li>5-Fr or 8-Fr ureteral<\/li>\n<\/ul>\n<\/li>\n<li>Dilator options include:\n<ul>\n<li>Savary-Gilliard. The 5-mm device will dilate to 15 Fr, the 7-mm up to 21 Fr.<\/li>\n<li>8-Fr, 12-Fr, or 16-Fr vascular access<\/li>\n<li>Heyman follower (sets of 10\u201324 Fr)<\/li>\n<\/ul>\n<\/li>\n<li>Lidocaine gel<\/li>\n<li>Replacement e-tube<\/li>\n<li>Surgical instruments (needle driver, suture scissors, +\/- thumb forceps)<\/li>\n<li>0 Prolene suture (Ethicon, <a href=\"http:\/\/ethicon.com\" target=\"_blank\" rel=\"noopener\">ethicon.com<\/a>)<\/li>\n<\/ul>\n<p><strong>Stoma care and infection control<\/strong><\/p>\n<ul>\n<li>Bleach<\/li>\n<li>Water<\/li>\n<li>Betadine<\/li>\n<li>Sterile 2\u2009\u00d7\u20092 gauze pads<\/li>\n<li>6-mL syringe<\/li>\n<li>Tomcat catheter<\/li>\n<li>Medical-grade honey or Manuka honey dressings<\/li>\n<\/ul>\n<p><strong>Tube declogging<\/strong><\/p>\n<ul>\n<li>60-mL syringe<\/li>\n<li>Water<\/li>\n<li>Optional declogging solution (e.g., Clog Zapper non\u2013enteric-coated pancreatic enzymes; Avanos, <a href=\"http:\/\/avanos.com\" target=\"_blank\" rel=\"noopener\">avanos.com<\/a>)<\/li>\n<li>Cleaning brushes (e.g., 5-mm straw cleaning brush, endoscope cleaning brush, feeding tube cleaning brush) <\/div><\/div><\/li>\n<\/ul>\n<h2 class=\"p2\"><span class=\"s1\">Esophageal Feeding Tube <\/span>Complications<\/h2>\n<h3 class=\"p3\">Accidentally Removed E-Tube<\/h3>\n<p class=\"p1\"><span class=\"s1\">When the e-tube is inadvertently removed, time is critical because the stoma mucosa begins contracting immediately. First, attempt to insert the largest comfortable-fitting temporary tube, such as a red rubber catheter or an open-ended ureteral catheter (<\/span><span class=\"s2\"><b>BOX 3<\/b><\/span><span class=\"s1\">). The temporary tube should pass through the stoma into the esophagus without excess force or resistance. If nothing passes easily, try inserting an appropriately sized guidewire (sized to fit the dilators) (<\/span><span class=\"s2\"><b>FIGURE 7<\/b><\/span><span class=\"s1\">). Confirm proper placement with radiographic imaging to ensure that the guidewire follows the path of the esophagus and terminates in the stomach. Use serially sized dilators to slowly stretch the stoma. Lubricate the stoma and dilators with lidocaine gel for pain control; dilation is usually tolerated well by the patient with just topical analgesia.<\/span><\/p>\n<div id=\"attachment_35895\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig7.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-35895\" class=\" wp-image-35895\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig7.png\" alt=\"\" width=\"350\" height=\"351\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig7.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig7-300x300.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig7-150x150.png 150w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2025\/06\/Tolbert_EsophagealFeedingTubes_TVPJulAug25_Fig7-768x771.png 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-35895\" class=\"wp-caption-text\">FIGURE 7. Placement of a guidewire into the stoma before dilation and esophageal feeding tube (e-tube) replacement in a dog after inadvertent e-tube removal.<\/p><\/div>\n<p class=\"p1\"><span class=\"s1\">After the stoma is dilated to the feeding tube size, lubricate the e-tube and slide it over the guidewire. Remove the guidewire and check e-tube placement with a radiograph (7th to 9th intercostal space) and anchor it with suture. For Mila feeding tubes (<\/span><a href=\"http:\/\/milainternational.com\" target=\"_blank\" rel=\"noopener\"><span class=\"s2\">milainternational.com<\/span><\/a><span class=\"s1\">), the 15-cm mark on the tube generally corresponds to the correct placement on the average cat or small dog. In the authors\u2019 experience, the anchor technique described above for the Mila winged flange is usually well tolerated by the patient and often results in a healthier stoma than the purse string technique.<\/span><\/p>\n<h3 class=\"p3\">Stoma Site Infection<\/h3>\n<p class=\"p1\"><span class=\"s1\">Treatment of a suspected infection begins with a systematic topical approach (<\/span><span class=\"s2\"><b>BOX 3<\/b><\/span><span class=\"s1\">), using systemic antibiotics only when topical treatment proves insufficient. The cleaning procedure requires preparing a dilute betadine solution in 0.9% saline (approximately 0.5% final concentration of dilute betadine solution), creating a tea-colored mixture. Using either an open-ended tomcat catheter or an IV catheter connected to a 6-mL syringe, thoroughly flush the site until all purulent material is removed. During irrigation, gently massage any palpable pockets beneath the stoma to ensure complete removal of the material. For particularly severe local infections, after thorough cleansing consider applying medical-grade honey directly to the affected skin to provide anti-inflammatory, antioxidant, and antibacterial properties.<sup>3<\/sup> Medical-grade honey products should be sourced from reputable medical suppliers to ensure proper storage conditions and product integrity. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Cover the treated area with a sterile 2<\/span><span class=\"s5\">\u2009<\/span><span class=\"s1\">\u00d7<\/span><span class=\"s5\">\u2009<\/span><span class=\"s1\">2 gauze pad and secure it beneath a collar or neck band. The dressing must be changed every 24 hours until the discharge resolves, typically within 2 to 3 days. After the discharge has resolved, return to the standard twice-daily dilute bleach protocol for ongoing maintenance. For abscesses that have become walled off from the stoma, first lance and flush the abscess before implementing the above protocol. Should the infection persist despite appropriate topical therapy, obtain a culture and sensitivity to guide selection of systemic antibiotics. Continue the topical protocol concurrently with the systemic antibiotic administration. If the infection cannot be controlled with these measures, the feeding tube should be removed.<\/span><\/p>\n<h3 class=\"p3\">Obstructed Tube<\/h3>\n<p class=\"p1\"><span class=\"s1\">Factors that contribute to e-tube occlusion can be structural or procedural. Structural elements, such as narrow tube diameter and\/or excessive tube length, create inherent risks. Procedural factors, particularly improper medication administration and insufficient flushing protocols, significantly increase obstruction likelihood. In addition, inadequately blended slurry can lead to diet residue accumulation within the tube lumen.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Because obstruction represents a significant yet avoidable complication, prevention is paramount for e-tube management. To avoid clogged e-tubes, implement a strict regimen of flushing with 10 to 15\u00a0mL of water before and after feeding or medication administration. When administering multiple medications, flush with at least 5 mL of water between each medication. Consult a pharmacist to determine which medications can be added directly to the slurry and which medications pose higher obstruction risks. Obstruction risk might be increased when using enteric-coated, time-released, or sustained-release tablet or capsule formulations. When fiber supplements are prescribed, thorough flushing will help prevent accumulation. To achieve optimal consistency and minimize obstruction risk, prepare slurries by using pitcher-style blenders rather than wand-style models. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">When managing an obstruction, begin with warm water irrigation. The technique requires a methodical approach using a 60-mL syringe\u2014never smaller as smaller syringes generate dangerous pressure levels that could compromise tube integrity. Apply gentle, rhythmic pressure and suction while flushing. If the initial warm water flush proves ineffective, progress to other declogging solutions (<\/span><span class=\"s2\"><b>BOX 3<\/b><\/span><span class=\"s1\">).<sup>4,5<\/sup> <\/span><\/p>\n<h2 class=\"p2\">Best Practices<\/h2>\n<h3 class=\"p3\">Equipment<\/h3>\n<p class=\"p1\"><span class=\"s1\">Equipment selection significantly affects slurry quality. A variable-speed pitcher blender consistently outperforms wand-style alternatives, offering superior particle size reduction and texture uniformity. Optimal blending duration typically ranges from 3 to 6 minutes, although lower-powered blenders may require extended processing time to achieve proper consistency.<sup>6<\/sup> <\/span><\/p>\n<h3 class=\"p3\">Slurry Consistency<\/h3>\n<p class=\"p1\"><span class=\"s1\">The target consistency must account for multiple factors: dietary components (including dry, canned, liquid diet, water), tube length and diameter, and syringe capacity for meal administration. The International Dysphagia Diet Standardization Initiative (IDDSI) provides a valuable framework for assessing liquid viscosity (<\/span><a href=\"http:\/\/go.navc.com\/44ZIgNB\" target=\"_blank\" rel=\"noopener\"><span class=\"s2\">go.navc.com\/44ZIgNB<\/span><\/a><span class=\"s1\">).<sup>7<\/sup> Although the IDDSI strategy was not created primarily for feeding tube slurries, an IDDSI score of level 2 to 3 often indicates an effective thickness for e-tubes in veterinary patients. Silicone o-ring syringes are recommended because they do not degrade as readily as rubber syringes after washing (<\/span><span class=\"s2\"><b>BOX 1<\/b><\/span><span class=\"s1\">).<\/span><\/p>\n<h3 class=\"p3\">Nutritional Density<\/h3>\n<p class=\"p1\"><span class=\"s1\">Nutritional density requires careful consideration when formulating the slurry. Using water alone as a diluent often results in inadequate caloric density, potentially compromising patient nutrition. For patients that need higher calorie intake, incorporating liquid enteral diet products as the primary diluent can significantly improve nutritional delivery while maintaining appropriate consistency.<\/span><\/p>\n<h3 class=\"p3\">Storage<\/h3>\n<p class=\"p1\"><span class=\"s1\">After the desired slurry has been created, store it in an airtight container and refrigerate it within 2 hours. Discard the remaining slurry if it is not used within 3 to 4 days.<\/span><\/p>\n<h3 class=\"p3\">Cleaning<\/h3>\n<p class=\"p1\"><span class=\"s1\">Equipment that was used to prepare the slurry should be cleaned after each use according to the manufacturers\u2019 guidelines. In the absence of specific instructions, adhere to FDA and CDC food safety protocols for equipment decontamination.<sup>8<\/sup> Begin the cleaning process by completely disassembling the blender. Clean all components thoroughly with soapy, warm water. Similarly, wash all ancillary equipment such as spoons, measuring cups, syringes, and bowls. Rinse all items in warm water to remove any soap residue. Sanitize the items by soaking in 2 gallons of water with 2 tablespoons (30 mL) of chlorine bleach for 2 minutes.<sup>9<\/sup> Remove objects from the chlorine soak and allow to air dry\u2014do<i> not<\/i> dry with a towel. <\/span><\/p>\n<h2 class=\"p2\">Summary<\/h2>\n<p class=\"p1\"><span class=\"s1\">Effective management of e-tubes requires careful attention to guidelines, which can help minimize complications associated with the tube and the patient. In addition, ensuring proper care throughout all phases of e-tube management\u2014including thorough cleaning of equipment after each use\u2014helps maintain the integrity of feeding support. With consistent monitoring and clear communication between the veterinary team and clients, e-tubes can provide a reliable and stress-free long-term solution for patients requiring enteral nutrition. <\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>With consistent monitoring and clear communication between the veterinary team and clients, e-tubes can provide a reliable and stress-free long-term solution for patients requiring enteral nutrition.<\/p>\n","protected":false},"author":236,"featured_media":35896,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":6880,"footnotes":""},"categories":[557],"tags":[13],"class_list":["post-35883","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-july-august-2025","tag-peer-reviewed","column-nutrition-notes","clinical_topics-nutrition"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Minimizing Small Animal Esophageal Feeding Tube Complications | Today&#039;s Veterinary Practice<\/title>\n<meta name=\"description\" content=\"With consistent monitoring, e-tubes can provide a reliable and stress-free long-term solution for patients requiring enteral 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