Improved nasogastric intubation technique for administration of nutritional support in dogs.

Established procedures for nasogastric intubation are difficult to perform in dogs because of anatomic variation of nasal passages and turbinate structures. Twenty-five clinically normal dogs were used to improve and refine the technique of nasogastric tube placement, and 13 clinical patients at our teaching hospital were evaluated for malnutrition and were considered candidates for nutritional support by nasogastric tube feeding. An improved method for the placement of nasogastric tubes in dogs was used. By pushing the external nares dorsally while advancing the tube in a caudoventral, medial direction, the tube passed through the ventral meatus and into the oropharynx and esophagus easily. The procedure does not require chemical restraint, and the complication of epistaxis was not observed in any dog. Materials required to perform this technique are inexpensive, and the method can be used for the administration of nutritional support, fluids, drugs, or contrast material.     

Capnographic documentation of nasoesophageal and nasogastric feeding tube placement in dogs

Objective: To evaluate the ability of capnography to document proper placement of nasoesophageal (NE) and nasogastric (NG) feeding tubes. This study was conducted in 3 phases. Phase I of this study was designed in order to test the efficacy of capnography to distinguish placement of a feeding tube in the alimentary tract versus the respiratory tract. Phase II was designed in order to document that carbon dioxide (CO₂) could be measured through a polyvinyl chloride (PVC) feeding tube. Phase III was performed in order to evaluate the technique of continuous monitoring during insertion of the feeding tube into the esophagus and stomach as would be performed during a clinical‐tube placement. Design: Prospective study. Setting: Research laboratory. Animals: 24 adult dogs. Interventions: In Phase I, sedated dogs were instrumented with an intratracheal catheter and an 8 French feeding tube placed nasally into the distal esophagus and later advanced into the stomach. In Phase II, dogs were anesthetized and an 8 French feeding tube was placed down the endotracheal tube, then into the esophagus and later advanced into the stomach. In Phase III, sedated dogs were instrumented with an 8 French feeding tube inserted intranasally and then advanced to the level of the nasopharynx, distal esophagus and, lastly, the stomach. Fluoroscopy was used in order to determine location of the feeding tube. Measurements and main results: Phase I measurements included respiratory rate and CO₂ from the trachea, esophagus, and stomach and pH of gastric fluid sample. Phase II measurements included respiratory rate and CO₂ from the endotracheal tube, feeding tube in the endotracheal tube, feeding tube in the distal esophagus, and feeding tube in the stomach. Phase III data collection included respiratory rate and CO₂ as the tube was passed through the nasal cavity, nasopharynx, esophagus and stomach. Phase I fluid samples were collected from 5 of the 9 dogs and had pH values from 1.68 to 4.20. In both phases, values for the respiratory rate and CO₂ from the esophagus and stomach were 0 ± 0, significantly lower (P < 0.001) than the values from the trachea. In Phase II, there was no significant difference between the respiratory rates (P = 0.886) and CO₂ (P = 0.705) readings obtained from the endotracheal tube compared to readings from the feeding tube in the endotracheal tube. In Phase III, there was a significant difference (P < 0.001) between the respiratory rates and CO₂ readings obtained from the nasal cavity and the nasopharynx when compared to those readings obtained from the esophagus and stomach. Measurement of CO₂ and respiratory rate resulted in a reading of 0 every time the feeding tube was in the esophagus or stomach. Conclusions: Capnography may be used in order to detect airway placement of NE and NG tubes.     

Nonendoscopic Antegrade Percutaneous Gastrostomy: The Effect of Preplacement Gastric Insufflation on Tube Position and Intra-Abdominal Anatomy

Nonendoscopic tube gastrostomy was performed on 41 anesthetized dogs using the technique of Fulton and Dennis with or without gastric insufflation prior to tube placement. Immediately after tube placement, dogs were euthanized and postmortem examinations performed. When gastric insufflation was not performed (group I), gastrostomy tubes penetrated the visceral surface of the stomach in 25% of dogs. The deep leaf of the omentum was interposed between stomach and body wall in the majority of these dogs, exposing other intra-abdominal organs to potential injury. Additionally, displacement and tethering of the spleen cranial to the gastrostomy site were observed in 33% of dogs in group I. Similar results were obtained when preplacement gastric insufflation was performed after the orogastric tube was inserted sufficiently far to displace the stomach laterally against the body wall (group II). In contrast, consistent positioning of gastrostomy tubes through the parietal surface of the stomach was achieved when the stomach was insufflated prior to lateralizing the left abdominal wall with the gastric end of the orogastric tube (group III). It was concluded that the blind percutaneous gastrostomy technique is made safer by insufflating the stomach immediately prior to pushing the gastric wall laterally into contact with the parietal peritoneum. J Vet Intern Med 1996;10:15–20. Copyright © 1996 by the American College of Veterinary Internal Medicine .     

Equine cervical esophagostomy: complications associated with duration and location of feeding tubes

Cervical esophagostomy for tube feeding was evaluated in 11 ponies. Minor complications responded to supportive therapy in 8 ponies. Two died of complications, and 1 pony had a permanent fistula because of persistent infection. There was a positive correlation between the duration of tube feeding and the event of closure of the esophageal stoma after the tube was removed. There was no difference in the frequency of complications related to duration of tube feeding. When the distal end of the feeding tube was located in the thoracic portion of the esophagus, instead of in the stomach, tubes were more readily dislodged. Reinsertion of some tubes was difficult or impossible to do and resulted in false passage of the tube into the mediastinal space, dissecting infections into the thorax, or both. Reflux of food around the tube occurred in ponies with the distal end of the feeding tube located in the stomach, but this was not associated with other complications.     

Outcome of and complications associated with tube cystostomy in dogs and cats: 76 cases (1995-2006)

OBJECTIVE: To determine indications for cystostomy tube use in dogs and cats, complications associated with their use, and outcome of dogs and cats in which cystostomy tubes had been inserted. DESIGN: Retrospective case series. ANIMALS: 37 dogs and 39 cats. PROCEDURES: Information was obtained from medical records. Long-term follow-up information was obtained by use of a client questionnaire. RESULTS: Indications for cystostomy tube placement were bladder dysfunction, urinary tract rupture, obstructive urinary tract neoplasia, urinary diversion following urogenital surgery, obstructive urolithiasis, and feline lower urinary tract disease. Median time tubes were in place was 11 days, but duration of tube use was significantly longer for animals with bladder dysfunction than for animals with urinary tract trauma, urinary diversion, or urinary tract obstruction. Thirty-seven (49%) animals had tube complications. Development of complications was not significantly associated with species, age, body weight, duration of tube use, or tube type, except that animals were significantly more likely to develop complications following long-rather than short-term use. In 42 animals, the underlying condition resolved and the tube was removed; 22 animals died or were euthanatized with the tube in place. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that cystostomy tubes may be used for animals with various conditions related to problems with urine outflow. Nearly half the animals in the study developed complications related to the cystostomy tube, suggesting that potential complications should be discussed with owners prior to tube placement. However, most complications were easily resolved.     

Enteral feeding of dogs and cats: 51 cases (1989-1991).

Feeding commercial enteral diets to critically ill dogs and cats via nasogastric tubes was an appropriate means for providing nutritional support and was associated with few complications. Twenty-six cats and 25 dogs in the intensive care unit of our teaching hospital were evaluated for malnutrition and identified as candidates for nutritional support via nasogastric tube. Four commercial liquid formula diets and one protein supplement designed for use in human beings were fed to the dogs and cats. Outcome variables used to assess efficacy and safety of nutritional support were return to voluntary food intake, maintenance of body weight to within 10% of admission weight, and complications associated with feeding liquid diets. Sixty-three percent of animals experienced no complications with enteral feedings; resumption of food intake began for most animals (52%) while they were still in the hospital. Weight was maintained in 61% of the animals (16 of 26 cats and 15 of 25 dogs). Complications that did occur included vomiting, diarrhea, and inadvertent tube removal. Most problems were resolved by changing the diet or adhering to the recommended feeding protocol. Nutritional support as a component of therapy in small animals often is initiated late in the course of the disease when animals have not recovered as quickly as expected. If begun before the animal becomes nutrient depleted, enteral feeding may better support the animal and avoid serious complications.     

碳纤维人工食管用于牛羊的实验研究

选用碳纤维作为食管代替物,对各切除颈段固有食管3～4cm的8例绵羊和2例犊牛行食管植入吻合术。植入的碳纤维人工食管长度为3～4.5cm,管径为1～2cm,管壁厚为0.1～0.15cm。人工食管与食管断端采用作者改进的高桥氏二层重叠缝合方法吻合。术后除2例绵羊因人工食管渗漏子第4d死亡外,其余吻合手术均获成功。绵羊术后4～5d采食咀嚼碎青草自如,但咽下较缓慢,有时反复2～3次方能咽下;术后5～20d,采食及吞咽恢复至正常状态;20d后又复出现吞咽缓慢。犊牛术后饮奶咽下顺利,到20d后偶有反复吞咽和奶汁由鼻孔中返流现象,经3～5d恢复正常。经X线透视或钡剂食管造影检查,术后7～14d,钡液顺利通过食管和人工食管,显示人工食管部较正常食管稍细,术后22～26d,人工食管脱落,脱落部食管狭窄,其前方食管呈纺锤状扩张。动物全身及血液,生化指标观察均无明显改变。病理学观察,术后15d可见在食管两断端由新生肉芽组织形成纤维膜管以包裹人工食管,在新生肉芽组织纤维膜管内面,靠近食管吻合口边缘,已长出灰白色薄层粘膜;术后22～25d,人工食管脱落于瘤胃或网胃中,食管缺损段已由新生的食管组织连接在一起,新生食管外周形成纤维膜包裹,管腔内面被覆有较完整的薄层粘膜;术后35～40d。见新生食管内面粘膜层覆盖完整,管壁稍增厚,内腔稍     

Nasogastric Intubation as Health and Safety Risk in Equine Practice—A Questionnaire

Placing a nasogastric tube can be a life-saving act for a horse but is considered an occupational hazard for veterinarians. An online questionnaire was performed to assess and specify potential risks. 123 equine veterinarians completed the survey, and the majority admitted using the mouth to handle the end of the nasogastric tube (sucking or blowing air) and having accidentally swallowed or aspirated stomach content or medications. This can potentially lead to aspiration pneumonia or pneumonitis. Mineral oil seems to be especially dangerous as aspiration may be asymptomatic at the beginning and lipoid pneumonitis may develop. Furthermore, 60% of responders would also handle the tube with their mouth if the horse was presented with fever and diarrhea or reflux formation, which might be affected by Salmonella sp. or Clostridium difficile producing toxins. The fact that nasogastric tubes are rarely being disinfected increases the risk of infection. 50% of veterinarians would use their mouth to suck or blow air into the tube during nasogastric intubation, even if the patient was presented with suspected poisoning. Rodenticide zinc phosphide is particularly dangerous as its breakdown product is a highly toxic gas. Inhalation leads to serious symptoms in humans, including pulmonary edema and neurological signs. Alternatives to mouth use (lavage, big syringe, or suction pump) when passing a tube should be considered, especially if a patient is presented with duodenitis—proximal jejunitis, diarrhea, or suspected poisoning. Awareness needs to be raised among veterinarians that nasogastric intubation is an extremely hazardous occupational practice.     

Removal of nasogastric tube fragments from three horses.

Three horses were admitted for retrieval of polyurethane nasogastric tube fragments. The fragments were removed from the esophagus or stomach of 2 horses by manipulation of a snare introduced through the biopsy port of an endoscope. The fragments were surgically removed from the stomach of the third horse.     

A new technique for insertion of esophagostomy tubes in cats

A new percutaneous insertion technique for esophageal feeding tubes in cats is presented. The technique has been successfully applied in 12 feline patients. The placement technique is relatively simple, takes approximately five minutes to perform, and requires a scalpel blade, a curved hemostat, and an applicator for the insertion of the feeding tube. In contrast to other esophageal tube placement techniques, the tube is inserted into the definitive aboral position in a one-step procedure. Because of its shoehorn shape, the applicator allows the tube to be inserted into the esophagus safely and precisely. Placement of the tube in the midcervical area does not interfere with the function of the pharynx and avoids having the animal irritated by the presence of the tube. The chosen diameter of the tube is large enough to permit feeding of diluted, blended, commercial canned food. For the patients of this study, feeding was started after recovery from anesthesia, and tubes were removed without complications once the animals had started to eat voluntarily.     

Abdominal Crisis in the Horse: A Comparison of Pre-Surgical Evaluation With Surgical Findings and Results

The results of preoperative examination, surgical intervention and the outcome of 50 cases of acute abdominal crisis in the horse are presented. Pre-surgical parameters discussed in this correlative study include duration of the condition prior to sergery, pulse rate, packed cell volume (PCV), abdominal distention, intestinal motility and tympany, rectal findings, reflux of fluid after passage of a nasogastric tube, and abdominal paracentesis. A retrospective study was performed to evaluate the usefulness of each clinical parameter in deciding that a case was surgical, arriving at a specific pre-surgical diagnosis, and in giving a prognosis. Rectal examination was the single most useful diagnostic tool. Reflux of gastric fluid through the nasogastric tube usually indicated obstruction of the small intestine.     

Minimally Invasive Inguinal Approach for Tube Cystostomy

Objective— To report a technique for tube cystostomy placement via a minimally invasive inguinal approach and outcome in 9 dogs and 6 cats with urinary tract obstruction or detrusor atony.
Study Design— Case series.
Animals— Dogs (n=9) and cats (6).
Methods— Medical records (January 2004–January 2008) of dogs and cats that had tube cystostomy via an inguinal approach were reviewed. Retrieved data included signalment, diagnosis, surgical technique, and complications. Access to the bladder was through a muscle splitting approach in the inguinal region with the cystostomy tube placed through a skin incision made several centimeters proximal to this incision and secured in the bladder by a purse string suture. Cystopexy during closure of the muscle layers ensured secure closure and minimized the likelihood of uroabdomen if tube dislodgment occurred.
Results— Cystostomy tubes were placed in 5 cats as an emergency procedure for treatment of acute urinary tract obstruction or urethral rupture, and as an elective procedure in 9 dogs and 1 cat. No complications occurred during cystostomy tube placement. Postprocedural complications were minor (peristomal irritation in 2 dogs with latex catheters, catheter laceration, premature removal) and only occurred when tubes were retained for >4 weeks. Urinary tract infection at catheter removal in 6 dogs resolved with antibiotic administration.
Conclusions— An inguinal approach for cystostomy tube placement facilitated rapid catheter placement into the bladder with minimal soft tissue dissection. Cystopexy during abdominal wall closure provided peritoneal protection should premature dislodgement of the cystostomy tube occur.
Clinical Relevance— An inguinal approach should be considered for rapid tube cystostomy particularly in metabolically compromised animals.     

Comparison of complications of percutaneous endoscopic versus surgically placed gastrostomy tubes in 42 dogs and 52 cats

Dogs and cats that had a percutaneous endoscopic gastrostomy (PEG) tube or surgically placed gastrostomy (SPG) tube inserted were retrospectively analyzed to compare complication rates and the severity of complications. Complication rates and severity scores were not significantly different when the PEG tube group was compared to the SPG tube group in either dogs or cats. Only when data from dogs and cats were combined did PEG tubes have a significantly higher complication rate and significantly greater complication severity scores.     

犬人造胃瘘管手术案例分析

[目的] 满足犬食道摘除手术,或生理性实验犬的饲喂及采集样品需要,进行试验性犬人造胃瘘管手术。[方法] 选取5只中等及大型犬,通过术前准备和检查,并做全身吸入麻醉。在腹底胃区切开皮肤,分离肌肉,拉出胃大弯,在无血管处切开胃壁,放入人造瘘管。对胃壁浆膜肌层进行双层荷包缝合。对腹壁肌肉进行结节对接缝合。术后使用聚维酮碘软膏或油剂注入肌肉与瘘管间隙,加速肉芽形成。手术6个月后对2只犬进行肉芽组织采样做病理切片。[结果] 5只犬术后15~25 d创口均取得良好愈合,并可以适应流食饲喂;通过病理学观察发现,肉芽组织生长良好,均为成熟肉芽。[结论] 该手术方法可为今后由于病理性原因进行造瘘术和生理实验手术提供实践依据。     

Removal of a nasogastric tube fragment from the stomach of a standing horse

An 82-cm fragment of nasogastric tube was removed from the stomach of an adult horse under standing sedation by use of an endoscope and electrocautery snare. This is the first report of successful non-surgical removal of a nasogastric tube fragment from the stomach of a horse.     

Esophageal ectasia in a quarterhorse colt

A one month old Quarterhorse colt was presented after a week history of bilateral nasal discharge and respiratory difficulty. The cervical esophagus was greatly dilated, tortuous and filled with diluted milk. A nasogastric tube could not be passed beyond the base of the heart. An aspiration pneumonia was found at postmortem examination and the esophageal segment from the pharynx to the base of the heart was dilated, thin-walled, had degenerative muscular changes, and a reduction in size and number of ganglion cells of the myenteric plexus. Muscular hypertrophy of the terminal esophagus had reduced its lumen size. Some similarities and disparities of this condition to achalasia of man and megaesophagus of dogs are discussed.     

Clinical use of low-profile cystostomy tubes in four dogs and a cat

Traditional cystostomy tubes (used for temporary or permanent diversion of urine in dogs and cats) are long (> or = 22 cm) and cumbersome to stabilize, requiring sutures or bandages to hold the tube against the body. Use of a low-profile gastrostomy port system as a low-profile cystostomy tube (LPCT) in 4 dogs and a cat was investigated; owner satisfaction with the device was assessed. Technical difficulty associated with placement and management of LPCTs was similar to that for traditional cystostomy tubes; with LPCTs, activity and mobility of pets was not compromised, and bandaging was not required. Complications included lower urinary tract infection, mild peristomal leakage of urine and leakage from components of the system, and subcutaneous peristomal infection. Four of 5 owners considered the tube to be easy to use; all owners said they would be comfortable repeating their decision to use the LPCT in their pet.     

Use of a carbonated beverage to disintegrate a phytobezoar obstructing the intrathoracic portion of the oesophagus of a horse

This report describes the treatment of a 17-year-old American Quarter Horse gelding for an oesophageal obstruction of approximately 24 h’ duration. An intraluminal oesophageal mass resembling a phytobezoar and located close to the cardia, was observed during endoscopic examination of the oesophagus of a horse showing signs of oesophageal obstruction. An intrathoracic oesophageal diverticulum, filled with fluid, was observed about 40 cm proximal to the obstruction. The end of a nasogastric tube was guided beyond the diverticulum, using gastroscopic observation, so that its tip rested close to the obstruction. The obstruction failed to disintegrate or move into the stomach despite vigorous, prolonged lavage. With the nasogastric tube left in place, and the horse's head elevated, 0.5 L cola was administered adjacent to the obstruction through the nasogastric tube. The head was maintained in the elevated position for an hour, after which time the head was lowered and oesophageal lavage resumed. The nasogastric tube was passed into the stomach within 3 min of re-instituting lavage. The successful use of a carbonated beverage to treat human patients for oesophageal or gastrointestinal obstruction caused by a phytobezoar is well documented. Carbonated beverages have also been reported to be effective in treating horses for gastric and enteric impactions caused by persimmon seeds. Administering cola into the oesophagus may help resolve oesophageal obstruction of horses caused by a phytobezoar or impacted feed material when horses are refractory to other treatments.     

Pull-through technique for vertical canal ablation for the treatment of otitis externa in dogs and cats

An alternative technique to ablate the vertical segment of the external auditory meatus, applicable to dogs and cats, is described. The results of this surgery in 11 dogs and one cat are compared with those in seven dogs using the traditional ablation procedure.