Feeding tubes

Lindsey Dodd BSc(Hons) VPAC VTS(ECC) PgCert in HE FHEA RVN

Feeding tubes are required for cats unable to meet nutritional requirements due to hyporexia, inability to eat, or a need to bypass a segment(s) of the gastrointestinal tract (GI). Table 93.1 illustrates available feeding tubes, indications, contraindications, and further details about each type. Nasoesophageal (NE) and esophageal (E) feeding tubes are the most regularly used in cats. Both are well tolerated, particularly E tubes, and the cat can still eat voluntarily. The advantages and disadvantages to each modality, as well the patient’s condition and the nutritional goal should be carefully considered, aiming to use as much of the functional GI tract as possible.1,2 

When to use a feeding tube

Feeding should begin without delay in hemodynamically stable patients with corrected electrolyte and acid-base disturbances and normal hydration status1,3 if a cat consumes less than 75% of their resting energy requirement (RER) (fig. 93.1).4,5 A lack of nutrition can cause immunosuppression and hepatic lipidosis.1 During patient assessment, consider if analgesia and antiemetics are appropriate, and ensure the environment is adjusted to reduce stress.2,3,6 Oral syringe feeding must be avoided to prevent food aversion or aspiration.2 Feeding plans should be regularly assessed, including the patient’s response to enteral nutrition1,4,7 and any associated refeeding syndrome.2,8

Placement of NO and O tubes

Please refer to corresponding video for placement guide (video 93.1). Typically, NE tubes in cats are between 3.5-6 French dependent upon the diameter of the nares. To aid placement, use local anesthetics beforehand, either 4-5 drops of lidocaine or proparacaine into nostril(s) and a drop into the ipsilateral eye (to aid numbing the nasal passages) (figs. 93.2 and 93.3). Allow adequate time for the local anesthesic to take effect. Administration may result in ptyalism as seen in the video.

After securing NE and E tubes check position by:

  • Confirming negative pressure by attaching an empty syringe. Tubes situated in the GI tract will give a negative pressure whereas tubes dislodged into the airway will pass air. Stomach contents may be aspirated from the stomach via NG tubes. Flush with sterile water (typically 5 mL or less depending upon the patient’s size) to check patency and for any associated coughing or increased respiratory rate.
  • Take radiographs or use Point-of-Care ultrasonography (always recommended post E tube placement).
  • Use capnography: the GI tract will indicate a 0 mmHg end tidal carbon dioxide reading and no visible waveform.
  • Assess the pH of any aspirated fluid from NG tubes.9 

The author suggests using at least one other modality after confirming negative pressure to ensure correct placement. Clearly label the tube or use an opposing connector to avoid mistakes where multiple catheters and tubes are in place.7 

How to feed and feeding plan

Before feeding, wear aseptic gloves, check the tube and placement to avoid accidental incorrect administration of food (e.g., into the airway or subcutaneous tissues). 

  • Ensure the cat is conscious and sitting or lying down in dorsal recumbency with its head in a natural position.  
  • Check for negative pressure. If concerns arise, refer to 92.2 to establish tube location. 
  • Use warm water flush the tube to check for resistance, nausea, tachypnea, gagging, and/or coughing. If concerns arise, stop feeding, and confirm tube location.

Anything administered through a tube should be warmed to body temperature; substances that are too cold can cause nausea and vomiting; substances that are too hot can damage the GI tract. 

  • Administer food slowing over ~10-30 minutes, depending on the volume;1 assess the cat’s response, and monitor for signs of nausea (lip-licking, exaggerated swallowing). Medications can be administered via E tubes before, during, or after feeding. 
  • The tube must be flushed, typically with 5 mL warm water after use to remove residual food/medication and prevent blockages. 
  • Use a patient-specific feeding chart10 (fig. 93.1). 
  • At least once a day, aseptically:
  • Check the tube marker (pen mark/marker tape on the tube) and the external section of the tube.
  • Check the nostril or stoma site for signs of infection or irritation.
  • Perform stoma care, cleaning around the stoma site. 
  • E tube bandages must be removed and new dressings applied using aseptic technique.10 Alternative dressing options are available for patients discharged with indwelling E tubes (e.g., fabric collars). 


1. Chan DL. The inappetent hospitalised cat: clinical approach to maximising nutritional support. J Feline Med Surg 11:925-933, 2009.

2. Gajanayake I. Management of the anorexic cat. In Practice 36:163-171, 2014.

3. Delaney SJ. Management of anorexia in dogs and cats. Vet Clin North Am Small Anim Pract 36:1243-1249, 2006.

4. Chan D. Making a difference - nutritional support in critically ill patients. Veterinary Focus 23:8-13, 2013.

5. Firth A. Early enteral nutrition – principles and practice. The Veterinary Nurse 4:392-399, 2013.


7. Phillips S. Nutrition in critical care. The Veterinary Nurse 11:256-262, 2020.

8. Chan DL. Refeeding syndrome in small animals. In Chan DL (editor). Nutritional management of hospitalized small animals. 2015, John Wiley & Sons, pp 159-164.  

9. Lumbis RH. How to place commonly used feeding tubes in dogs and cats. The Veterinary Nurse 8:104-115, 2017.

10. Bloor C. How to tube feed. The Veterinary Nurse 10:210-215, 2019.

11. Hodshon B, Tobias KM. Esophagostomy feeding tubes. Clinician’s Brief 12:66-72, 2014.

12. Freeman L, Becvarova B, Cave N, et al. WSAVA Nutritional Assessment Guidelines. J Small Anim Pract 52:385-396, 2011.


Feeding tubes

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Video 93.1 Nasoesophageal and esophageal tube placement

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