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.9
After securing NE and E tubes check position by:
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).
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.
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.
Video 93.1 Nasoesophageal and esophageal tube placement