Monday, December 15, 2014

Care and Feeding of a Cat with an Esophagostomy Tube


If your cat has been diagnosed with pancreatitis, oral pain or other condition that makes it difficult or painful to eat, your cat may have had a feeding tube placement procedure recommended. The procedure is relatively quick and, with proper pain medications, painless. Once the tube is placed, a high-calorie, vitamin-rich diet can be given to the cat with minimal stress while he or she is brought back to health. In these cases, placement of a feeding tube often means that the cat is able to go home from the hospital much sooner than would be possible, otherwise.



The type of diet and vitamin or mineral additives that should be fed will be determined by the doctor, based on the individual needs of your cat. Generally a syringable diet will be mixed with water and nutrient powders and placed into the blender to smooth the mixture. Store the food in the refrigerator, and warm a portion of the food to body temperature (101.5 degrees F) in the microwave before using. Do not heat above body temperature!

For most cats with an esophageal feeding tube, food in the stomach may cause nausea, so start slowly. We generally recommend that the average 10 pound cat should start with 50ml of food through the E-Tube four times daily for two days, then increase to 55ml five times daily. Gradually increase the amount you are feeding.  Your eventual aim will be at least 300 to 350ml (over 1 cup) per day.  If  your cat continues to tolerate the feedings you may increase feedings by 5ml per day; up to 75ml per feeding if there is no vomiting. This will allow you to feed fewer times each day.  It is important that you feed enough so that your cat gains weight!

Administer the feedings slowly over 5-10 minutes; slower if vomiting occurs.  Observe for swallowing during the feedings.  Some vomiting (especially at first) is anticipated. If your cat vomits, you should wait an hour and start again. Be organized so things go efficiently with as little handling of the patient as possible.  If feedings are well tolerated, you may gradually become quicker. For some cats, quicker feedings will go more smoothly.

Be sure to flush the esophagostomy tube with 6ml of warm water after each feeding and replace the cap. If the tube becomes clogged, try flushing a small amount of diet cola through the tube with a small (1 to 3ml) syringe.  The esophagus is very stretchy, so your cat CAN eat and drink with this tube in place, however please do not allow your cat to consume grass if they are allowed outside. Grass ingestion is more likely to cause vomiting, and the more frequently your cat vomits, the higher the risk that they will vomit the tube.


Clean the ostomy site (the hole where the tube enters the skin) daily with warm water and surgical scrub. Warm soapy water is ok to use too. Report any concerns.

DAILY MEDICATIONS

It is likely that your cat will be on several medications if this tube is in place. An antibiotic should be given to prevent infection at the tube site. Cats with pancreatitis or hepatic lipidosis (fatty liver) will likely be taking anti-nausea medications such as metoclopramide (Reglan) or maropitant (Cerenia). Cats with certain liver diseases may be taking Denamarin or Ursodiol. Cats with kidney disease may be taking Calcitriol, famotidine (Pepcid), potassium supplements, or aluminum hydroxide. Some of these medications can be given in powdered form and mixed with food or water, others come as tablets and must be crushed before putting through the tube.

Your cat’s esophagostomy tube will be sutured in place and there will be a light bandage placed around his neck.   Observe closely to make sure your pet is not pawing at the tube or bandage.  

If  your cat vomits the esophagostomy tube—carefully use scissors to cut off all exposed tube protruding from the mouth.  Do not try to feed!   Your cat  will need to have the remainder removed and the tube replaced.  If the patient is comfortable, tube replacement can wait until morning. Call as soon as possible; if it is after hours and you are in doubt, contact the nearest emergency clinic.  The portion of the tube left in your cat’s neck can be used as guide for replacing the next tube through the same ostomy site, so don’t pull the remaining portion of the tube from your cat's neck.

If you end up at a veterinary hospital that is not familiar with the replacement technique, please direct them to this video.