Feeding Tube by AliceMacHarvey

Clinical Nutrition Service Phone: 919.513.6999 NCStateVeterinaryNutrition@ncsu.edu

Your pet has had a feeding tube placed to ensure that they receive optimal nutrition necessary to recover from or manage their disease ailment(s). Inadequate and/or inappropriate nutrition can have detrimental effects on many organ systems and increases the incidence of complications. We realize that utilizing a feeding tube can be quite scary at first. In an attempt to relieve some of your concerns and fears, we are providing you with a detailed nutrition plan and information to help you with diet preparation, feeding, trouble shooting, and tube care. Please contact the Clinical Nutrition Service should you experience any difficulties in the nutritional care of your pet. Your pet’s Clinical Nutrition Team Member is:

_______________________________________

Attach client documents here.

Clinical Nutrition Service • 919.513.6999 EMERGENCY • 919-513-6911

ALLOW YOUR PET TO EAT ON THEIR OWN Prior to using the feeding tube, allow your pet to eat on their own. ü To ensure your pet is getting all of the nutrition they need to recover without overfeeding or underfeeding, please measure their meals via a gram scale.

To determine the percentage of food consumed voluntarily: 1. Place your pet’s empty food bowl on the scale and tare the scale to zero. 2. Add the specified volume (grams) of food to the empty bowl on the scale. 3. Present the measured food to your pet to eat voluntarily for up to an hour. 4. If your pet has not consumed all of what was offered, weigh the volume remaining without taring. Subtract this volume from the starting volume to determine the amount in grams your pet consumed. 5. Divide the amount consumed by the offered volume and multiply by 100 to get a percent. See example below. 6. Adjust the tube feedings according to the feeding chart in the attached nutrition consult. Example: Weight of meal offered Weight of food remaining

72 grams (g) - 54 g

Amount consumed 18 g Percent consumed 18 g / 72 g = 0.25 X 100 = 25 %

DIET PREPARATION 1. Gather the necessary supplies. You will need:

v Diet blend recipe for your pet (outlined in attached consult) that indicates the: N Prescribed canned diet N Prescribed liquid diet N Oil, if indicated in the diet recipe v Blender dedicated to pet food only v Catheter-tip syringes v Wide-bottomed food storage containers with secure lids (Tupperware preferred) 2. Combine the listed volumes of canned and liquid diets in a blender per attached consult instructions. 3. Blend to a smooth consistency. If mixture is still chunky, gently push the chunk material through a strainer back into the blender and re-blend to a smooth consistency. 4. Fill the catheter-tip syringe(s) up to the prescribed meal volume (refer to attached consult). 5. Transfer any remaining diet blend to a wide bottom Tupperware container and refrigerate. Most diet blends can be refrigerated for up to 72 hours (3 days).

FEEDING THROUGH THE TUBE 1. Gather your supplies in a clean and comfortable work area. You will need (a): v Clean catheter-tip syringes v A bowl of clean water v A 20 ml slip-tip syringe v Clean paper towels v Any medications to be administered with a meal via the feeding tube.

2. Ensure the diet blend is at body/room temperature prior to feeding by placing the container of diet blend in a warm water bath in the sink or leaving it on the counter for 1 hour prior to feeding. DO NOT microwave the diet blend. 3. If the diet blend appears too thick after warming: add 1-2 tablespoons of the liquid diet and re-blend.

4. Fill the catheter tip syringes with the volume of diet blend that will supplement the amount of diet they have NOT consumed voluntarily (follow attached feeding chart guidelines) 5. Crimp the tube as shown (b) to prevent air entering or fluid leaking from the tube and attach the diet-filled catheter-tip syringe (c). This should be done anytime a syringe is connected

6. Hold the cap in one hand while slowly pushing with the other hand on the end of the syringe to deliver the diet through the tube (d). This will prevent the two from separtaing while feeding. ** A delivery rate of 5-10 ml of diet blend per minute is recommended to minimize feeding intolerance. 7. Watch for signs of feeding intolerance including: v Salivation (drooling) v Retching or vomiting. STOP THE DIET DELIVERY IF YOU WITNESS ANY OF THESE SIGNS.

8. Continue feeding until all pre-filled measured syringes have been administered. 9. Once the entire meal has been fed, Crimp the tube, remove the last food syringe, dry the area well. and replace it with a catheter-tip syringe filled with ______ ml of warm water (e). 10. Slowly administer the water through the tube to flush any remaining diet out of the feeding tube. Re-cap the feeding tube (f).

TUBE CARE & TROUBLESHOOTING

Check to make sure all parts of the feeding tube are working and the tubing is not torn or split. Parts that do not work correctly or break during use will need to be changed. Call your NC State Veterinary Hospital primary clinician if you notice any problems.

At least once daily you should clean and inspect the insertion site for signs of infection. Please call your NC State Veterinary Hospital primary clinician if you observe:

N Red, irritated skin N Foul-odor N Discharge N Swelling

IF THE TUBE FALLS OUT, TRY TO PUT IT BACK IN AS SOON AS POSSIBLE! If you are unsuccessful, come to the Medicine or Nutrition service to have it replaced immediately.

STEPS FOR TUBE AND SKIN CARE

KEEP IT CLEAN ! 1. Wash your hands with soap and water. 2. Gather supplies in a clean and comfortable work area (a). v A germ-free (clean) wipe, cotton swab, or paper towel. v Clean warm (tap water only) water v Neosporin ointment (triple antibiotic ointment), v Split gauze, make-up pad, or other dressing

3. Gently remove any bandage or wrap materials covering the tube (b). 4. Inspect and clean around the insertion point using a wet paper towel or a cotton swab (c). v Start next to where the tube goes into the skin and swab outward. v You may also need to wipe the tube and the stabilizer wings (if present). 5. Check to ensure the sutures are still intact (d) 6. Apply Neosporin ointment around the tube insertion site and replace a split gauze or other dressing to the insertion point. (e) 7. Re-apply the neck wrap /specialty collar or bandage to keep the tube

and insertion site clean and protected. (f)

IF THE FEEDING TUBE GETS CLOGGED IF THE FEEDING PORT GETS CLOGGED

Medicines or liquids can plug your pet’s feeding tube if it is not flushed sufficiently. It is important to flush with enough Medicines or liquids can plug your pet’s feeding port if it is not flushed sufficiently. It is water before, after, and when giving medicines. It is also important toflush flush before, after, and in giving medicines. It is also important important to thewith tubeenough after eachwater diet feeding. You to flushflush thewith portenough (tube)water aftertoeach feeding. should clear diet the tube of any You should flush with enough water to clear the X Blocked contents seencontents in the tubing. volume This is indicated port of any seenThis in water the tubing. water volume is indicated on on your pets’nutrition nutrition consult. consult. If Ifyour pet’s tube port is notisbeing your pets’ your pet’s not being used, flush it a used, flush it a few times each day to keep it from getting plugged.

few times each day to keep it from getting plugged.

your pet’s getget plugged, you canyou try can to flush 5-10 IfIf your pet’stube portdoes does plugged, try ittowith flush it with 5-10 ml of ml of warm water in a syringe attached to the tube. If you hold the warm water in a syringe attached to the port. If you hold the attached attached syringe above your pet’s head, the water will flow into the syringe above your pet’s head, the water will flow into the port by gravity. tube by gravity.

pull If this does not work, add 5-10 ml of warm water to a 60 ml catheter tip If this does notthe work, add 5-10 of warm waterthe to asyringe 60 ml catheter syringe with plunger in ml place. Attach to the port and use a push tip syringe with the plunger in place. Attach the syringe to the tube gentle push-pull motion. This might loosen the plug. and use a gentle push-pull motion. This might loosen the plug. Flush gently with warm water

Push ü DO NOT USE SOFT DRINKS, FRUIT JUICES, OR TENDERIZERS TO UNPLUG Pull THE TUBE. THIS CAN DAMAGE THE TUBE AND CAUSE FUTURE PLUGS.

ü DO NOT INSERT ANYTHING INTO THE TUBE TO TRY AND UNPLUG IT.

If you theTHE port by doing these things, call your State Veterinary Hospital IF YOU cannot CANNOTunplug UNPLUG TUBE BY DOING THESE THINGS, CALLNC YOUR CLINICAL NUTRITION TEAM MEMBER. THEY MEDICINE team. They can prescribe a medicine to CAN helpPRESCRIBE loosen theAplug. TO HELP LOOSEN THE PLUG. Do not use soft drinks, fruit juices, or tenderizers to unplug the port. This can damage the port and cause future plugs. Do not insert anything into the port to try and unplug it.

WHEN TO CALL THE NC STATE VETERINARY HOSPITAL OR GO TO AN EMERGENCY VETERINARY SERVICE

Call if: W h ethe n tveterinarian o C a l l t h eorNan C emergency S t a t e V eveterinary t e r i n a r yservice H o s pimmediately ital or o tposition o a n has Em e r g ethe n ctube y Viseno t elonger r i n asecure, ry Se i c etube falls out. 1. TheG tube changed, orr ifv the 2. The insertion site or sutured skin is excessively irritated, swollen, painful, or infected.

Call the veterinarian or an emergency veterinary service immediately if: 3. Excessive, foul-smelling material is found at the insertion point.

The tube position has cracks changed, the is no longer secure, if theexternal tube falls out. 4. The tube or rips, ortube its attachments (feeding tube or adapter, stent) become The insertion site or sutured skinbeisreattached. excessively irritated, swollen, painful, or infected. detached and cannot Excessive,5. foul-smelling material is found at theproblems. insertion point. Your pet coughs or develops breathing The tube cracks or rips, or its attachments (feeding port adapter, external stent) become detached and cannot be reattached. 6. Your pet coughs or develops breathingService problems. Clinical Nutrition • 919.513.6999 2. 3. 4. 5.

Ph. 919.513.6999

EMERGENCY • 919-513-6911NCStateVeterinaryNutrition@ncsu.edu

NC State Clinical Nutrition Service

MEDICATION DELIVERY For pills, use 2 soup spoons, one for the pill(s) and one on top to crush the pill(s). Once crushed, add a small amount of water to the pills to dissolve them. Use a 3ml syringe to administer the dissolved pill(s) through the feeding tube. For liquid medications, administer the liquid through the feeding tube. Once the medications are administered into the tube, flush the tube with warm water using a 10 ml syringe.

USEFUL SYRINGE MANAGEMENT TIP! Once done feeding, separate the plunger from the syringe and rinse in warm water. Let dry. Prior to re-using for the next feeding, spray the rubber and syringe barrel with canola oil to help syringe last longer. When it becomes too difficult to push/pull the plunger, discard that syringe.

Let food be thy medicine and medicine thy food. - Hippocrates