IVE_US_Feeding tube_Guide_A4_Mar2026 FA

Feeding Tubes
in Small Animal
Practice
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Index
Indications for a feeding tube
3
Feeding tube types advantages
and disadvantages
4
Choosing a feeding tube
5
Choosing a diet
6
Energy requirements
and how much to feed
7
Step by step feeding protocol 8
2 FEEDING TUBES IN SMALL ANIMAL PRACTICE

Indications for a feeding tube
Feeding tubes should be considered whenever a patient has failed to voluntarily
intake 80% of their Resting Energy Requirements (RER - see page 7 for the calculation)
for more than three days. Common indications for feeding tubes include:
• Acute pancreatitis
• Gastrointestinal disease (eg parvovirus, inflammatory bowel disease causing
inappetence)
• Liver disease (especially cholangiohepatitis in cats)
• Trauma (especially to the face) such as dog fights or road traffic collisions
• Acute kidney injury
• Any catabolic state where their intake (or absorption) isn’t keeping up with their
needs (eg severe burns, protein-losing enteropathy, septic peritonitis)
The following checklist can be used to determine whether a patient needs assisted
feeding – patients with two or more of the following should commence tube feeding
as soon as they are stable enough:
`
Food intake <80% RER for 3+ days
`
Severe vomiting/diarrhea
` Body Condition Score (BCS) <4/9
`
Mild to severe muscle wasting over the spine
`
Illness expected to last 3+ days
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Types of feeding tube
The type of feeding tube chosen will depend on the individual patient, how long they
need support for, the equipment available, and the experience of the clinician.
Tube type
\Naso-esophageal
(NE)
Typical duration
3-10 days
Advantages
• Cheap
• Easy to place
• No anesthesia required
• Can be removed immediately
if necessary
Disadvantages
• Small bore – diet needs to be liquid
• Prone to becoming dislodged
\Naso-gastric (NG)
Typical duration
3-10 days
• Cheap
• Easy to place
• No anesthesia required
• Food bypasses esophagus
• Can be removed immediately
if necessary
• Small bore – diet needs to be liquid
• May encourage reflux and/or
esophagitis and esophageal strictures
\Esophagostomy
(E)
Typical duration
1 week + (can be left
in place for months if
necessary)
• Cheap
• Simple to place (except in very
large dogs)
• Larger bore to take semi-liquid/
blended diets
• Can be removed immediately
if necessary
• Requires (brief) general anesthesia
• Incision may become infected
• Prone to becoming blocked
\Gastrotomy (G)
Typical duration
2 weeks + (can be left
in place for months
or years)
• Bypasses esophagus
• Larger bore can accommodate
higher-calorie blended diets
that would be too thick for
NE/NG tubes
• Requires anesthetic to place
• Displacement causes severe
complications (peritonitis)
• Endoscopic placement needs special
equipment
• Cannot be removed sooner than
10-14 days
\Jejunostomy (J)
Typical duration
2 weeks +
• Bypasses upper GI tract and
pancreas, potentially beneficial
for patients with pancreatitis
• Anesthesia required
• Advanced skills – laparotomy
required
• Tube displacement causes severe
complications (peritonitis)
• Diet must be completely liquid
and delivered by constant infusion
• Cannot be removed sooner than
10-14 days
4 FEEDING TUBES IN SMALL ANIMAL PRACTICE

Choosing a feeding tube
No
Is the patient stable enough
for an anesthetic?
Yes
Less than
two weeks
How long is the patient
likely to need support for?
More than
two weeks
Does the patient have
nasal disease?
Does the patient have
uncontrolled vomiting?
No
Yes
No
Yes
Is a there a suitable diet
that’s completely liquid?
Does the patient have
esophageal disease, or a high
risk for regurgitation due to
recumbancy or dysphoria?
Yes
No
No
Yes
Does the patient have
esophageal disease?
Does the patient have a
normal, working stomach?
No
Yes
Yes
No
NE tube
NG tube
E tube
G tube
J tube
\ Please note it’s the veterinarian’s responsibility to choose an appropriate feeding tube,
and the size of the animal, their experience, and the equipment they have available may all alter
the preferred option.
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Choosing a diet
The preferred diet for feeding tubes varies depending on the patient. As with
other clinical nutrition, you’ll need to consider the individual’s health conditions,
intolerances, and needs. For example, you may wish to consider:
• Cachexia
high protein
• Critically ill
high calorie
• Tube type
liquidity
• Hyperlipidemia
fat restriction
• Chronic kidney failure
moderately protein-restricted
• Hepatic encephalopathy
moderately protein-restricted
\ Please note that there are limited liquid diets available, and if a patient has complex dietary
needs a larger-bore tube may need to be chosen to enable delivery of blenderized diets.
If blenderized diets are being used, straining may be needed to reduce the risk of tube
blockage, but be aware that this can change the nutrition in the final meal.
6 FEEDING TUBES IN SMALL ANIMAL PRACTICE

Energy requirements
and how much to feed
There is no perfect way to work out the caloric needs of a patient in recovery. The
best approach is usually to use Resting Energy Requirements (RER) then check the
patient’s weight and body condition score daily to identify under- or over-feeding.
RER can be calculated using the following formulae:
For all patients:
RER (in kcal) = 70 x (body weight in kg) 0.75
For patients 2-30kg:
RER (in kcal) = (30 x body weight in kg) + 70
\This gives the total caloric requirements in 24 hours.
Next, the volume of the food (ml) required to achieve this calorie
intake should be calculated. This calculation is:
RER (in kcal)
Calorie density
of food (in kcal/ml)
= Number of mls required in 24 hours
This should be split into feedings every 4-6 hours. Divide the total required calories
by the number of feeds in 24 hours to get the volume (in mls) required per feed.
If a patient has been hyporexic for a period of time, their stomach capacity will have
reduced. To avoid refeeding syndrome, feed 25% of the calculated RER in 4-6 feeds
on day one, increasing over the course of a few days according to their progress.
7

Feeding protocol
\Step 1:
Check the
patient and tube
• Offer voluntary feed, if appropriate to do so
• Check any stoma site for signs of infection
• Check that all the visible tube parts are intact
• Flush the tube slowly with sterile water in a sterile syringe –
if the patient coughs, the tube has migrated to the trachea
and needs replacing. If the tube doesn’t flush, it is blocked
and may need replacing
\Get to know the volume of tubes in your practice to determine exactly how much
flush you will need
\Step 2:
Give the feed
• Give the pre-measured feed slowly over 10-20 minutes
depending on the volume.
• Watch for signs of gulping, retching or salivating – if these
occur, stop the feed and consider reducing meal size by 50%
for the next 24 hours before gradually increasing again.
\Warm the food to body temperature by placing in warm water
\Step 3:
Flush again
• Flush the tube through to clean it and prevent blockages.
The flush should be sufficient to clean the entire tube and
given slowly enough to prevent regurgitation – 10mls is
usually sufficient.
• Some authors recommend instilling a column of sterile water
in the tube and capping it – this prevents air intake and the
tube getting blocked, and reduces the volume required to
flush-check the tube at the next feed.
8 FEEDING TUBES IN SMALL ANIMAL PRACTICE

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