Nasogastric (NG) Feeding Tube – Insertion

Hi I’m Megan today I’m going to be placing a nasogastric feeding tube in this dog, this dog is here with a suspected salmon poisoning disease so he has been vomiting had some diarrhea hasn’t eaten for a few days and he also has a lot of fluid in his stomach that isn’t going anywhere so we’re going to place a nasogastric feeding tube meaning it goes all the way into his stomach so that we can suction out that residual volume that’s in there and hopefully help him feel a little bit better and also will be able to feed him a liquid diet through that tube so because of the size of this patient and the fact that we are going to be suctioning maybe some really thick gross material out I am going to use a 10 French feeding tube for him and he has been pre-medicated with a little bit of butorphanol that give him some sedation and I also have some propofol this isn’t necessarily a painful procedure but it’s uncomfortable and a dog this size we don’t want to be wrestling too much because the probability of someone getting injured is pretty high so when I place these tubes heavy sedation is fine I like to try to avoid general anesthesia if possible because I do like to see them swallow a little bit but we’ll see how cooperative he is so we’ll go ahead and get started I’m placing some proparacaine into this nostril is just a topical numbing agent and I also like to place it in the eye as well and that’s just to kind of help with sensitivity and I’m going to go ahead and place it in both eyes and this isn’t a sterile procedure but he may sneeze out some gross things so I like to wear gloves there’s also possibility that this tube can end up going down his trachea into his lungs and so I want to keep the tube as clean as possible in case I do end up in his lungs this tube does have a little weight on one end here that should help it kind of drop into the right spot and then it also has a stylet in here as well and I’m going to go ahead and use just some lidocaine gel and use the lidocaine to lubricate the end of this tube so Leilani is going to hold his head in a neutral position and she’s also got her hands down around his neck so she can feel if he’s swallowing cause that’s a good sign that we’re in the right spot I’m going to feed this tube in a ventral medial direction so towards the center and then kind of down towards his chest I also like to snub nose them a little bit so kind of push the nose up that can help it drop into the right spot now when I feed this tube I’m paying very close attention that there’s no crunching if I feel any crunching that means I’m in the sinuses and I need to back out and redirect it also should feed relatively easily if I reach a point where it stops I don’t want to push real hard I just want to back out and redirect this is kind of a blind procedure and so you just want to go very gently it’s very easy to cause a lot of bleeding with this procedure and that causes irritation and then it’s more challenging to keep the dog leaving the tube alone if he’s caused a lot of damage in there so it’s feeding very easily and this is why I like them to be just heavily sedated and not anesthetized because hopefully we can get a swallow out of him so pre-measured this and this is about where we pre-measure to so Leilani you can just let his head kind of rest on the table here and give him a little break and now we’re going to test our placement so first thing I want to do is attach a syringe and just draw back and you can see the plunger once I pull back the plunger is on you know under negative pressure so it’s kind of pulling back so that is a good sign I could be up against the stomach wall I could be in the esophagus but I’m not drawing back endless amounts of air so that’s the first signal that lets me know I’m probably in the right spot the next is to fill a syringe with air and I’m going to just inject this air through the tube and I’m going to listen with my stethoscope on his stomach and I’m going to listen for air bubbles in the stomach so I’m going to give this to Leilani and have her inject and I’m going to go ahead and listen go ahead and push that pretty fast through there Leilani even though he is snoring I can hear just a little bit of bubbling in his stomach so that is also a really good sign so in this syringe I have some sterile saline and I’m going to slowly infuse this in there and when I’m watching for is any sort of cough reflex if I were in his lungs and infusing any water or saline into his lungs I would anticipate some sort of reaction from him and I’m not getting any so that’s yet another good sign and then lastly we’re going to take a lateral radiograph and we’re going to get the chest as well as the cranial abdomen so that we can see if it’s in his stomach we can also see the carina and make sure that we are feeding it definitely true the right spot so we’ve taken our placement radiograph and we are indeed in the stomach which is exactly where we want to be and so now I’m going to suture this in and we’ll be ready to roll so now I’m going to remove the stylet I’ve already injected that sterile saline through here so the stylet is going to pull out very easily if you have not injected water it’s going to stick so just make sure that there’s some something that goes down this tube that will allow you to remove this stylet and now i’m going to secure this tube it’s important for me to notate how far in the tube is so it’s right at his nostril here is 80 centimeters and i am going to write that on his treatment sheet so that as the technician that continues care with him we know if the tube is backing out or not now what happens in these larger dogs a lot is if I bring this tube back flush against his nose you can see that it’s kinking there and that is going to be a problem as we’re trying to move and feed him through this tube so sometimes unfortunately with these larger dogs you need to give it a little bit of a larger loop there so that it doesn’t kink so it’s going to be very important since there is a loop here that’s perfect for him to get a toenail in and pull it out he’s definitely going to have to wear an e-collar so i’ll have Leilani just to the finger there I’m using a 3 OTT nylon suture to suture this in and I’m going to use a Chinese finger trap so the first thing I’m going to do is get a good bite of skin right where his nose kind of meets his face there and this is going to be what secures you know the the knot in his face so it’s again got to be a pretty good bite of skin and then I’m going to tie a knot here and I want this to be close to his face but not really flush think about the person who’s going to be removing this tube they’ve got to have enough space that they can get some suture scissors underneath this knot to cut it loose I’m going to do six throws on this now I’m going to incorporate the tube in here and I’m going to start by tying a square knot and this is a pretty good size tube so I can pull kind of tight when you have smaller tubes especially in cats you want to be very careful that you don’t pull the future so tight that it obstructs the tube right so now that I have a square knot I’m going to cross my suture behind the tube and then tie another square knot on top and I want this to be above the knot that I’ve already tied so we’re going to kind of lace this up the tube so cross behind bring it around front tie a square knot I’ve got my Chinese finger trap down here and now I’m just going to secure he’s got a pretty good length of tube extending and I want to put all of the weight of this tube hanging on that one knot so I’m just going to make a little butterfly with a piece of tape and then I’m going to suture this to the side of his face just kind of a little tension loop so once i’m done with this we’ll go ahead and place an e-collar on him allow him to wake up a little bit and we will start feeding him through this tube in a few hours and that is how we place a nasogastric feeding tube in a dog.

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