scott@vtx-cpd.com

Replying to Christina Frigast 04/05/2025 - 11:36

Hi Christina,

That all makes perfect sense, and I completely agree. Feeding tubes remain underutilised in many settings, even though early nutritional support has clear evidence for improving outcomes and potentially shortening hospital stays. While cost is often cited as a barrier, it rarely reflects the true balance between timely intervention and the morbidity associated with delayed nutritional support.

The recent JAVMA paper by Freilich and Jugan (2025) underscores this point. In their retrospective review of 295 dogs and cats, the median time to feeding tube placement was two days, and only 18 percent of patients had specific feeding instructions recorded in the medical record. Earlier placement—particularly of nasogastric tubes—and weekday admissions were associated with shorter delays, while initial use of oesophageal tubes or weekend admission prolonged time to feeding initiation.

Regarding contraindications, I tend to avoid nasogastric or nasoesophageal tubes in patients with active vomiting or uncontrolled regurgitation, significant nasal or upper airway trauma, marked coagulopathy (especially if epistaxis could be difficult to control), reduced mentation without a protected airway, or high aspiration risk in the absence of safe positioning. That said, for borderline cases, I’ve used very slow trickle feeding via syringe driver to monitor tolerance and reduce the risk of reflux or regurgitation, which can be helpful as a stepwise approach.

The 2024 JSAP study by Camacho and Humm provides further reassurance about the safety of both nasoesophageal and nasogastric tubes. In their randomised controlled trial of 97 animals, tube misplacement into the respiratory tract occurred in just 3.1 percent of cases, and most complications during placement were minor. There were no significant differences in vomiting or regurgitation rates between the two tube types once placed. Although radiography remains the gold standard for confirming placement, the study noted that negative pressure at the thoracic inlet and capnography may offer useful adjunctive confirmation.

However, rare but serious complications do occur. A 2023 JAVMA study by Odunayo et al. described 13 dogs that developed pneumothorax following NG tube misplacement into the tracheobronchial tree. Of these, five died or were euthanised, and most required thoracocentesis or thoracostomy tube placement. The overall incidence was low (0.3 percent of nearly 4,800 placements), but it highlights the need for vigilance and rapid response to respiratory compromise following placement.

As for oesophagostomy tubes, the 2019 JVIM study by Nathanson et al. reviewed complications in 225 patients (123 cats, 102 dogs). They reported an overall complication rate of 44 percent, with similar rates in cats and dogs. Most were minor, but infectious complications requiring surgical debridement occurred in a subset, and three patients were euthanised due to severe tube-related issues. No particular patient characteristics predicted complications, so consistent monitoring and client education remain critical for managing these patients safely at home.

Altogether, I think the evidence supports earlier and more confident use of feeding tubes, ideally starting with NG or NE in hospital and transitioning to E-tubes if prolonged support is expected.

I always say to owners that the placement of an oesophageal feeding tube often gets you out the hospital quicker!

All the best,

Scott 🙂

Replying to Neus E. 28/04/2025 - 10:31

Hi Neus,

Thanks so much for jumping in, completely agree with all of this. Diagnosis and targeted treatment are absolutely the priority, and I also tend to reserve specific albumin supplementation for cases where the clinical signs (rather than the number) really demand it. I think your point about using plasma more for oncotic support and to reduce crystalloid volume in SIRS-type patients is key. And yes, nasogastric tubes are such a practical way to get early nutrition in without needing full anaesthesia—great option while stabilising before considering anything more invasive.

Really helpful summary.

Scott 🙂

Replying to Christina Frigast 28/04/2025 - 10:16

Hi Christina,

Great questions.

For aggressive enteral nutrition, I usually aim to introduce a complete and balanced recovery diet as early as possible. Hill’s a/d, Royal Canin Recovery, or Clinicare are all good options depending on tolerance. If a feeding tube is in place, I really like the Royal Canin GI High Energy Liquid as it is specifically formulated for tube feeding, energy dense, and generally very well tolerated. In patients without a tube, Oralade is a useful starting point to support hydration and provide glutamate, but it is not nutritionally complete, so I try to transition to a more complete diet quickly. Placing a nasogastric tube allows for gentle, consistent nutritional support and can help avoid the stress of syringe feeding. It also enables trickle feeding, which is often better tolerated in fragile patients and may reduce the risk of reflux or vomiting. In some cases, a syringe driver can be used to provide a constant rate infusion of liquid diet over several hours, which works especially well for patients with poor appetite or gastrointestinal sensitivity.

Here’s the full link to the Royal Canin GI High Energy Liquid for dogs in case it’s helpful:

https://www.royalcanin.com/uk/dogs/products/vet-products/gi-high-energy-liquid-dog-4913

For fluid support, I usually start at 1 to 2 mL/kg/hr in stable hypoalbuminemic patients. That provides volume support without risking overload. I adjust based on perfusion parameters, urine output, respiratory rate, and any evidence of effusions or peripheral oedema. If there are signs of third spacing, I tend to reduce the rate further and reassess frequently.

Hope that helps.

Scott 🙂