Nursing skills
Nasal feeding
Learn the basics of nasal feeding for FIP cats, including selecting the right food, mastering proper techniques, and understanding crucial operational precautions. This guide will help ensure your cat receives safe and effective nasal feeding, improving nutrition and speeding up recovery.
Nose feeding skills
Precautions
- During the entire time the feeding tube is in place, food can be offered to the patient, as the tube is unlikely to interfere with voluntary food intake.
- If there are symptoms of vomiting, start with nasal feeding and then administer an antiemetic injection. If the injection is given first, you must wait 8 hours before nasal feeding to avoid immediate stimulation.
- Be sure to use a thick tube, about the thickness of a data cable, not a thin one! Otherwise, it may get clogged, and you will only be able to feed water!
- Use an Elizabethan collar to prevent the cat from kicking off the tube. Other collars are not as effective and are not recommended!
- Since the tube’s opening is relatively small, the food needs to be very finely processed to prevent clogging. Solutions include:
- (A). A blender that can make the food ultra-fine without the need for filtering; just add an appropriate amount of water and it can be administered.
- (B). A regular blender with a filter; add some water and blend, but there may be residue that needs to be filtered, making it a bit more cumbersome but more economical. In both methods, adding 5ml of water makes it easier to process, but it’s optional. It is recommended to use a 10ml syringe for feeding food and a 5ml syringe for feeding water.
- When using the syringe, administer food and water very slowly, at a turtle’s pace! It is suggested to take 4 minutes to push 10ml. Pushing too fast can cause the tube to move in the stomach, which may stimulate the stomach and cause vomiting!
- Remember not to overfeed. If the cat moves its mouth, it usually indicates that it’s had enough. If the condition is poor, feed 10ml every hour; if better, feed 30ml every 2-3 hours. If vomiting is not related to feeding, it could be pathological, in which case administer an antiemetic injection. Feed small amounts multiple times, calculating the total intake based on body weight and dividing the feedings accordingly.
- Once the cat can lick food on its own without nausea, the nasal feeding tube can be removed.
- The nasal feeding tube is a soft tube that enters through the nostril and extends to the esophagus. The tube diameter is selected based on the animal’s nostril size and usually does not require anesthesia, at most just sedation. The tube is stitched to the cheek or forehead to hold it in place, with the end extending into the esophagus. After placement, an X-ray may be taken to confirm the tube’s position.
- Flush the tube with 5ml of water before and after feeding to prevent blockage. If the syringe becomes difficult to push during nasal feeding, do not force it. Instead, gently pull back and push the syringe repeatedly to try to clear the blockage. Forcing it can suddenly clear the blockage, potentially stimulating the esophagus and stomach and causing vomiting. If it cannot be cleared, consult a veterinarian.
- Adult cats are typically fed every three hours. Hospitals usually recommend using a nasal feeding tube for no longer than 15 days, although it can be used as long as the tube does not harden.
- The area around the nasal feeding tube should be inspected daily or twice daily to check for any discharge or bleeding. If there are scabs, clean them with a damp cotton swab or gauze. Check the tube’s patency before each use.
- Nasopharyngeal tubes have dietary restrictions due to their narrow lumen, which limits intake to pure liquid diets. These diets are often energy-dense (e.g., 1 kcal/ml) and high in protein and salt. Therefore, they should be used cautiously in patients who are intolerant of high protein (e.g., renal or hepatic failure) or high sodium (e.g., heart failure).
- Feeding through a nasopharyngeal tube can be done through bolus feeding or continuous infusion. Daily intake should be divided into 3-6 meals, and generally, the meal size (including flushing volume) should not exceed 10-12 ml/kg. Establishing a steady infusion rate with liquid diets is relatively simple since these diets can be administered using a syringe driver or liquid pump.
- Before each feeding or medication administration, flush the tube with a small amount of sterile water or saline to confirm patency and correct tube placement. If resistance is encountered or the patient coughs after flushing, stop and investigate the issue before proceeding.
- At the end of feeding, flush the tube with a small volume (5ml) of water to prevent blockage. When using continuous infusion through a nasopharyngeal tube, the animal should be continuously monitored to ensure the tube does not move from the esophagus to the trachea, causing accidental aspiration.
- Complications associated with nasogastric tubes are generally minor and unlikely to result in death or severe morbidity. In one study, the most common complications of nasogastric tubes were vomiting, diarrhea, and accidental tube removal, occurring in 379 patients. Other minor complications (e.g., nasal irritation, sneezing) may occur during tube placement or due to the tube itself.
- A previously correctly placed tube may enter the trachea if the patient vomits, so it’s crucial to confirm that the tube remains in the correct position before each use.
- Nasopharyngeal tubes are not suitable for long-term use or home feeding due to their limited tolerance for prolonged use.
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