Читать книгу Gastrointestinal Surgical Techniques in Small Animals - Группа авторов - Страница 60

Local anesthesia is applied in the ventral meatus of the nasal cavity. The extremity of a nasoesophageal tube is usually sitting in the middle of the thoracic esophagus. The length of the tube is measured from the tip of the nose to the level of the 8th or 9th rib. If a nasogastric tube is placed, it is measured from the tip of the nose to the last rib. The tube is introduced in the ventral meatus of the nasal cavity after the nares are gently pushed dorsally with the thumb while the hand is holding the head of the dog or cat. The tube is advanced and when it reaches the nasopharynx the dog or cat will start swallowing, which will facilitate the passage of the tube in the esophagus. The tube is then advanced to the desired length to reach the middle of the thoracic esophagus or the stomach (Figure 4.2).

Figure 4.2

If the patient is coughing, the tube should be withdrawn because it is progressing into the larynx and the trachea.

After placement of the tube it is stabilized on the side of the nares with a simple interrupted suture. Another suture is placed on the side of the lips and cheeks to stabilize the tube.

It is paramount that appropriate placement of the tube is confirmed before it is used to provide nutrition to the patient. Since the tubes are small it may not be possible to palpate the tube in the neck. First aspiration of the tube should generate negative pressure if it is in the esophagus or gastric content if it is in the lumen of the stomach. If air is aspirated it has been placed in the airway. If the tube is in the stomach, injection of 5 ml of air should induce borborygm, easily detected with a stethoscope placed over the stomach. Injection of 5 ml of sterile saline will induce coughing reflex if the tube is in the airway. Finally, since the feeding tubes are radiodense a lateral radiograph should confirm the accurate placement of the tube (Figure 4.2).