Cat - Tube Feeding

Why worry about nutrition?

Maintaining nutritional intake in sick cats is vitally important. Unlike healthy cats that are able to reduce their metabolic rate when not being fed, cats that are unwell are unable to turn their rate down and will therefore 'starve' much more quickly. It has also been shown that a poor nutritional status is associated with a reduced ability of the gastrointestinal tract to prevent bacteria invading from the gut lumen through the wall and into the circulation. Immune function is also compromised and wound healing slower. These factors combine to increase the risk of a cat becoming septic.

What simple techniques can be employed to encourage my cat to eat?

Cats tend to be less food driven than dogs and are more easily put off eating. Sometimes, simple changes to the routine making food and feeding more pleasant may be effective. Such changes would include

• Warming the food to blood heat (this is a much lower temperature than the 'hot' food that we eat)
• Providing small meals of odorous, highly palatable food (for cats these are usually high protein/high fat foods)
• Hand feeding
• Making the feeding area feel safe, warm and comfortable

If a cat has refused food for more than 3 days then it is important to start to instigate alternative feeding methods. In some cats, but not in all cases, appetite stimulants such as diazepam (Valium) or cyproheptadine (Periactin) are effective. In cats that are refusing to eat, force-feeding is counterproductive. Not only is it unpleasant for the cat and risks the cat inhaling food, it increases aversion to food and may therefore prolong the time to when the cat will eat voluntarily.

What can be done if my cat refuses to eat?

In many circumstances due to the nature of the problem e.g. severe facial trauma or where the cat continues to refuse food, tube feeding is appropriate. There are a number of different types of tube feeding possible and the method chosen will depend on the problems that are being faced. The simplest form of tube feeding is naso-oesophageal. Other methods that can be employed include the placement of a gastrostomy, oesophagostomy or jejunostomy tubes.

What is naso-oesophageal feeding and how is the tube placed?

Naso-oesophageal tubes can usually be placed with no or light sedation. The sensitive lining to the nose is anaesthetised with local anaesthetic drops and a narrow diameter, soft, flexible tube is inserted into the nostril and fed over the back of the soft palate into the food pipe (oesophagus) and comes to lie at about the level of the 9th rib. The tube is then attached to your cat's head via stitches or surgical glue. It is generally necessary to fit a collar to prevent the cat from interfering with the tube. Because the tube is quite narrow, only very liquid food, water and some medications can be given using this method. Naso-oesophageal tubes can generally be kept in place for approximately 5 days.

When are naso-oesophageal tubes inappropriate?

• When long term feeding is required
• If your cat is vomiting
• Where there is severe facial trauma
• In cases where the oesophagus is not functioning normally
• If your cat is unconscious

What are gastrostomy tubes?

Gastrostomy tubes are placed directly into the stomach and exit through the body wall so your cat will have a tube coming out from their left side. They need to be placed under general anaesthesia either surgically or via an endoscope (known as a PEG tube). Where available, endoscopic placement is quicker and there is no surgical wound to heal after the procedure.

Will my cat tolerate a gastrostomy tube?

In general cats tolerate gastrostomy tubes very well and, because a collar is not required, in many cases a gastrostomy tube is better tolerated than a naso-oesophageal tube. Within a few days of placement, most cats do not seem to have any pain or discomfort associated with the tube.

What are the advantages of a gastrostomy tube?

There are many advantages with gastrostomy tubes, mainly associated with the tube being of a wider diameter so feeding is much easier and the particle size can be bigger. Gastrostomy tubes also have the advantage that they can remain in place for long periods (months) and are suitable for management at home. However, cats with tubes have to be kept indoors. Short, low profile tubes are available for long term cases. With such a tube fitted, your cat will be able to lead an almost normal life and feeding quickly becomes a routine part of the day for you and your cat.

Is feeding through a gastrostomy tube difficult?

No! Most people quickly get the hang of preparing food and connecting the syringe up to the feeding tube as well as caring for the site from which the tube exits through the skin. Before more food is given, it is important to check whether the last meal has moved out of the stomach by attaching an empty syringe and gently drawing back the plunger (aspirating). If there is food left, your veterinary practice will be able to advise you about what to do.

What can I feed my cat?

Your veterinary practice can talk to you about available foods. These can be either commercial tinned or powdered food or normal cat food that has been liquidised. The amount that needs to be fed and the number of meals will depend on how big your cat is, whether they need to gain (or lose) weight and the disease problems being treated.

What are the complications with gastrostomy tube feeding?

Generally, there are few complications with tube feeding once the exit site through the stomach and body wall (stoma) has settled down. After this stage, even if the tube is dislodged, there is no risk of food leaking into the abdomen. Complications can arise as the tube is being placed and as the stoma is settling down but these are relatively uncommon. Your cat will be hospitalised during the initial period after tube placement so that everything can be closely monitored by the veterinary staff who are familiar with the signs that suggest a problem may be developing.

Are there situations where tube feeding is not possible?

In rare circumstances e.g. uncontrollable vomiting or unconsciousness, tube feeding is not possible. In such cases it may be necessary to consider intravenous feeding. However, at present, intravenous feeding is complicated, difficult and expensive. It is only undertaken when no other feeding methods are available.