PEG tubes, and feeding Cassius. Warning - Wall of Text to follow...
As some of you may know, my early generation boy Cassius has a condition called Megaesophagus (This is covered in another thread, so I won’t go over it all again here, but here’s the link if you’re interested…
viewtopic.php?f=2&t=15238).
He has recently had issues with his throat, and is currently unable to eat normally, so he has had a PEG tube (Percutaneous Endoscopic Gastrostomy tube) fitted to assist with feeding.
I spent a fair amount of time on the internet looking for information on these tubes, and the lack of informative posts regarding this type of tube feeding for cats really frustrated me. Many people seem to think a feeding tube is the end of the line for a cat, but it's really not. This method of feeding has proved far easier than the upright feeding we were struggling with previously. So I thought I would go through Cass’ new feeding process with you all, and hopefully this might help someone in the future.
So, here goes… Spoiler alert – some of the photos are a wee bit gross.
FEEDING:
Cassius currently gets 70ml of liquidised EN food, four times a day. It seems a lot, but at just on 3kg right now, he needs to put on some weight! I prepare the food each morning by liquidising 1 ½ tins of Purina EN with 50mls of warm water until it is a thick soupy consistency. The food can be kept in the fridge between feeds.
Assemble all of the necessary equipment. This includes:
Syringes of liquid food – warmed to body temperature
Syringe of warm water – again, body temperature
Empty syringe
Any medications
Towel
Small empty tub
Paper towels
Hungry cat
Procedure:
1. I wear an old shirt. It gets messy. Ask someone to help. Put an old towel down on the table – it is easier to feed him at that height.
2. Start by drawing up the liquidised food into two large (60ml) syringes. 35ml in each makes them easier to handle.
3. I also draw up 30ml water into another syringe. Tap water is fine.
4. Place all syringes into a jug of warm water and warm to body temperature.
5. Find Cassius. He is usually on the table by now waiting for food. Sometimes he's patient. Usually he's howling...
6. I pull the netting bandage forward and unravel the tubing from under the netting. Check that the plug was secure in the port.
7. Always remember to kink the tube to prevent air entering the tube when removing or replacing the plug or a syringe. A small amount of air entering the tube is ok, but large amounts should be avoided.
8. Remove the plug. ALWAYS PUT THIS PLUG SOMEWHERE SAFE! THIS IS VITAL! If I drop this plug there will be chaos when it comes time to replace it. I use a small Tupperware container beside the food just for the plug.
9. I start by attaching an empty syringe to the port, and then I draw back on the syringe to see if there is any fluid left in his stomach. There should not be more than 10 – 15mls fluid left in the stomach. If I get a large volume of fluid from his stomach at this point, I do not feed this meal. Dispose of this fluid.
10. Flush the tube with a small amount of the warmed water (10 – 15mls) to ensure that it is not blocked.
11. Attach the first food syringe. I administer this slowly over the next 15 – 20 minutes (approx 4ml per minute). The food drips and makes a mess. Note to self: consider investing in a paper towel company.
12. If the feeding tube becomes blocked, I flush with a few mls of warmed water. Try manipulating the tube to see if the blockage can be squidged away. If this does not clear it, I try flushing with cola. The acid and the bubbles in the fizzy drink should dissolve the blockage.
13. Hubby is now bribing Cassius to stay still by allowing him to lick at the end of the other food syringe. Or, we’re chasing him around the kitchen, trailing the tube and splattering liquid food up the walls.
14. Any medications can be given through the feeding tube too. The plug has a smaller port at the end for smaller syringes. Remember to kink the tube and flush with a few mls of warmed water after the meds have been given.
15. When all of the food has been given, I flush the tube again with 15mls of warm water, given at a rate of approx 5ml per minute.
16. When finished, I wrap the plug in a cotton swab and coil up the tubing, tucking it under the netting. Ensure the swab remains around the end of the tube and the plug – this will let me know if the ports are leaking, as the swab will become wet. We re-dress Cassius in his netting bandage, and make a fuss of him.
17. I then write up the feed. How much Cass was given, what drugs he had, any residual fluid and any other info that might be useful for the vet.
And that’s the feed. We will repeat the above in four hours. This can be done by yourself, but it is SO much easier with two people. My husband distracts Cass while I take care of the feeding.
But we’re not done yet… We need to check the incision site daily for redness, inflammation, excess discharge (a small amount of discharge is expected) or smelly discharge. If the wound is looking ok, or only a little bit nasty, we need to clean it and replace the dressing. If the wound is oozing pus or bleeding, we need to contact the vet for further advice.
CLEANING:
The cleaning can be done directly after the feed, or more likely, an hour or so after a feed once Cassius has calmed down and is snoozing with a full belly.
(Look at that fat wee bald belly... Just look at it! Don't you just want to blow raspberries on it? I'm holding the netting away from his tummy so he can have a nice groom, and also protecting the tube site from him licking it...)
Gather the necessary materials. They include:
Gloves
Several gauze swabs soaked in a diluted disinfectant solution
Gauze swab soaked with warm water
Scissors
One Allevyn Adhesive Dressing. Make a small Y-shaped cut half-way into the pad for the tube
Clean muscle vest if necessary
Procedure:
1. Wear gloves.
2. Roll up the muscle vest to expose the tube site. If the netting is grubby and needs changing, I remove it completely at this point.
3. Unravel the tube and ensure that the plug is not loose in the port.
4. Gently remove the old dressing. I snip through the dressing rather than pull it off, being VERY careful not to snip through the stitches holding the tube in place. This would be bad.
5. Using the soaked swabs, I gently wipe away any dried discharge around the incision site.
(This is looking good - just a wee bit of dried gunk, and no redness.)
6. We wipe the disinfectant away with the water soaked swab. I do not leave disinfectant on the skin, as this can cause a reaction.
7. Carefully place the clean dressing around the feeding tube, and gently press onto the skin with the white shiny side facing the skin, matt pink side up.
8. I pull the vest down into place over the tube. Or, I replace the muscle vest with a clean one, if I removed it.
9. Replace the swab around the plug, coil up the tube and tuck it under the netting.
10. Make a fuss of Cass. We’re done. Now I can put a cute jumper over the whole lot to stop him licking at it.
Or, he gets the silly cushion collar.
I don't have many photos yet of the cleaning procedure, as it's difficult to wipe and take pictures at the same time! I'll get more images over the next few weeks as we get better at it...
And that's that. We're hoping that in a couple of weeks Cassius will be fitted with a special low profile port, that will mean he won't need the sexy muscle vest and the long piece of tube trailing after him all the time. I'll continue to update this thread as we go on, and I hope that this information helps anyone else struggling to find information on this type of feeding.