Tube Feeding in Cats

My veterinarian is suggesting that my cat needs to be fed by a feeding tube. What exactly does this mean?

Tube feeding is an alternative way of providing nutrition to a cat that is suffering from anorexia (lack or loss of appetite) or has some anatomical or surgical condition that prevents it from eating normally.

Why is tube feeding necessary?

In some cases, a cat is unwilling or unable to eat on its own. However, proper nutrition is a critical factor in the successful recovery from any disease.

Malnutrition causes an impaired ability to fight infections or to heal properly after an illness or surgery. To complicate matters further in cats, their physiology is very different compared to dogs or people, and the consequences of not eating are much more significant. In fact, cats that do not eat for as little as forty-eight hours can develop a potentially life- threatening form of liver malfunction known as hepatic lipidosis. These factors combine to make maintaining adequate nutrition paramount in cats that are ill or undergoing surgery.

Is there something else I can do to encourage my cat to eat?

Poor appetite is a common symptom in cats that have even the mildest illness. Sometimes simply changing the type of food or the time or location of feeding will trigger anorexia, especially if the cat has any sort of underlying problem. If your cat is eating less food than normal, here are some simple steps to try to encourage a normal appetite:

• Slightly warm the food prior to feeding. It is important that the food is heated only slightly, to a much lower temperature than the 'hot' food that we eat.
• Offer frequent, small meals of odorous, highly palatable food. Most cats will prefer foods that are high in protein and fat. Your veterinarian can recommend a personalized feeding plan for your cat, depending upon its needs.
• Try hand feeding, or gently placing small morsels of food on your cat's tongue.
• Ensure that the feeding area is quiet, warm, and comfortable.

If your cat has refused food for more than two days, you should consult your veterinarian immediately. DO NOT WAIT. In some cats, appetite-stimulating drugs such as mirtazapine (brand name Remeron®) or cyproheptadine (brand names include: Periactin®, Ciplactin®, Klarivitina®, Nuran®, Periactine®, Periactinol®, Peritol®, Supersan®, Trimetabol®) may be effective.

In cats that refuse to eat, force-feeding is counterproductive. Not only is it unpleasant for the cat, there is a greatly increased risk of the cat inhaling food into the trachea or windpipe and developing aspiration pneumonia. Force-feeding will often increase aversion to food and may actually prolong the time before the cat will resume eating voluntarily.

What will happen if I am unable to get my cat to eat?

After three days of anorexia, the cat's body begins to enter a dangerous period. If nutrition is not quickly provided, the body will start mobilizing and metabolizing stored energy from the liver and other vital tissues. In this situation, serious and potentially irreversible damage may occur. If the cat fails to respond to conservative medical treatment, or if blood testing indicates liver compromise or other metabolic abnormalities, your veterinarian may recommend placing a feeding tube. The most common types of feeding tubes used are the naso-gastric tube (sometimes interchangeably referred to as a naso-esophageal tube), the esophagostomy tube, and the gastrostomy tube. The type of feeding tube that will be used in your cat will be determined by the specific circumstances.

What is a naso-gastric or naso-esophageal tube?

Naso-gastric tubes are the simplest to insert and are the most common form of tube feeding in cats. Naso-gastric tubes can usually be placed with minimal sedation. A local anesthetic will be applied to the sensitive lining of the nostrils and then a narrow, flexible tube is inserted into the nostril. It is passed through the nasal cavity into the back of the throat and down into the esophagus until it reaches about the level of the ninth rib. The tube is then attached to your cat's head by stitches or surgical glue.

"These tubes can generally be left in place for five days."

It is generally necessary to fit a protective collar to prevent the cat from interfering with the tube. Because of the small diameter of the feeding tube, only extremely liquefied food, water, and some medications can be given through it, and the tube is prone to becoming clogged. Naso-gastric tubes are not used if the cat will need long term feeding, if the cat is vomiting, if there is severe facial trauma, if the esophagus is not functioning normally, or if the cat is unconscious. These tubes can generally be left in place for five days.

What is an esophagostomy tube?

Esophagostomy tubes are slightly larger than a naso-gastric tubes, and enter the esophagus through a small incision in the neck. The cat must be sedated or anesthetized to place this type of feeding tube. There are several benefits of an esophagostomy tube compared to a naso-gastric tube. The larger diameter of this feeding tube allows thicker food to be fed and there are fewer clogs or other potential complications. Feeding by esophagostomy tube takes considerably less time compared to naso-esophageal tube feeding.

"Esophagostomy tubes can generally be kept in place for several weeks to months."

Esophagostomy tubes can generally be kept in place for several weeks to months. Most cats have a padded bandage or other wrap placed around their neck where the tube is inserted, and the tube will be capped when not in use. For more information, see the handout "Esophagostomy Tube Feeding in Cats").

What is a gastrostomy tube?

A gastrostomy tube is a large diameter tube that is surgically placed directly into the stomach through the skin and body wall. The end of the tube exits the skin just above the stomach on the side or flank of the cat. The cat must be given a short-term general anesthetic so that the gastrostomy tube can be inserted. A gastrostomy tube is used when long-term assisted feeding is required.

"Gastrostomy tubes may be left in place for several weeks to months."

Gastrostomy tubes may be left in place for several weeks to months. The cat will need to wear an abdominal wrap or protective stockinette, onesie, or t-shirt while the tube remains in place. The tube will be capped when not in use (for further information, see the handout "Gastrostomy Tube Feeding in Cats"). It takes less time to feed a cat through a gastrostomy tube.

Is it hard to feed a cat through a feeding tube?

Feeding a cat through a feeding tube is easier and less complicated than you might think. Most people quickly get the hang of preparing food and connecting the syringe to the feeding tube. Caring for the tube placement site is also easy and requires little effort. Before each feeding, it is important to check whether the last meal has moved out of the stomach. You will do this by attaching an empty syringe and gently drawing back the plunger (aspirating). If there is food left, you will see evidence of this in the syringe. Your veterinarian will advise you about what to do in this situation based on your cat's specific condition and needs.

What type of food do you feed through a feeding tube?

Your veterinarian will prescribe a personalized feeding plan for your cat. Most commonly, you will use commercially available canned or powdered food, or a canned cat food that has been liquefied in a blender.

The amount that needs to be fed and the number of meals will vary, depending on the size of your cat, the calorie content of the food, whether the cat needs to gain (or lose) weight, and the disease or problems being treated.

What are the complications of tube feeding?

Generally, there are few complications with tube feeding once the cat is stable. The most common complications include infection at the site of tube insertion into the skin, inadvertent removal of the tube by the cat or owner, and clogging of the tube. The risk of food leaking out of or around a gastrostomy tube into the abdomen is very rare once a stoma or adhesion between the body wall and stomach has formed (the adhesions usually form within one to two weeks of placement). Your veterinarian will specifically instruct you on how to resolve any complications or problems that arise.

Are there situations where tube feeding is not possible?

In rare circumstances, such as cats with uncontrollable vomiting or cats that are unconsciousness, tube feeding is not possible. In these cases, it may be necessary to consider intravenous feeding. Intravenous feeding of cats is complicated, difficult, and costly; therefore, it is only recommended when no other feeding methods are available.