Esophagostomy Tube Placement

Esophagostomy Tube Placement

Lee Herold DVM, DACVECC

www.atdove.org

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1. Gather all supplies needed for esophagostomy tube placement. (figure 1) 2. After induction of general anesthesia and intubation, place the patient in right lateral recumbency. Clip and surgically scrub the left lateral cervical region. (figure 2) 3. Put on sterile gloves to prepare your tube and supplies. Depending on the type of tube used (red rubber catheter or commercially available esophagostomy tubes) you may choose to cut off the blunt end of the tube to prevent food material from packing in this end and clogging the tube. 4. Gauge how much to insert your tube by pre-measuring from the exit site on the lateral cervical region to approximately the 7th intercostal space. This will place the end of the tube in the distal 1/3 of the esophagus. 5. Place a mouth gag to help with access to the oral cavity for esophagostomy tube placement.

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6. Depending on the size of your patient, you can use a curved carmalt forcep or curved hemostat. Place the tip of the carmalt into the oral cavity and into the proximal esophagus such that the tip of the forcep is curving upward. For most cats, the exit site will be approximately halfway between the angle of the mandible and the point of the shoulder. Take care to avoid the jugular groove ventrally. (figure 3) 7 . If your carmalt is appropriately placed, the skin will be tented over the tip of the curved carmalt in the region of your exit site. With a #10 or #15 scalpel blade, make a stab incision (usually only 3-4mm incision) through the skin over the tip of the carmalt forcep. In dogs or large cats with a greater amount of cervical soft tissues, you may need to use the scalpel blade to assist in getting through the subcutaneous tissues. With gentle pressure, advance the carmalt so that the tip penetrates through the esophageal mucosal and through the stab incision to form your stoma for tube placement. (figures 4a, 4b) 8. The tip of your forceps should now be protruding approximately half to one centimeter from your stoma. Place the distal tip of the esophagostomy tube within the jaws of the carmalt. Gently retract the carmalt forcep, pulling the tube into the stoma and out of the mouth. (figure 5)

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Esophagostomy Tube Placement

www.atdove.org
9. Retroflex the tip of the esophagostomy tube back into the oral cavity and into the esophagus. Take care that you dont pull the tube completely out of the stoma during the flipping process. Successful flipping and straightening of the tube into the esophagus can take repeated manipulation and adjustment of the tube. You will be able to see the tube straighten toward the nose and move more freely in and out of the stoma when the tube has been appropriately flipped. (figure 6) 10. Mark the tube with a permanent marker where it is exiting the skin or place a stay suture to keep the tube in place while you take a right lateral thoracic radiograph to assess correct tube placement. The tip of the tube should be visible in the distal 1/3 of the esophagus. You also want to assess for any kinks or curves in your tube more proximally that may indicate that it was not fully flipped or straightened. If necessary, adjust the tube by retracting it or advancing it a bit more. 11. Secure the tube with a pursetring string suture around the stoma site, combined with a Chinese finger trap on the tube itself. (figure 8) 12. A loose circumferential soft padded bandage can be placed around the cervical region to cover the exit site.

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