Using ultrasonography for verifying feeding tube placements in cats

Barbara Bruno, Paolo Savarino, Renato Zanatta, Silvia Rallo, Andrea De Giovanni, Cristiana Maurella, and Antonio Borrelli

Background: Ultrasonography may be used to verify feeding tube placement in cats, as opposed to radiographic evaluation. The authors aimed to investigate the feasibility and accuracy of this method, which has several advantages over radiography, such as being noninvasive, rapid, and radiation-free.

Study: The study was a prospective investigation of 25 client-owned cats that required nasogastric or nasoesophageal feeding tube insertion for various reasons. The position of the feeding tube was checked by both radiography and ultrasonography, using different transducers and planes. The agreement and reliability between the two methods were assessed using statistical analysis.

Methods: The feeding tubes were inserted by an emergency physician and secured to the nose and cheek. The tube position was confirmed by a right lateral thoracic radiograph, followed by ultrasonography performed by a blinded operator. Ultrasound examination was performed in three steps: transverse and longitudinal plane of the left ventrolateral side of the neck, and longitudinal angled plane of the epigastrium. To verify the tube position, a mixture of saline and air was injected through the tube and observed for flow or fog in the esophagus and stomach.

Results: All feeding tubes were correctly placed in the esophagus and none were displaced into the trachea. Both ultrasonography and radiography identified the feeding tube at the esophageal level in all cats, showing a maximum level of agreement. Ultrasonography detected the tube in the stomach in 16 cases, but radiography confirmed only 13 cases, resulting in a lower value of Cohen’s kappa. Ultrasonography showed a high sensitivity but a lower specificity for detecting the tube in the stomach. The use of bubble contrast did not improve the agreement or accuracy of ultrasonography.

Limitations: The study had some limitations, such as the small sample size, the lack of data on feeding tube misposition, the use of two different ultrasound transducers, and the influence of the ultrasound operator’s skill and experience on the diagnostic performance.

Conclusions: The study concluded that ultrasonography is a good method to evaluate feeding tube placement at the esophageal site, but less reliable at the gastric site. The technique could have several advantages in the daily practice of emergency physicians, but further studies are needed to assess its feasibility and applicability.

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