Complication rates associated with nasoesophageal versus nasogastric feeding tube placement in dogs and cats: a randomised controlled trial

F. Camacho, K. Humm

Background
Nasoesophageal (NO) and nasogastric (NG) feeding tubes are widely used for enteral nutrition in veterinary practice. This study aims to compare complication rates, evaluate the accuracy of placement methods, and assess accidental respiratory tract placement during NO and NG tube placement in dogs and cats.

Methods

-Study Design: Prospective, randomized controlled trial involving 97 animals (82 dogs, 15 cats) requiring nasoenteric (NE) feeding tubes during hospitalization.

-Interventions: Animals were randomized to receive either NO or NG tube placement. Placement methods, including negative pressure tests, capnography, pH measurement, and ultrasound, were evaluated against thoracic radiographs (gold standard).

-Data Collection: Complications during placement and tube use were recorded.

-Analysis: Statistical comparisons were performed to determine differences in complication rates.

Results

1) Tube Placement Accuracy:

-Misplacement into the respiratory tract occurred in 3.1% of cases (all dogs).
-Negative pressure at the thoracic inlet and capnography were the most reliable non-radiographic methods, with 86.2% and 90.5% concordance with radiographs, respectively.

2) Complications During Placement:

-Complications occurred in 25.8% of cases, primarily minor (e.g., sneezing, discomfort).
-Major complications included two cases of cardiopulmonary arrest, one fatal.
-Sedation was used in 32% of cases, but did not reduce placement attempts.

3) Complications While In Situ:

-Complication rates were 51% overall, with no significant difference between NO (44.9%) and NG (57%) tubes.
-Common complications included sneezing (20 cases), regurgitation (8 cases), and mechanical obstruction (5 cases)

4) Key Findings:

-No significant difference in complication rates between NO and NG tubes.
-Radiography remains the most reliable placement confirmation method.
-Capnography showed potential but is not a standalone replacement.

Limitations
Small sample size for cats may limit detection of species-specific trends.
Variability in testing and placement techniques among clinicians may have influenced results.
Low misplacement rate limited the ability to thoroughly evaluate all placement tests.

Conclusions
The misplacement of NE tubes into the respiratory tract is rare, and complication rates are similar between NO and NG tubes. While non-radiographic methods like capnography and negative pressure tests show promise, radiography remains the most reliable confirmation method. Clinicians should consider patient stability and minimize sedation risks during tube placement.

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