Tips for Living with an E-Tube
Esophagostomy tubes (E-Tubes) have helped save countless feline lives. Here are a few tips I have learned from the long term use of an e-tube in my cat afflicted with intestinal lymphoma. None of these tips are meant to replace the advice of your veterinarian; always follow their protocol and don’t be afraid to ask questions! (Click here for a PDF version of these tips that you can download and print for future reference.)
- Establish a feeding place and stick to it. Cats do best with routine. I found that putting a special (washable!) blanket on a table works best. You can sit comfortably at eye level with the cat so both of you can relax. The cat is less likely to wiggle and try to run away. If your cat will take a treat (or special belly rub) you can do it here, after his feedings. Soon the cat will know the routine and will wait by the table to be picked up and fed. Trying to feed the cat on a couch or chase him down results in spilled formula, dropped caps, avoidance behavior, and worse.
- Know where the cap is. Establish a routine of where to put the cap when you are feeding; preferably, in a special dish or cup. Otherwise, you WILL go to cap the tube and not be able to find the cap. (Better yet, if you have not had the tube placed yet, Jorgensen Laboratories makes a special tube that has a cap attached via a dangler that cannot be lost.)
- Have an extra cap. Sooner or later, you won’t screw the cap on tight enough, or the cat will manage to shake it loose during the day, never to be found again. You should always have a spare on hand. Some veterinarians will order one for you, but you may have to purchase the entire tube apparatus. Believe me, if you lose the cap at midnight on a holiday, it will be worth whatever you paid. If the worst happens, it gets lost and you don’t have another, I once made a ball of dry paper towel and closed the end with that until the next morning. Not recommended; but the point is, don’t ever leave the tube end exposed to air and pathogens.
- Have a supply tray. Put everything for a feeding on a portable tray. The cup with water for flushing, paper towels, the cup the cap goes in, all the medications already prepared, and one last item that should be on hand-the de-clogger. This can be as simple as a large-sized paper clip formed into a straight length that can be inserted into the tube in case of a mild clog. If the clog occurs far down in the tube, you can syringe in a small amount of regular coke and leave it there for a couple of hours. The bubbles and natural acid will usually clear the clog; if not, contact your vet.
- Keep the site shaved. You cannot inspect the site properly if hair is growing around or into it. Your veterinarian will shave the area on request, or if you have a longhaired cat like mine that grows hair quickly, you can purchase clippers (human clippers available at drugstores are sometimes cheaper than pet ones).
- Flush and fill. At one point, I thought I’d save time by just flushing after feeding with 5 ml of water. Within a day or so the tube developed a sour smell. It is imperative to get all the food out of the bottom of the tube, and then fill the tube with water, to keep food from pushing back up into the tube. No need to overdo, 10-20 ml of water should do it. (ask your vet)
- Keep the site clean, dry and loosely covered. This is what Kitty Kollar® was designed to address. Your vet may give you products to clean the site. Or, you may use Betadine or Chlorhexedrine solution 10% to water 90% to gently wipe or pat the area when you change the bandaging. Bandages or coverings should be placed loosely so that the site can breathe, and never let the area stay wet or moist. Do NOT use Triple Antibiotic ointment (“Neosporin”) unless directed by your veterinarian!! Some cats have adverse allergic reactions to one of the ingredients. Your veterinarian can prescribe a different ointment if it is needed, but usually just keeping it clean is adequate.
- Mark the “skin line”. Your collar should have sutures placed in the cat’s neck at skin level. You will want to mark that spot on the tube with a Sharpie pen, in the event that kitty breaks the sutures (fairly common) and pulls the tube out slightly. Most of the time, a tube that is out slightly can be gently eased back into place, but you must NOT go past that original line. (see picture above for what sutures look like)
- Use the best syringes for feeding. There is definitely a difference in feeding syringes. The ones with black rubber plungers will become “sticky” and fail after a few feedings. It is better to use the European silicone “o-ring” syringes. They last hundreds of times and virtually never stick. Also, some of them have wider tips than others. After trial and error, I found a brand that has a narrower tip. If food is prepared that is small enough to pass through this tip, it never clogs the tube. With the wider tips I got a lot of clogs. It’s also easier if you have small hands to use a 20 or 35cc syringe than the monster 50 or 60cc size. After I found the”perfect” syringes, I made them available on this website for purchase.
- Use the right blender. If the food is too thick you are not going to be successful. You don’t need an expensive blender, I love the Magic Bullet (available online, at Costco, and drugstores, around $50). What is nice is you can microwave your food to warm it right in the cup, then attach the blade part and blend for a few seconds to the perfect consistency. (If you warm your food, you must check it with a thermometer to make sure it is not above 100 degrees. It is extremely serious and deadly if you tube hot food into your cat and can result in esophageal and stomach burns that may not be repairable.) You can buy additional blender cups so you always have a clean cup. You can set it to blend for 20-30 seconds while you get your syringes and other supplies ready.
- Use the right food. If your vet has requested that you use a certain food, of course use that. But if not, know that not all foods blend alike. Some have grains, chunks, shreds or flakes that make it nearly impossible to blend them up finely enough. For example; if you are going to use Fancy Feast, only the “Gourmet” (also called Classic) flavors will blend up perfectly. They are “pate-style”, without chunks, and blend into a smooth puree without much effort (added bonus: there is no gluten in those flavors). Anything with whole shrimp or fish or pieces of “real meat” is not a good candidate for blending. You can strain some of those foods, but that adds a lot of time and labor and may remove some of the protein source. I never needed to strain using pate-style food.
- Leave it in. Time after time my cat would eat great for a week, only to stop again for a week. I have spoken to many others who have had the same experience. It would be awful to have the tube removed and have to have it reinserted; it hurts nothing if it is there and not used for a while. Vets sometimes recommend leaving it in until the cat eats on his own for a week; I recommend waiting a month.
- Be prepared. If your kitty does manage to pull out his tube, it can usually be reinserted by a veterinarian non-surgically if you get the cat to them within a couple of hours. If not, your cat will have to undergo another surgery. So be sure you have the name of the closest emergency facility that does tube insertions, to be able to take your kitty right away if needed. It is much less expense and much less trauma for your kitty to use the same site and avoid surgery.
- Give Kitty a chance to eat. Some people prefer to draw up all the formula in syringes so it is ready to go. This is certainly the method of choice when your cat is debilitated or having severe aversion to all foods. However, once he begins to feel a little better and maybe is investigating food, try this. Pour your warm, blended formula into a ramekin type cup and place that in front of him and fill your syringes before you feed. I discovered this by accident; my cat tried to “horn in” on the formula while I was filling the syringe, and started to lap up half of the formula before being done and ready for me to tube the rest.
- Be grateful. This tube enables you to know that your kitty goes to bed with a full tummy and is receiving all the nutrition he needs. Whatever trouble it is, it is completely worth it.