Nasogastric Intubation

I. Indications

1. Administration of fluids and milk to foals with a depressed suck reflex.
2. To check for fluid or gas distention in the stomach of painful, bloated or weak foals.

II. Techniques

1. Tube Selection

1. Sterile Kaslow® size 18 French 48 inch tube (American Pharmaceal Co., American Hospital Supply).
2. Harris® Enema Tube - 24 French, 60 inches (American Hospital Supply).
3. Nutrifoal® - Foal enteral feeding tube, 12 French, 45 inches, (Ross Laboratories -Distributed by W.A. Butler, Co., 800-282-3148 or Columbus Service: 800282-1073).
4. Mila® Nasogastric Feeding tubes - Non-irritating radiopaque polyurethane material with stylet. Available sizes (5Fr-18Fr, 55-240 cm (22 inches-100 inches). Tubes are length adjustable. www.milaint.com
5. Cook® Clearview Nasogastric Feeding Tube 10Fr 150 cm (60 inches). www.cookgroup.com
6. Silicon stomach feeding tube. 6 mm x 150 cm. Jorgensen Laboratories. www.jorvet.com

2. Method of passing tube

1. Warm the tube to room temperature in water.
2. Measure the tube next to the foal to determine the length required to gain entrance to the stomach. (Distal 2/3's of chest; approximately the 12-14th intercostal space). Mark the tube with tape.
3. Lubricate the end with K-Y jelly.
4. Pass the tube in the ventral nasal meatus.
5. Advance the tube when swallowing occurs. Rotate the tube or push air through the tube to aid swallowing if necessary.
6. Verify the tube is in the esophagus by all these methods.

1. Increased resistance.
2. Visualization of distension on the left side of the neck.
3. Palpation of the tube in the neck area when moving it back and forth.

7. Pass the tube into the stomach.
8. Check for reflux by putting water into the tube and aspirating back.
9. Administer fluids or milk.

3. Method for passing small and flexible tubes

1. These tubes are small diameter and are very well tolerated by foals.
2. Tube can be left in place and foal can still nurse the mare and be tube fed supplemental milk.
3. We use these tubes in convalescing foals that need additional milk or fluids and can still try to nurse mare.
4. Because the tube is small and flexible - Can chill the tube in freezer to stiffen it up for passage or use a guide wire. May need to check position radiographically.
5. I prefer to measure length required to get into stomach, cut any excess length off distal end. Pass tube until proximal end is within the nostril. Suture it directly to nostril. Foal cannot rub tube and can still easily nurse.
6. This tube comes with a feeding system containing a 3 liter bag and coupling that fits into the end of the stomach tube. Nutrifoal pouch with pre-attached flexiflo gravity feeding set - Ross Laboratories - Distributed by W.A. Butler -800-282-3148.

III. Leaving the Tube in Place

1. Use the smallest tube possible.
2. Flush the tube with clean water and cap with syringe or plug.
3. Remove tube from stomach to distal esophagus.
4. Place tape on tube (dry spot) adjacent to false nostril leaving a flap. Secure tape to tube with superglue or suture (otherwise, when tape is wet, tube slips). Suture a 1" piece of folded tape to the false nostril. Tie the two tape ends in place with suture to secure the tube in place.

1. Alternately, tape tube to halter.
2. Secure tube as described.

5. Larger tubes may be kept in place for 48 to 72 hours. Change to other nostril if irritation, nasal discharge, bleeding or signs of pain occur. Small tubes can be in place for 7-10 days.
6. Fluids, milk or liquid medication should be given with the foal's head up to allow gravity flow into the stomach. If cardia spasm occurs, the tube should be placed in the stomach for each feeding and re-secured in the distal esophagus at the end of the feeding.