TECHNIQUE

Oesophagostomy Tube Placement in Rabbits (Disease Investigation & Management - Treatment and Care)

Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords Esophagostomy tube placement
Description
Anaesthesia
  • Provide pre-emptive analgesia (buprenorphine 0.01 - 0.05 mg/kg intramuscularly).
  • Anaesthetise the rabbit.
Preparation
  • Place the rabbit in lateral recumbency.
  • Clip and surgically prepare the left side of the neck.
  • Arrange sterile drapes for surgery
  • Pre-measure the tube from just below (caudal to) the pharynx to the ninth to tenth rib space (about two thirds of the way to the stomach) and mark the tube.
Procedure
  • Insert curved Kelley's forceps through the mouth and down to the mid-cervical region, caudal to the parotid gland.
  • Push the tip of the forceps laterally and palpate the tip through the left side of the neck.
  • Using a No. 10 scalpel blade, make a stab incision through the skin and oesophagus on the left side of the neck.
  • Push the tip of the forceps out through the incision.
  • Grasp the narrow end of the oesophagostomy tube with the forceps and pull it out through the mouth.
  • Turn the tip of the tube around and pass it back down through the mouth and down the oesophagus.
    • If the rabbit has not been intubated, ensure the head is not hyperextended, to minimise the risk of the tube entering the larynx and passing down the trachea.
  • Use a laryngoscope and/or palpation with a finger to ensure that the tube has not kinked at the pharynx.
  • If kinking has occurred, manipulate the tube with a finger or forceps as required to ensure it passes down the oesophagus and re-check.
  • Note: once the tube is correctly positioned, it should be possible to retract and insert the tube smoothly through the ostotomy site without any obvious friction.
  • Insert the tube until the mark is at the level of the incision.
  • Use a Chinese finger-trap suture to hold the tube to the skin.
    • Nylon or polydioxanone suture material may be used.
  • For additional security, apply butterfly tape to the tube and suture this to the skin.
  • Gently bandage the tube in place on the neck.
    • 5 cm (2 inch) wide padding material and 5 cm wide self-adhesive tape (e.g. VetWrap, (3M) for a 2 kg rabbit.
  • Gently coil the tube around , leaving the free end pointing caudally, and use an additional layer of self-adhesive tape to hold it in place.
  • Take a radiograph to confirm correct placement of the tube in the oesophagus.
Post-operative
  • Continue analgesia: buprenorphine 0.01 - 0.05 mg/kg intramuscularly every eight hours for 48 hours.
  • Give perioperative antibiotics: 5 mg/kg enrofloxacin twice daily through the tube can be used.
  • Feed the rabbit through the tube.
    • If the rabbit has been anorectic for some time, give one third of maintenance energy requirement (MER) on the first day (in divided feeds), two thirds on the second day and full from the third day.
    • If the rabbit has still been eating some food, give 50% MER on the first day and full MER from the second day.
    • MER for a 2 kg adult rabbit is approximately 175 kcal per day.
  • Following feeding, aspirate on the feeding syringe to draw off any air in the stomach (stop once you get fluid).
  • Flush the tube with 10 mL water to reduce the risk of blockage.
  • Continue offering the rabbit fresh water, high-quality timothy or grass hay, and other food.
Removing the tube
  • Remove the tube once the rabbit is eating and drinking, and gaining weight.
  • The tube can be left for up to six weeks.
  • Allow the osteotomy site to heal by granulation and epithelialization (suturing is not necessary).
  • Usually the osteotomy site heals within two weeks following removal of the tube.
    • There are no reports of oesphageal stricture or persistent oesophagocutaneous fistula formation.

(J29.15.w2, J529.34.w1)

Appropriate Use (?)
  • As an alternative to syringe feeding, nasogastric tube placement or orogastric tube, for repeated feeding (where several days of force feeding are anticipated). (J29.15.w2)
  • These tubes can be of a larger diameter than a nasogastric tube, and thereby allow feeding with more fibrous foods. (J29.15.w2)
Notes
  • An Elizabethan collar is not usually necessary. (J529.34.w1)
  • These tubes do not interfere with breathing. (J29.15.w2)
  • High-calorie veterinary enteral diets may be used initially to ensure energy intake and minimise the risk of the rabbit developing hepatic lipidosis.
  • Provide fibre to stimulate gastrointestinal motility and production of short-chain fatty acids by the hindgut, as soon as possible. For this, a convalescent diet designed for small herbivores should be used, e.g. Critical Care for Herbivores (Oxbow Pet Products). 
  • These tubes do not interfere with normal ingestion of food. (J529.34.w1)
  • Usually the rabbit starts eating after two to five days of enteral feeding. (J529.34.w1)
Complications/ Limitations / Risk
  • The tube can be placed incorrectly.
  • The tube can become obstructed.
  • Infection may occur at the site of tube placement.
  • Oedema may occur if the bandage around the neck is too tight
  • The patient may be irritated by the tube. 
  • The rabbit may remove the tube. 

(J29.15.w2, J529.34.w1)

Equipment / Chemicals required and Suppliers
  • 12 to 14 French red rubber or polyurethane tube. (J29.15.w2)

Expertise level / Ease of Use
  • This procedure should only be carried out by an individual with appropriate clinical training and practical experience. This would usually be a veterinarian.
Cost/ Availability --
Legal and Ethical Considerations In some countries there may be legislation restricting the use of this type of technique to licensed veterinarians. For example in the UK: "The Veterinary Surgeons Act 1966 (Section 19) provides, subject to a number of exceptions, that only registered members of the Royal College of Veterinary Surgeons may practice veterinary surgery." (See: LCofC1 - RCVS Guide to Professional Conduct 2000 - Treatment of Animals by Non-Veterinary Surgeons).
Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referee Frances Harcourt-Brown BVSc FRCVS (V.w140)
References J29.15.w2, J529.34.w1

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