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Issue number 26.2 Nutrition

Feeding hospitalized cats

Published 22/03/2021

Written by Rene Dorfelt

Also available in Français , Deutsch , Italiano , Español and ภาษาไทย

When should a cat be fed? Basically, as soon as possible. If anorexia is or may be present for more than 3 days. In kittens after a few hours of anorexia. As soon as cardiovascular and hemodynamic parameters are stable; major electrolyte abnormalities such as hyperkalemia should be corrected before feeding commences.

 

Place lidocaine gel around the nose

 

When should a cat be fed?

Basically, as soon as possible!
If anorexia is or may be present for more than 3 days
In kittens after a few hours of anorexia
As soon as cardiovascular and hemodynamic parameters are stable; major electrolyte abnormalities such as hyperkalemia should be corrected before feeding commences
Within 24 hours of presentation
Within 6-12 hours following gastrointestinal surgery
 

 

 

What diet should be offered?

Tasty food with a pleasant odor
Consider starting with some “treats” to stimulate appetite 
A critical care diet with high energy and high protein content
Food should be at room temperature

How should the cat be fed?

Enteral if possible
Partial parenteral if enteral nutrition does not provide adequate energy intake 
Parenteral nutrition if enteral nutrition is not possible 

What is the best way to stimulate appetite?

Use highly palatable food
Create a cat-friendly, calm environment with soft, warm bedding and a place to hide
Make sure the cat is not in pain; administer analgesia as appropriate
Give anti-emetics and gastric protectants if the cat appears nauseous
Appetite in cats is stimulated by smell; clean the cat’s nose if obstructed with mucus or other material
Offer fresh food at room temperature on a regular basis

What about appetite-stimulating drugs?

May be used if conventional techniques do not work
Cyproheptadine is an H1-antihistaminic drug (1-4 mg/cat every 12-24h PO) 
Mirtazapine is a 5-HT3 antagonist (3-4 mg/cat every 3 days PO)
Benzodiazepines (e.g., midazolam) may be used as a short-term option if other drugs fail. They may induce appetite at a very low dose (0.05 mg/kg IV) but may also cause sedation. However, hepatic failure has been described after giving diazepam to cats

What if the cat will not eat?

Careful force-feeding using a syringe may be carried out if other techniques fail. It may also be beneficial to put some food on the cat’s paws, as the cat may lick it off whilst trying to clean itself
Feeding tubes should be used if enteral feeding is possible, but the energy requirements are not fulfilled by spontaneous food intake 

Naso-esophageal feeding tube

Easy to place without general anesthesia
Can be removed whenever required
Usable for three or more days
Only suitable for liquid diets 

Materials required: 

Feeding tube 4.5-6 FG 
Lidocaine-containing lubricant 
Suture material
Needle holder
Scissors

Placement technique:

Place some lubricant on the lower nasal meatus and at the tip of the tube (Figure 1)
Measure tube length from the nose to the 8th intercostal space and mark with a permanent marker (Figure 2 and 3)
Introduce the tube into the lower nasal meatus by directing the tube tip ventro-medially (Figure 4)
Allow the cat to swallow the tube by flexing the neck slightly, and advance the tube until the mark reaches the nose (Figure 5)
Suture the tube using a Chinese finger trap; a second suture should be placed at the level of the upper jaw or on the forehead (Figure 6)
As an alternative to suturing, tissue glue may be used, but note that, when the tube is removed, some hair (and possibly skin) may be removed as well 
Check positioning with radiography

 

 

Place lidocaine gel around the nose

Figure 1. Place lidocaine gel around the nose. © René Dörfelt

Measure tube length from the nose to the 8th intercostal space

Figure 2. Measure tube length from the nose to the 8th intercostal space. © René Dörfelt

Mark the tube using a permanent marker

Figure 3. Mark the tube using a permanent marker. © René Dörfelt

Introduce the tube into the nose in a ventromedial direction

Figure 4. Introduce the tube into the nose in a ventromedial direction. © René Dörfelt

Allow the cat to swallow the tube by flexing the neck

Figure 5. Allow the cat to swallow the tube by flexing the neck. © René Dörfelt

Suture the tube in position with a Chinese finger trap

Figure 6. Suture the tube in position with a Chinese finger trap. © René Dörfelt

 

Esophagostomy feeding tube

Bypasses mouth and pharynx 
Suitable for both liquid and slurry diets
Can be left in place for many weeks if necessary
Can be removed whenever required
General anesthesia needed for placement 
 
Materials required:
Feeding tube 9-12 FG
Long Rochester-Péan forceps or equivalent (or a commercial esophageal tube introducer) 
Scalpel blade
Skin disinfectant
Suture material
Needle holder
Scissors
Dressing materials
 
Placement technique:
Anesthetize and intubate the cat
Place the cat in right lateral recumbency
Clip and disinfect the left neck
Measure tube length from mid-neck to the 8th intercostal space and mark with a permanent marker
Introduce the forceps into the esophagus from the mouth (Figure 7)
Direct the tip of the forceps laterally until it can be felt dorsal to the jugular vein, then push the tip of the forceps towards the skin (Figure 8)
Make a stab incision with the scalpel blade over the tip of the forceps (Figure 9) and push the forceps out through the skin incision (Figure 10)
Grasp the tube tip with the forceps (Figure 11) and withdraw the tube tip out of the mouth (Figure 12)
Redirect the tube caudally into the esophagus (Figure 13)
Advance the tube caudally until the tip of the tube is caudal to the skin incision, then maneuver the tube to ensure it is not kinked
Advance the tube until the mark is level with the skin
Suture the tube in place using a Chinese finger trap (Figure 14)
Apply disinfectant lube around the insertion site and wrap the neck with bandages (Figure 15)
Check positioning with radiography
 

 

Introduce the forceps into the oral cavity

Figure 7. Introduce the forceps into the oral cavity. © René Dörfelt

Direct the tip of the forceps laterally

Figure 8. Direct the tip of the forceps laterally. © René Dörfelt

Make a stab incision over the tip of the forceps

Figure 9. Make a stab incision over the tip of the forceps. © René Dörfelt

Push the forceps through the skin incision

Figure 10. Push the forceps through the skin incision. © René Dörfelt

Grasp the tip of the tube with the forceps

Figure 11. Grasp the tip of the tube with the forceps. © René Dörfelt

Pull the tube tip into the mouth

Figure 12. Pull the tube tip into the mouth. © René Dörfelt

Redirect the tube tip back into the esophagus with the forceps

Figure 13. Redirect the tube tip back into the esophagus with the forceps, until the tube tip is caudal to the incision site; ensure the tube is not kinked and then push it further down the esophagus until the mark is level with the skin incision. © René Dörfelt

Suture in position with a Chinese finger trap

Figure 14. Suture in position with a Chinese finger trap. © René Dörfelt

Wrap the neck using dressing materials

Figure 15. Wrap the neck using dressing materials. © René Dörfelt

Tube feeding technique

Use food at room temperature
Flush the tube before and after feeding with 2-3 mL of water
Start with small boluses (1-2 mL/kg every 2-4 hours)
Feed the cat 1/3 of its resting energy requirement* (RER) the first day, 2/3 RER the second and 3/3 RER the third day
Increase bolus size stepwise up to 10 mL/kg (if tolerated by the cat)
As an alternative to bolus feeding, a liquid diet can be given by constant rate infusion at a rate of 1-2 mL/kg/h. With this technique, the tube should be rinsed with water every 4-8 hours

*Daily RER can be calculated as follows: Kg0,75 x 70 = RER (kcal)

 
Rene Dorfelt

Rene Dorfelt

René Dörfelt, Ludwig Maximilian University, Munich, Germany Read more

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