Veterinary Resources
Educational resources and practical guidance for veterinary professionals managing feeding tubes and patient recovery.
Preventing E-Tube Site Infections
Proper daily care is critical for reducing inflammation and minimizing infection risk at the stoma site. The following recommendations are intended to support routine e-tube maintenance and improve patient outcomes.
Daily Care Recommendations
Proper daily care is critical. Immediate cleaning of any contamination is recommended to help reduce inflammation and minimize infection risk at the stoma site.
Dilute Bleach Protocol
Mix ¼ teaspoon bleach with ½ cup tap or bottled water.
Prepare a fresh solution immediately before each use.
Dampen gauze or a cotton pad with the solution.
Apply to the stoma site for 5 minutes twice daily.
Continue while the tube remains in place.
Important Note:
Because diluted bleach loses effectiveness over time, a fresh solution should be prepared immediately before each application.
Treating Suspected Infections
Early intervention and thorough cleaning can help manage localized stoma site infections and reduce inflammation around the tube site.
Betadine Flushing Procedure
Prepare a dilute betadine solution in 0.9% saline until it reaches a tea-colored appearance.
Using an open-ended tomcat catheter or IV catheter attached to a 6-mL syringe, thoroughly flush the affected site.
Continue irrigation until all purulent material has been removed.
Gently massage any pockets beneath the stoma during flushing to help remove trapped material.
Additional Support Measures
For severe local infections, consider applying medical-grade honey directly to the affected skin.
Medical-grade honey may provide anti-inflammatory, antioxidant, and antibacterial benefits.
Continue monitoring the site closely for improvement.
When to Seek Additional Care
If local infection does not improve with cleaning and supportive care, additional veterinary evaluation and treatment may be necessary.
Accidental E-Tube Removal
Time is critical when an e-tube is accidentally removed. Prompt action may help preserve stoma access and simplify tube replacement.
Immediate Response
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Act as quickly as possible following tube removal.
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Attempt to place the largest comfortable-fitting temporary tube into the stoma.
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Suitable temporary options may include a red rubber catheter or open-ended ureteral catheter.
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Never force a tube if significant resistance is encountered.
Guidewire Placement
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If a temporary tube cannot be easily placed, an appropriately sized guidewire may be considered.
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Radiographic confirmation should be obtained to verify proper positioning within the esophagus and stomach.
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Guidewire placement should only be performed by qualified veterinary professionals.
Stoma Dilation and Tube Replacement
Serial dilators may be used to gradually expand the stoma opening.
Lidocaine gel may be applied to improve patient comfort during dilation.
Once adequate dilation is achieved, the replacement feeding tube can be advanced over the guidewire.
Confirm final tube placement with radiographic imaging and secure appropriately.
Important Note
Do not force placement of a tube or guidewire if resistance is encountered. Improper placement may result in patient injury.
Additional Resource:
Feeding Tube Complications & Troubleshooting:
A comprehensive guide covering feeding tube complications, prevention strategies, and troubleshooting recommendations.
Read Article →
Figure 1. Guidewire placement example used during e-tube replacement procedures.