Step 5. Once the tube is advanced to the appropriate mark, secure the remainder to the patient’s head.
In dogs, use suture (± tissue glue) or skin staples to secure the tube near or along the nasal planum (A). At a point level with the forehead (dogs or cats) or the buccal pouch on the lateral face (dogs), place butterfly tape on the tube and staple or suture the tape to the skin (B). Place an Elizabethan collar and secure the tube on the neck under and behind the collar.
Author Insight: If a finger trap pattern is used, several drops of tissue glue can be placed along the suture to prevent slippage when the tube becomes wet (A).
Step 6. Confirm initial tube placement by suctioning to verify presence of negative pressure, flushing with 3–5 mL of sterile saline and listening for a cough, or attaching the tube to an end-tidal CO2 monitor.
Verify tube location with survey (A) or contrast (B) radiography. Inject 2–3 mL of iohexol or other nonionic, iodinated contrast medium into the tube, followed by 3–5 mL of air or sterile saline. Note how the contrast medium highlights the esophageal folds.
Figure 6. In this dog, the proximal end of the tube is not associated with the trachea.
Author Insight: When an NE tube is placed appropriately, its end is located at the eighth intercostal space (approximately). Even properly placed tubes can appear to be in the airways, because the esophagus overlies the trachea and bronchi on caudal cervical and thoracic radiographs.
KATHLEEN AICHER, DVM, is a resident in small animal internal medicine at North Carolina State University. Her interests include GI, hepatobiliary, and infectious diseases. Dr. Aicher completed a rotating small animal internship at University of Tennessee and earned her DVM from Texas A&M University.
BRIAN ALLETT, DVM, is a resident in radiology at University of Tennessee. He completed a small animal internship with emphases on internal and emergency medicine. Dr. Allett practiced as an emergency veterinarian at small animal specialty and referral practices in California before returning to the university setting. He earned his DVM from Ross University.
KAREN M. TOBIAS, DVM, MS, DACVS, is professor of small animal surgery at University of Tennessee. She taught at University of Georgia and Washington State University and authored Manual of Small Animal Soft Tissue Surgery. Dr. Tobias was coeditor of Veterinary Surgery: Small Animal. She completed an internship and residency at Purdue University and The Ohio State University, respectively, and earned her DVM from University of Illinois. Dr. Tobias presented on essential wound care techniques at the NAVC Conference 2013.